Dr. David Singer is a rising star brain surgeon. He did all the right things and made all the right sacrifices to get to where he is. Despite everything he has going for him, he finds himself struggling to balance his career with his newly growing family. His one-track focus is jarred by a budding friendship with a special patient who holds a mirror up to his own life. In the hypercompetitive, high stakes, and unforgiving world of neurosurgery, is it possible to find some kind of balance?
Published on: 2016-11-13
Released on: 2016-11-13
Format: Kindle eBook
About the Author
Dr. Berkowitz is the Director of Research and afounding faculty member of the Boston University School of Medicine Physician Assistant Program. He holds a PhD in Epidemiology from the University of Pittsburgh and has practiced for many years as a PA in neurosurgery. Dr.Berkowitz is a researcher and a medical educator who has published numerousworks in neurosurgery and healthcare research journals. He lives with his wife and son in Boston, Massachusetts.
Clinical, research, administrative and didactic roles.
Under the coordination of Dr. Roger Hartl (WCMC) and Dr. Jose Piquer (NED).
Annual salary 55 000 USD.
Free accommodation in Zanzibar.
Prioritize neurosurgeons with interest in spine surgery or pediatric neurosurgery.
Sponsored WFNS 2019 meeting attendance.
Global Neurosurgery is a hot topic in Global Health. Tanzania is a developing country with 55M inhabitants and 9 fully trained neurosurgeons. Trauma (both brain and spine), congenital malformations and hydrocephalus are the most common neurosurgical disorders in sub-Saharan Africa. Both WCMC (New York city, US) and NED Foundation (Valencia, Spain) have been involved in neurosurgical projects in Tanzania for more than 10 years.
2017 is the year to join efforts and provide a shared fellowship focused in clinical, research, administrative and didactic roles.
We are looking for a fully trained neurosurgeon interested in Global Health and humanitarian causes to work in Tanzania. This fellow will rotate in between Mnazi Mmoja Hospital (Stone Town, Zanzibar – 5months), Muhimbili Orthopedic Institute (MOI) (Dar es Salaam – 4 months) and Bugando Medical Centre (Mwanza – 3 months).
Dr. Robert Louis, a neurosurgeon at Hoag Memorial Hospital Presbyterian in Orange County, CA, is pitched some type of new technology, gadget or medication every day. He’s shown things so often that he developed an internal filter that automatically sets expectations a lot lower than the enthusiasm of the rep. But that all changed in October 2015.
That’s when Surgical Theater reps dropped by to showcase the Surgical Navigation Advanced Platform, or SNAP. Designed by former Israeli fighter pilots, the technology uses virtual reality to allow neurosurgeons to “fly” through a patient’s brain to get a better look at tumors, nerves, blood vessels and tissue prior to surgery. Before surgery, the patient’s brain is captured and recreated as a 3D model for Dr. Louis or his colleague Dr. Christopher Duma, neurosurgeon and director of Hoag’s Brain Tumor Program, to navigate.
Hoag is currently using an Oculus DK2, but the FDA recently cleared the consumer Oculus Rift for use and that will be deployed moving forward in all medical facilities, according to Jim Breidenstein, president and COO at Surgical Theater’s SNAP division.
Louis said prior to the introduction of this technology, he’d have to reference black-and-white 2D “slices” of the brain and then use his imagination (and 20 years of surgical experience) to map out the surgical procedure in his head before entering the Operating Room.
Since SNAP is registered with both Stealth, a technology Hoag uses, and Brainlab, that 3D model of the patient’s brain is used to track the tips of the instruments as the neurosurgeon navigates the brain. It works like a GPS inside the head, allowing doctors to track their instrument in real-time.
“Instead of looking at a 2D model, I can now see the tips of the instruments on the 3D Surgical Theater System on screen and compare that to what I’m seeing through the lens of the microscope,” said Louis, who is also director of Hoag’s Skull Base and Pituitary Tumor Program.
Hoag, one of 10 hospitals using this technology, has already used SNAP on 100 patients.
“We’ve seen an increase in the rate of complete tumor removal and a decrease in the rate of neurological complications,” Louis said.
Louis said this new technology helped him save Marcus Barnes, 41, who had a brain tumor. Louis focuses on non-evasive surgeries whenever possible, preferring to take tumors out through the nose, ear or eyebrow whenever possible. His original plan was to make a small incision by the eyebrow for Barnes, but when he put on the Oculus headset and explored the virtual reality model of his brain, he found that the patient’s optic nerve would block him from extricating the entire tumor that route.
“We changed the approach and we did a small incision behind the hairline instead,” Louis said. “We made this change before even touching the patient and we were able to get the entire tumor out successfully.”
SNAP also played another role in this particular operation. The technology has been designed so anyone, including patients, can get a look inside their head. Louis wheeled the headset into Barnes’ room while he was being prepped for surgery so he could show him why he was changing the operation the morning of, which Louis admits is something that would normally make a patient nervous. But this technology allowed the patient to see exactly what the doctor sees – and will see during surgery.
“Everybody loves seeing their brain in 3D and in color,” Louis said. “They feel much more engaged in their own process with VR. It goes from ‘I trust you’ to ‘I understand what’s going on with my body.’ Research shows patients who are more engaged and have a better understanding of their pathology will have a better outcome.”
In September, Louis will begin testing a brand new augmented reality technology from Surgical Theater. The new technology will be used inside the OR, and use the 3D model of the patient’s head to project a real-time 20-30% shadowed view of exactly where the tumor is via AR while the neurosurgeon is performing the operation through the lens of a microscope or viewing the screen of the endoscope.
“The tumor is visible partially in my field-of-view so I know exactly what direction I’m going,” Louis said. “I don’t think AR will replace the pre-op rehearsal in VR, but it adds to the tools we use during surgery and it’s another big advance to be more precise.”
Louis said the less disruption of normal tissue and critical anatomy in getting to the tumor, the fewer neurological complications and less blood loss there is for the patient.
There are 10 hospitals using this VR technology today, including University Hospitals Case Medical Center, University Hospitals Rainbow Babies and Children’s Hospital, The Ronald Reagan UCLA Medical Center, The Mount Sinai Hospital, Mayo Clinic and NYU Langone Medical Center. Some of these hospitals are using SNAP in an additional way.
VR can also be used to train residents, Breidenstein said.
“Students can see in 20 minutes what has taken neurosurgeons like Dr. Louis 20 years to perfect in his own mind,” Breidenstein said. “It can dramatically shorten the learning curve of tomorrow’s surgeons.”
At UCLA, Dr. Neil Martin uses Surgical Theater to travel pre-operatively through a patent’s head.
There are multi-user options, so the doctor and the student each can have an individual avatar and they can look at the anatomy of the brain from a teaching perspective. This option is also available online, so that the doctor and student don’t have to be in the same state or country.
Breidenstein said over 2,000 patients have been treated using Surgical Theater technology to date.
“By design, we’ve had a limited launch and strategic plan with 10 centers for the current physical year,” Breidenstein said. “In 2017, we’ll take our technology and expand and scale it based on the learning and volumes of clinical data we’re collecting. Our goal it to get SNAP into all key centers in the surgical world.”
Alon Geri, co-founder and executive vice president of engineering at Surgical Theater, said SNAP has been designed to evolve with technology. The Windows-based technology already works on both Oculus Rift and HTC Vive, as well as several enterprise AR devices. Geri said any headset that will be available in the market will be supported in the future, when it makes sense.
Geri, who used to fly Blackhawks in the Israeli Air Force, ended up designing this virtual reality technology on a challenge. He had spent several years developing a virtual reality flight simulator for pilots when a neurosurgeon asked him if he could do the same thing for doctors. He accepted the challenge.
“Once surgeons started to experience it, it blew their minds,” Geri said. “It allows them to prepare for complicated surgery cases and gets them into the zone to go under the microscope.”
En silencio, con una petición expresa de discreción, el doctor Julio Sánchez Juan falleció en Oviedo el pasado lunes, a la edad de 91 años. Valenciano de nacimiento, fue el primer jefe del servicio de neurocirugía del Hospital General de Asturias, y más tarde asumió este mismo cargo en la Residencia Sanitaria Nuestra Señora de Covadonga. Se jubiló en 1994, cuando estos dos centros sanitarios ya habían sido fusionados con el Instituto Nacional de Silicosis en el denominado Hospital Universitario Central de Asturias (HUCA). Entre las muchas distinciones que recibió, destacaron ayer sus familiares más cercanos, “siempre se sintió especialmente honrado por la Encomienda de la Orden civil de Sanidad (1969) y la Encomienda con Placa de la Orden Civil de Sanidad (1970), concedidas por el Estado a petición de los pacientes”.
Nacido en Ollería, el 6 de septiembre de 1924, era hijo de una valenciana y de un maestro de escuela salmantino afecto a la Institución Libre de Enseñanza. A los ocho años se trasladó con su familia a Madrid, donde estudió Medicina. Su excelente expediente le permitió integrarse en el equipo de Carlos Jiménez Díaz y Sixto Obrador Alcalde, padre de la neurocirugía en España, en el Instituto de Neurocirugía del Instituto de Investigaciones Médicas. En 1954 fue invitado por el Estado alemán para trabajar en la Städtische Nervenklinik de Bremen, a raíz de la publicación de algunos de sus trabajos científicos. Durante su estancia en Alemania adquirió una experiencia muy relevante en técnicas quirúrgicas diversas, como el abordaje de las hernias discales que luego practicaría con éxito en Asturias.
De vuelta a España, Sixto Obrador le recomendó trasladarse a Asturias, donde todo estaba por hacer en el ámbito neuroquirúrgico. Comenzó su ejercicio profesional en Oviedo en 1955. En 1957 se casó con María José Lorenzo Ordóñez y se afincó definitivamente en la capital del Principado, donde viven parte de sus cinco hijos y once nietos. En 1963 ganó por oposición la jefatura de neurocirugía del Hospital General, y en 1966 las oposiciones a jefes de servicios de neurocirugía de la Seguridad Social. Así pasó a ocupar el puesto en el Hospital Covadonga. Junto a su dedicación clínica, Julio Sánchez Juan publicó una cincuentena de estudios monográficos y en revistas especializadas tanto nacionales como extranjeras. Leyó su tesis doctoral en 1980. Desde 1974 hasta 1990 fue profesor de neurocirugía en la Universidad de Oviedo.
Además, cultivó otros saberes, como la etología, la paleontología, la filosofía, la micología o la literatura (escribió la novela “Gaetano”). Formó parte de la ejecutiva del PSOE durante la transición y hasta 1982, año en el que abandonó su militancia y su actividad política poco después de la victoria electoral de Felipe González. Mantuvo un vínculo particular con el concejo de Colunga. En su casa rural de la pedanía de Sales cultivó la amistad con el radiólogo Carlos Lueje, el arzobispo Díaz Merchán o el bioquímico Francisco Grande Covián, entre otros.
He was one of the greatest neurosurgeons of his time based on the innovative surgical brain procedure he developed to eliminate facial spasms and the facial pain caused by trigeminal neuralgia.
That procedure known as microvascular decompression guided the field of brain neurosurgery for decades with various applications, resulting in major awards for his work.
Peter J. Jannetta, a former University of Pittsburgh neurosurgeon who joined Allegheny General Hospital in 2000 to establish the Jannetta Cranial Nerve Center, still was publishing research papers and teaching in AGH’s neuroscience residency program when he died Monday at the hospital after a fall.
The 84-year-old neurosurgeon had homes in Oakland and the Ligonier area.
“He was truly a Renaissance man from day one,” said Donald Whiting, chairman of the Allegheny Health Network’s Neuroscience Institute. “He was one of the true fathers of modern neurosurgery, and he’ll be missed. He had the insight and knowledge you can’t get from books.”
AHN described him as one of the world’s pre-eminent neurosurgical pioneers based on “one of the most important modern-day breakthroughs in the field of neurological disease.”
Albert Rhoton, former chairman of the department of neurosurgery at the University of Florida, described Dr. Jannetta as the innovator who “helped to cure generations of patients with the most devastating, agonizing pain that one can experience. He is the godfather to almost every neurosurgeon in the world.”
Dr. Jannetta, a native of Philadelphia, graduated in 1953 from the University of Pennsylvania, where he swam and played lacrosse and football, and then from its Perelman School of Medicine in 1957, where he completed his general surgical residency in 1963.
While completing his neurosurgical residency at UCLA in 1966, he treated a patient for facial spasms with novel surgery through the base of the brain to move a blood vessel pressing against the facial or trigeminal nerve, thus halting the spasms and pain that can affect facial muscles, the eyes and ears.
“It was revolutionary and became the standard treatment for a number of conditions,” Dr. Whiting said. While serving as chief of neurosurgery at Louisiana State University’s New Orleans Medical School, he was appointed as Pitt’s chairman of neurosurgery in 1971, where he advanced his surgical procedures and published benchmark articles that were among more than 400 he wrote during his career.
Jack Wilberger, chairman of AGH’s department of neurosurgery who studied under Dr. Jannetta, described him as “one of the great neurosurgeons of our time,” adding that “without Peter, the revolution of microvascular surgery of the brain would not have proceeded as quickly and successfully as it did.”
Dr. Jannetta also was an accomplished teacher with numerous students from his residency programs who went on to head the nation’s top neurosurgery programs.
For his work, he received, among others, the Olivecrona Award from the Karolinski Institute in Sweden, the Zulch Prize for Medical Research from the Max Planck Society for the Advancement of Science and the World Federation of Neurosurgical Societies’ Distinguished Medal of Honor. In 2007, his career was celebrated at a local event featuring poet laureate Maya Angelou as keynote speaker.
Away from the hospital, Dr. Jannetta played Dixieland music on the banjo and was an avid art collector, recently donating major works to the Westmoreland Museum of American Art in Greensburg.
He is survived by his wife, Diana Jannetta; his first wife, Ann Jannetta; four daughters, Susan Jannetta of New York City, Joanne Lenert of Dunn Loring, Va., Carol Jannetta of Dover, Mass., and Elizabeth Jannetta of New York City; two sons, Peter T. Jannetta of Oakland and Michael Jannetta of Putnam Valley, N.Y.; one stepson, Robert Davant III of Washington’s Landing; and one stepdaughter, Hilary Rose of Ross; eight grandchildren and two step-grandchildren. Funeral services will be private. The family requests donations to the Jannetta Neuroscience Foundation Inc., 5023 Frew St., Pittsburgh, PA 15213.