UPMC Physician Resources

Archives for Neurosurgery

Second Annual Update on the Multidisciplinary Management of Pituitary Tumors

PITTSBURGH, Feb. 27, 2014 – The Second Annual Update on the Multidisciplinary Management of Pituitary Tumors will be held at UPMC Shadyside in Pittsburgh, Pa., on Friday, April 4, 2014.

This conference will cover the most recent advances in the diagnosis and treatment of pituitary tumors, including functioning and nonfunctioning tumors, hypopituitarism, and pituitary adenomas. The role of and advances in surgical and medical therapies for pituitary tumors, and perioperative management of pituitary tumors will also be discussed.

Who Should Attend
This conference is designed for physicians, physicians’ assistants, nurses, and other health care professionals practicing in the areas of Endocrinology and Metabolism, Family Medicine, General Internal Medicine, and Neurosurgery.

Location
UPMC Shadyside, West Wing Auditorium – First Floor, 5230 Centre Avenue, Pittsburgh, PA, 15232

Course Directors
Paul A. Gardner, MD
Associate Professor of Medicine
University of Pittsburgh School of Medicine
Co-Director, Center for Cranial Base Surgery, UPMC

Sue M. Challinor, MD
Associate Professor of Medicine
Division of Endocrinology and Metabolism
University of Pittsburgh School of Medicine

For more information, or to register online, please visit the Center for Continuing Education in the Health Sciences page.

Continuing Medical Education
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this live activity for a maximum of 6.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 0.6 continuing education units (CEUs) which are equal to 6.2 contact hours.

UPMC Physicians Offer Lectures Throughout the Region

UPMC has assembled a group of physician leaders from UPMC Passavant who will be available to make informal, informational presentations to small groups as well as larger audiences in western Pennsylvania, northern West Virginia, and eastern Ohio. These physicians represent a wide range of specialties and will discuss topics related to their specific clinical interests.

Physician presenters can discuss topics such as brain surgery, cardiac surgery, cardiology, colon and rectal surgery, orthopaedics, plastic and reconstructive surgery, spine surgery, surgical oncology, and vascular surgery.

The featured speakers include:

For more information about this new lecture series and specific topics, or to schedule a presentation, in western Pennsylvania, northern West Virginia, or eastern Ohio email OPRoutreach@upmc.edu.

Chief of Pediatric Neurosurgery Named Chairman of Scholarly Journal

Ian F. Pollack, MD, chief of the Division of Pediatric Neurosurgery at Children’s Hospital of Pittsburgh of UPMC, was recently named chairman of the editorial board of the Journal of Neurosurgery: Pediatrics. Dr. Pollack has served on the editorial board since 2003.

The Journal of Neurosurgery publications are scholarly journals of the American Association of Neurosurgeons. The Journal of Neurosurgery: Pediatrics was originally a quarterly supplemental, but has been published monthly since 2005.

Dr. Pollack is the Walter Dandy Professor of Neurological Surgery at the University of Pittsburgh School of Medicine and co-director of the Brain Tumor Center of the University of Pittsburgh Cancer Institute. His primary research interests focus on identifying and evaluating innovative strategies for treating malignant brain tumors, improving the treatment of children with brain tumors, and optimizing the management of childhood craniofacial disorders.

Children’s Hospital of Pittsburgh of UPMC & Pitt Public Health Researchers Receive NIH Grant to Study Pediatric Traumatic Brain Injuries

PITTSBURGH, July 25, 2013 Children’s Hospital of Pittsburgh of UPMC and University of Pittsburgh Graduate School of Public Health researchers have been selected by the National Institutes of Health (NIH) to lead a $16.5 million international study to evaluate treatments for pediatric traumatic brain injuries (TBI).
This effort is being led by Michael J. Bell, M.D., director, Pediatric Neurocritical Care and Neurotrauma at Children’s Hospital and Stephen Wisniewski, Ph.D., senior associate dean and co-director of the Epidemiology Data Center at Pitt Public Health. Dr. Bell will coordinate patient enrollment and clinical activities within the project and Dr. Wisniewski will coordinate data collection and the statistical analysis for this project.
The five-year study aims to provide compelling evidence to change clinical practices and provide recommendations for guidelines that could immediately improve outcomes for injured children.
The researchers plan to enroll 1,000 children up to 18 years old from over 36 locations in the United States and abroad to compare the effectiveness of immediate treatments of the injury, including strategies to lower intracranial pressure, strategies to treat secondary injuries and the delivery of nutrients in a study that is called the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial.
“Incremental improvement in outcomes of traumatic brain injury could make enormous differences for the health of children, but such advances have remained elusive,” said Dr. Bell, also associate professor, Critical Care Medicine and Neurological Surgery at the University of Pittsburgh School of Medicine. “No mitigating treatments have been translated into clinical practice, so we hope this study helps us gain a better understanding of contemporary therapies.”
“Traumatic brain injury is the leading cause of death in children in the U.S. with the CDC estimating more than 7,000 children dying each year from TBI,” said Dr. Wisniewski, also professor of Epidemiology at Pitt Public Health. “Given the incidence of the condition and the outcomes from previously reported clinical studies, we estimate that up to 1.3 million life-years are at risk each year from severe TBI. Any benefits that can be gained by improving clinical practice can have enormous consequences for children right now, and for clinical trials in the future.”
The study, which is expected to more than double existing evidence-based treatment recommendations for traumatic brain injuries in children, will provide volumes of data for improved TBI research protocols that would limit variability in treatments. Such variability has led to the failure of previous randomized controlled trials. The study also will evaluate the effectiveness of six therapies encompassing three specific aims – intracranial hypertension therapies, secondary insult prevention, and metabolism.
Children with severe traumatic brain injuries where an intracranial pressure monitor is placed will be enrolled in the study. The children will receive the standard of care offered by their hospital in the United States and Europe and extensive data on their cases will be collected over the week following the injury. Outcomes will be tested at 6 months and 1 year after injury for all children.
Dr. Wisniewski plans to use statistical methods to evaluate the impact of treatments on outcomes up to one year after the injury. This will allow the researchers to determine what approach works best.
“Completion of this study will provide compelling evidence to change clinical practices, provide evidence for new recommendations for future guidelines and lead to improved research protocols that would limit inconsistencies in traumatic brain injury treatments – helping children immediately through better clinical practices and ultimately through more effective investigation,” Dr. Bell said.
“Beyond the large impact that these recommendations will have on the field of pediatric traumatic brain injury, we expect our study to lead to the development of feasible randomized controlled trials,” Dr. Wisniewski said. “Such trials are the best way to provide assurances that a recommended treatment truly has the greatest odds of healing an injured child.”
“This novel study, which includes many dedicated international physicians and scientists, has the potential to accelerate our knowledge of how to treat children who sustain severe traumatic brain injuries,” said Ramona Hicks, Ph.D., a program director at the NIH National Institute of Neurological Disorders and Stroke (NINDS), which is providing the grant support for the study. “NINDS looks forward to rapid results that will inform clinical practice within the next few years.”
Other key investigators on the project include an international group of TBI experts: Patrick M. Kochanek, M.D. and Sue Beers, Ph.D., University of Pittsburgh; P. David Adelson, M.D., Barrow’s Neurological Institute Phoenix Children’s Hospital; Jamie Hutchison, M.D., The Hospital for Sick Children in Toronto; Robert Tasker, M.D., Boston Children’s Hospital; and Monica Vavilala, M.D., University of Washington. Statisticians and epidemiologists include Tony Fabio, Ph.D., M.P.H. and Sheryl Kelsey, Ph.D., Pitt Public Health; and Joel Greenhouse, Ph.D., M.P.H., Carnegie Mellon University.  Collaborators from the NIH include Deborah Hirtz, M.D., and Ramona Hicks, Ph.D.

UPMC Again Earns Top-10 Spot on U.S. News & World Report Honor Roll of America’s Best Hospitals

PITTSBURGH, July 16, 2013UPMC clinches the 10th place in U.S. News & World Report’s annual Honor Roll of America’s Best Hospitals for the second year in a row – again making it the highest-ranked medical center in Pennsylvania.
 
“This prestigious recognition speaks to the skill and commitment of UPMC physicians, nurses and staff as they continue to provide exceptional care to our community. UPMC is dedicated to making a difference in the lives of our patients, and we are honored when our excellence in health care is recognized,” said Elizabeth Concordia, executive vice president of UPMC and president of the Hospital and Community Services Division. “We are proud that patients continue to choose us to deliver world-class care right here in western Pennsylvania.”
 
Nationally, UPMC is ranked for excellence in 15 of the 16 specialty areas, and is among the top 10 hospitals in eight specialties: Ear, Nose & Throat; Gastroenterology; Geriatrics; Gynecology; Neurology and Neurosurgery; Psychiatry; Pulmonology and Rheumatology.
 
Last month, U.S. News named its 2013 Honor Roll of America’s Best Children’s Hospitals, on which Children’s Hospital of Pittsburgh of UPMC ranked 10th. This year marks UPMC’s 14th appearance on the Honor Roll.
 
“UPMC’s national ranking highlights our unique combination of superb medical care, a leading health insurance plan and close ties to one of the nation’s best medical schools at the University of Pittsburgh,” added Steven Shapiro, M.D., executive vice president and chief medical and scientific officer, UPMC.  “We are proud to be a leader on the U.S. News Honor Roll — but, most importantly, to be leading the way in developing new and better ways of taking care of patients.”

Brain Abnormalities Found in Concussion Patients Similar to those in Alzheimer’s Patients, Pitt Study Finds

PITTSBURGH, June 18, 2013 – The distribution of white matter brain abnormalities in some patients after mild traumatic brain injury (mTBI) closely resembles that found in early Alzheimer’s, according to a new study published in this month’s Radiology by University of Pittsburgh School of Medicine investigators.
White matter in the brain is made up of long, finger-like fibers projecting from nerve cells and is covered by a whitish fatty material. While gray matter, the part of our brain without the fatty covering, holds our knowledge, white matter is what connects different regions of gray matter, allowing different parts of the brain to communicate with one another.
The study suggests that the initial traumatic event that causes mTBI, or concussion, acts as a trigger for a sequence of degenerative changes in the brain, which result in patient symptoms and are very similar to the degenerative changes seen in early Alzheimer’s. Saeed Fakhran, M.D., assistant professor of radiology at Pitt, and his research team wanted to see if there was a relationship between white matter injury patterns and severity of post-concussion symptoms in mTBI patients with normal findings on conventional magnetic resonance imaging (MRI) exams. The researchers studied data from imaging exams performed on 64 mTBI patients and 15 control patients utilizing an advanced MRI technique called diffusion tensor imaging (DTI), which identifies microscopic changes in the brain’s white matter.
“In the past, we believed that patients with mTBI have symptoms because of abnormalities secondary to the initial injury,” said Dr. Fakhran. “Our preliminary findings suggest that the initial event causing the concussion is like lighting a fuse, acting as a trigger for a sequence of degenerative changes resulting in patient symptoms that could potentially be prevented.”
According to Dr. Fakhran, sleep-wake disturbances (SWD) are among the most debilitating post-concussive symptoms, affecting patients’ quality of life and productivity and magnifying post-concussion memory and social dysfunction. Such disturbances are among the earliest symptoms in Alzheimer’s patients, and also are seen in many mTBI patients. In addition, many mTBI patients have difficulty filtering out white noise and concentrating on important sounds, making it difficult for them to understand the world around them. Hearing problems are an independent risk factor for developing Alzheimer’s disease, and the same type of problem in mTBI patients has predicted which patients with memory problems will eventually develop Alzheimer’s disease.
“For this study, we looked back, analyzing images of injuries. In further research, we hope to recruit patients immediately after their injury and watch brain changes as they occur over time. The first step in developing a treatment for any disease is understanding what causes it, and if we can prove a link, or even a common pathway, between mTBI and Alzheimer’s it could potentially lead to effective treatment strategies for both diseases,” said Dr. Fakhran.

Pitt Researchers Find No Increase in Brain Cancer Related to Working at Connecticut Jet Engine Manufacturing Plant

PITTSBURGH, May 24, 2013 – Researchers at the University of Pittsburgh Graduate School of Public Health have concluded a 12-year, multi-part study into a perceived increase in brain cancer at the Pratt & Whitney jet engine manufacturing plant in North Haven, Conn., and have found no statistically significant elevations in the overall cancer rates among the workforce.
The results of the study, available online, will be published in the June edition of the Journal of Occupational and Environmental Medicine.
In May 2000, the Connecticut Department of Public Health (CTDPH) began an investigation of a reported increase in brain cancer at the North Haven facility and identified several cases of glioblastoma (GB), the most common form of brain cancer. A preliminary comparative cancer incidence analysis was inconclusive, and the CTDPH recommended Pratt & Whitney hire an independent research group to conduct a comprehensive study.
In July 2002, Gary Marsh, Ph.D., director of the Center for Occupational Biostatistics and Epidemiology, Pitt Public Health, and Nurtan Esmen, Ph.D., Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago (UIC), began work on a large, multi-part investigation to determine whether mortality from or the incidence of central nervous system (CNS) neoplasms, or tumors, including GB, were elevated among workers at the North Haven plant or seven other Pratt & Whitney facilities serving as comparison sites, and whether those rates were associated with specific workplace exposures.
“Pitt Public Health and UIC researchers analyzed the records of almost a quarter million subjects over a 53-year period, making it one of the largest and most comprehensive cohort studies in an occupational setting,” said Dr. Marsh. “It also is the first large-scale study of workers in the jet engine manufacturing industry.”
Pitt epidemiologists and biostaticians studied the employment records and death certificates of more than 223,000 Pratt & Whitney workers employed during a period stretching from 1952 to 2001. Researchers identified 723 workers diagnosed with CNS neoplasms during 1976 to 2004. Those tumors were malignant, benign or unspecified, and included 277 GB cases. Researchers interviewed workers or available family members to gain more detailed information on behavioral and personal lifestyle factors. Low participation rates precluded analysis of this data, but the Pittsburgh case-control study provided the basis for a more refined assessment of workplace exposures.
The UIC exposure assessment considered 11 chemical or physical agents on the basis of known or suspected carcinogenic potential that could affect the central nervous system or other organs. UIC generated quantitative exposure estimates for soluble and mineral oil metalworking fluids, nickel, cobalt, chromium, solvents and a combustion aerosol generated during high-speed and high-temperature grinding that was unique to the North Haven plant. Researchers assigned qualitative exposures for ionizing radiation, electromagnetic fields, polychlorinated biphenyls and lead-cadmium. Exposure to one or more of 20 jet engine part families and 16 process categories created for the study also was assigned.
The UIC quantitative estimates showed workers had decreasing exposures to these chemicals over the course of the study period; in addition, the quantitative exposure levels were similar to or lower than those in published data from other industries.
At the conclusion of the study, researchers found no statistically significant increase in overall CNS neoplasm rates among the Pratt & Whitney workforce as compared with the corresponding rates in the general populations of the U.S. and Connecticut. Comparisons among the five Pratt & Whitney plant groups revealed a slightly higher incidence of CNS neoplasms and GB among workers at the North Haven plant; however, further evaluation found no association with estimated workplace exposures.
“If not due to chance alone, the slightly elevated GB rates at the North Haven plant may reflect external occupational factors that we did not measure, or other factors unique to North Haven or the baseline plant used in the internal comparisons,” said Dr. Marsh.
During an overall evaluation of mortality rates from all causes of death, Pittsburgh and UIC researchers noted elevated chronic obstructive pulmonary disease (COPD)-related mortality rates in two of five plant groups studied, but found no association with the occupational factors examined in the study. Researchers could not rule out exposures workers received outside of the workplace, or other risk factors, such as smoking, as reasons for the observed COPD excesses.
Additional co-authors of this study include Ada O. Youk, Ph.D., Jeanine Buchanich, Ph.D., and Sarah Downing, B.S., Department of Biostatistics, Pitt Public Health; Kathleen J. Kennedy, M.S., and Roger P. Hancock, M.C.E., UIC Division of Environmental and Occupational Health Sciences; Steven E. Lacey, Ph.D., Department of Public Health, Indiana School of Medicine, Indianapolis; Jennifer S. Pierce, Ph.D., ChemRisk, LLC, Chicago; Mary Lou Fleissner, Dr.P.H., formerly with the CTDPH Division of Environmental Epidemiology and Occupational Health, Hartford.
The University of Pittsburgh and the University of Illinois at Chicago received funding from Pratt & Whitney for this research, but the design, conduct, analysis and conclusions are those of the authors.

Child Neurodevelopmental and Mental Health Disabilities on the Rise, Children’s Hospital of Pittsburgh of UPMC Study Finds

PITTSBURGH, May 5, 2013 – More children have disabilities now than a decade ago, and the greatest increase is among children of higher-income families, according to a Children’s Hospital of Pittsburgh of UPMC study presented today at the Pediatric Academic Societies(PAS) annual meeting in Washington, DC.

Results of the study, led by Amy Houtrow, M.D., Ph.D., M.P.H., chief, Division of Pediatric Rehabilitation Medicine at Children’s Hospital, also showed that while disabilities due to neurodevelopmental and mental health problems have increased sharply, disabilities related to physical health conditions have decreased. This trend was most noteworthy among children under 6 years of age whose rate of neurodevelopmental disabilities nearly doubled during the study, from 19 cases to 36 cases per 1,000 children.

“A century of health care improvements and social changes have altered the face of childhood chronic disease and disability,” said Dr. Houtrow, who also is an associate professor of physical medicine and rehabilitation and of pediatrics at the University of Pittsburgh School of Medicine. “Nearly six  million kids were considered disabled in 2009 and 2010—almost one million more than in 2001 and 2002.”

Dr. Houtrow said that while previous studies have found an increase in the  prevalence of childhood disability, she and the research team wanted to look more closely at the specific conditions and socio-demographic factors associated with disabilities.

The researchers studied data from the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention from 2001 to 2002 and from 2009 to 2010. Participants included  more than 102,000 parents of children up to age 17.

The research team assembled a composite of disability indicators to identify disabled children and their associated underlying chronic conditions. Conditions were categorized into three groups: physical, neurodevelopmental/mental health, and other.

The overall rate of disability for children under age 18 increased 16.3 percent between the 2001 to 2002 study period and the 2009 to 2010 study period.

Children living in poverty represented the largest numbers of overall children with disability in both time periods but not the highest growth rates. The largest increase in growth rates of disabilities was seen among children living in households with incomes at or above 300 percent of the federal poverty level—about $66,000 a year for a family of four in 2010.

“We are worried that children living in lower income families may be having problems accessing diagnostic and treatment services,” Dr. Houtrow said.

Since the study could not pinpoint why the disability rate is increasing, more research is needed, the author concluded.

Co-investigators were: Kandyce Larson, Ph.D., American Academy of Pediatrics; Paul Newacheck, Dr.P.H., Professor of Pediatrics and Health Policy, University of California San Francisco; Neal Halfon M.D., M.P.H., Professor of Pediatrics, Health Policy and Management, UCLA.

For more information on Dr. Houtrow and the Division of Pediatric Rehabilitation Medicine, visit http://www.chp.edu/rehab.

 

 

 

UPMC Celebrates 25th Anniversary of First Gamma Knife Procedure to Treat Brain Lesions Non-Invasively

PITTSBURGH, Aug. 14, 2012 – Twenty-five years and nearly 12,000 patients ago, UPMC neurosurgeons treated a vascular malformation from a patient’s brain using 201 focused beams of ionizing radiation without making a surgical incision in the first use of Gamma Knife® surgery in North America.
 
The innovative technology uses multiple beams of intensely focused radiation to precisely destroy vascular malformations and brain tumors or to inactivate pain or abnormal movement centers, explained L. Dade Lunsford, M.D., co-director of the UPMC Center for Image-Guided Neurosurgery and Lars Leksell Professor and Distinguished Professor, Department of Neurological Surgery, University of Pittsburgh School of Medicine. Because it reduces the risk of damage to healthy neighboring tissues, the technique has allowed patients to return home on the same day and to return to normal activities much more quickly than possible with more invasive procedures.
 
“We now treat more than 650 patients annually with the Leksell Gamma Knife® system and have published numerous scientific papers, textbook chapters and books about the procedure and its long-term outcomes,” Dr. Lunsford said. “In the late 1980s, UPMC gave the Gamma Knife approach a chance to prove its effectiveness and, as that process unfolded, we became a leader in the field of radiosurgery.”
 
In the procedure performed on Aug. 14, 1987, Dr. Lunsford and his team used the Gamma Knife system – the fifth one in the world – to treat a patient with an arteriovenous malformation of the brain, a vascular lesion that may lead to stroke, seizures or death if left untreated. Today, the technique is routinely used to treat such vascular malformations as well as intracranial tumors that either originated in the brain or spread to it from other sites.
 
Dr. Lunsford and colleagues noted in the April issue of Expert Reviews of Neurotherapeutics that Gamma Knife radiosurgery can target tumors that are hard to reach surgically, and can be used to eliminate diseased tissue that could not be safely removed during conventional operations. It can be particularly helpful in cases of multiple tumors or metastases that spread from other body sites. More than 10,000 patients with brain tumors have undergone Gamma Knife at UPMC in the last 25 years. In addition, more than 1,000 patients have undergone Gamma Knife radiosurgery for the disabling facial pain called trigeminal neuralgia and movement disorders associated with Parkinson’s disease or familial tremor.
 
“We expect that during the next five years, there will be an increased trend to use radiosurgery as a first-line treatment of multiple intracranial metastases rather than whole-brain radiation,” said Douglas Kondziolka, M.D., Peter J. Jannetta Professor and vice-chairman, Department of Neurological Surgery, and professor, Department of Radiation Oncology, and co-director of the UPMC Center for Image-Guided Neurosurgery. “In a single outpatient visit, Gamma Knife radiosurgery can target many brain tumors.”
 
The Center is home to the latest generation of the radiosurgery equipment, called the Leksell Gamma Knife Perfexion®. Dr. Lunsford is a consultant for and stockholder in Stockholm, Sweden-based Elekta AB, maker of the technology. Dr. Kondziolka is also a consultant for the company.

UPMC Clinches Top-Ten Spot on U.S. News & World Report Honor Roll of America’s Best Hospitals

PITTSBURGH – UPMC rose to 10th place in U.S. News & World Report’s annual Honor Roll of America’s Best Hospitals – making it the highest-ranked medical center in Pennsylvania. U.S. News & World Report ranked UPMC first in the state and first in Pittsburgh.

“This national recognition is a testament to the skill and dedication of our physicians, nurses and staff and to the superb care they provide every day at UPMC. Our patients and our community have come to expect this level of excellence and we are committed to assuring we deliver. Our proudest achievements come when we make a difference in the lives and health of our patients,” said Elizabeth Concordia, executive vice president of UPMC and president of the Hospital and Community Services Division. “When patients require care, the choice is clear; the nation’s best care is here at UPMC.”

Nationally, UPMC is ranked for excellence in 15 adult specialty areas and is among the top 10 in nine specialty areas: Ear, Nose & Throat; Gastroenterology; Geriatrics; Gynecology; Nephrology; Neurology and Neurosurgery; Orthopaedics; Psychiatry and Pulmonology.

Last month, U.S. News named its 2012 Honor Roll of America’s Best Children’s Hospitals, on which Children’s Hospital of Pittsburgh of UPMC ranked ninth. This year marks UPMC’s 13th appearance on the Honor Roll. Last year, the list placed UPMC 12th nationally.

“A stellar ranking such as this validates what we know to be true – that UPMC is one of the very few academic medical centers in the nation that brings together the best in patient care, top-notch facilities and superior scientists,” added Steven Shapiro, M.D., senior vice president and chief medical and scientific officer, UPMC. “The exceptional clinical services that UPMC provides, fortified by Pitt’s academic research, work hand-in-hand to help us care for patients when they need us.”

About UPMC

UPMC is a $10 billion global health enterprise with more than 55,000 employees headquartered in Pittsburgh, Pa., and is transforming health care by integrating more than 20 hospitals, 400 doctors’ offices and outpatient sites, a health insurance services division, and international and commercial services. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is redefining health care by using innovative science, technology and medicine to invent new models of accountable, cost-efficient and patient-centered care. For more information on how UPMC is taking medicine from where it is to where it needs to be, go to UPMC.com.

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