Brain surgery, science and education


As a pediatric neurosurgeon, neuroscientist, and educator, I come across many interesting bits of information and wonderful people. I will try to share some of this with you here. While the site draws heavily from my experiences as the Campagna Chair of Pediatric Neurosurgery at Oregon Health & Science University, and head of neurosurgery at Doernbecher Children's Hospital, this is a personal blog. My thanks to my wonderful OHSU colleagues, who share this exciting and rewarding work with me.


Friday, December 14, 2012

Next Generation


I am very proud of each and every resident trained in the neurosurgery residency program at Oregon Health & Science University/Doernbecher Children’s Hospital. This week, we got some news that one of them will join us in the small but important specialty of pediatric neurosurgery, caring for children with surgical disorders of the brain and spinal cord.

Dr. Eric Thompson joined the OHSU neurosurgery training program in 2005. Raised and educated in Nebraska, Eric was a young and quiet resident, who developed and interest, and great talent, caring for children and their families. He also went into the laboratory to help develop better ways of treating children with brain tumors: understanding how to stop tumor growth and reduce the impact of chemotherapy on kids.

In the meantime, Dr. Thompson also developed a leader’s voice. He took a role in teaching students and younger residents. He spoke about his research at national meetings. He represented all OHSU residents on the institutional education committee and won a socioeconomic fellowship for leadership development from our national neurosurgical societies.

It was no surprise to me that my colleagues at the world leading pediatric brain tumor clinical and research program in Toronto, Canada, selected Dr. Thompson to serve as their 2013-14 Chief Fellow. They see both the accomplishment and promise for our field that he carries with him. I am excited to see our resident succeed, but also very excited for the future of my chosen field, pediatric neurosurgery. I am also delighted that the experience of caring for children at Doernbecher Children’s Hospital is inspiring the best of our young trainees, in many fields, to dedicate their careers to carrying on and improving the tradition of pediatric medicine and surgery.

Dr. Eric Thompson

Sunday, November 11, 2012

A Stitch in Time Saves More Than Nine


One of the true challenges of neurosurgical care is that small details can have a big effect. In short, the central nervous system is one of the least tolerant organ systems in the body to irritation, injury, infection and other ill effects.

While I was training in general and then pediatric neurosurgery, I was troubled that despite careful attention, very delicate and important drains in the fluid spaces of the brain sometimes fell out. This often happened at night, required an additional procedure to replace the drain, and in the worst cases caused a temporary leak of cerebrospinal fluid (CSF) out of the drain site, resulting in infection. In some cases, with small fluid spaces, called ‘ventricles’, replacing the drain could also be tricky, and involved a small but important amount of risk.

So, throughout my career, whenever I worked with a new colleague (resident, fellow, or faculty member), I paid careful attention to details of how they liked to secure their CSF drains. I asked questions. I made notes.

When I started as the head of pediatric neurosurgery at Doernbecher Children’s Hospital, I combined what I found to be the best tricks and techniques into a very systematic way of stitching in CSF drains. I stuck with it. I taught every one of our residents how to do it, and I insisted they use my system. The method spread within our Department, but no further.

That was until 2011, when a senior and respected colleague of mine wrote me an email from Africa. He was running a neurosurgical service at a mission hospital in one of the poorest countries on earth. He had very little nursing support. His drains fell out all the time. His nurse practitioner had years before worked at Doernbecher. She mentioned to him that our drains “never fell out”. He did not believe it, but he sent me the note.

I told my friend how I do it. A month later, he sent another note. Not a single drain had fallen out. He insisted I describe the technique as an official scientific report. Moreover, he recommended that I send it to our top ranked journal. I wrote back to him complaining that this was just a curious way of securing a drain stitch. I would be a laughing stock for trying to publish a scientific paper on that. But my friend reminded me that scientific papers are there to improve patient care, and that drains falling out may not be fancy science, but are a real problem harming children literally all over the world.

So Nathaniel Whitney, one of our terrific OHSU neurosurgery residents, and I wrote the paper. With help from our world-class medical illustrator, Andy Rekito, we included detailed diagrams showing how to do it. To my surprise and delight, the Journal of Neurosurgery:Pediatrics accepted the paper immediately. Here is the link:


My friend soon sent a wonderful congratulatory note, and thanked me for following through. He deserves thanks for a suggestion that did not occur to me, and for keeping a sharp eye as he always does on the welfare of our patients and new ways to promote it.

A month later, I got another wonderful note about this project. A friend and colleague in the Midwest, another pediatric neurosurgeon whom I used to work with, saw his resident tying in a drain exactly as I do it. He asked the resident who taught him that. “I just read it in the Journal of Neurosurgery” was the answer.

Helping children in Oregon & SW Washington is Doernbecher’s primary mission. By working with our colleagues around the world, in this case from Africa to Minnesota, we also strive to advance the welfare of all children.

This may be some of the least fancy academic work I have ever done. In some ways though, I think it may turn out to be some of the most impactful.

  
The problem with a traditional Roman sandal tie

Friday, October 5, 2012

Standing Up For the Team


Caring for children is both a critical mission and a gift. Those of us privileged to work at OHSU-Doernbecher Children’s Hospital are stewards of systems of care that are vital to the health of our children and the sustainability of our communities. Part of that vitality and sustainability are the training of the next generation of practitioners.

Doernbecher partners with the Schools of Medicine and Nursing at OHSU to train the doctors who will care for our children and their children in the future, long after our own work is done. The presence of trainees in the hospital enriches us. We think of new and improved ways to deliver care. There are additional doctors present in the hospital at night who can respond to a sudden change more quickly than in typical care settings. There are more people available to educate families and patients about their illness and their care.

This week, I was honored for my work as the Director of the neurosurgical residency training program that is housed at both Doernbecher Children’s and OHSU Hospitals. The Palmer J. Parker Courage to Teach Award is given to 10 residency or fellowship program directors in the United States each year to recognize the value and importance of medical and surgical training and of educators. Mentorship, promotion of excellent patient care and safety, and educational innovation are core attributes for the award.

Although the honor is in my name, it is clearly a reflection of the quality and expertise of the faculty and residents at Doernbecher and OHSU with whom I work, their commitment to the highest quality education, to innovation, and to world class patient care.

I am proud of the young neurosurgeons training at OHSU-Doernbecher. Mentoring them is one of the most fulfilling aspects of my job. They contribute directly to the safety and wonderful outcomes of patients we care for. I am honored and humbled that the ACGME has recognized the work we do together.

The team at work in the operating room



Simulation based training


Monday, September 3, 2012

Interrupting Storms in the Brain


Seizures are electrical storms that sweep across the surface of the brain, or cortex. The repeated occurrence of seizures is called epilepsy. According to the Centers for Disease Control and Prevention, epilepsy affects 2.2 million Americans, including hundreds of thousands of children.

Epilepsy is a damaging and dangerous disease in children for many reasons. First, children may be injured or lose oxygen during a seizure. Second, repeated seizures may eventually damage the brain. Third, the medicines used to control seizures are sedating and can themselves cause problems with development and brain function. Fourth, epilepsy causes educational, social and practical barriers to participation and progress during the important childhood years.

Surgical and computer technology offer a new and very effective treatment for children with epilepsy who respond poorly to medications: vagal nerve stimulation. The vagus carries information to and from the brain and the various organs in our bodies (such as the heart, lungs and intestines). Electrical stimulation of this nerve excites centers in the brainstem that in turn ‘quiet’ the excitability of widespread areas of the cerebral cortex. Researchers discovered this property of vagus nerve stimulation by accident, and introduced it as a therapy for seizures in the 1990s.

The pediatric epilepsy center at OHSU Doernbecher is the only accredited full service epilepsy center for children in the state. The center is also one of the most experienced in the country at using vagal nerve stimulation in children, from as young as 3 months of age. In the last 10 years, over 300 vagal nerve stimulation devices have been implanted at OHSU Doernbecher. During the procedure, surgeons wrap a tiny electrode around the vagus nerve in the neck and connect it beneath the skin to a small generator pack just below the clavicle (much like a heart pacemaker device).

Although vagal nerve stimulation is not a cure for epilepsy, it often helps dramatically in the most difficult cases, and those in which medication has largely failed. In a recent publication from OHSU Doernbecher, we report success rates of greater than 90%. The OHSU Doernbecher experience also documents excellent responses in children less than 12 years old and in children with some forms of generalized epilepsy, many of who are traditionally denied care using this device: 
                                    



The pediatric epilepsy center at OHSU Doernbecher also offers a full range of the most sophisticated functional imaging to diagnose epilepsy disorders, advanced epilepsy monitoring, medication trials, diet therapy, and surgery to remove an epilepsy focus (and potentially cure the disease).

Most important to the success of our patients are the terrific doctors and nurses who participate in the program and who have dedicated their careers to stamping out the ill effects of epilepsy in children. These include specialist pediatric epileptologists like Drs. Colin Roberts and Carter Wray, some of the most highly trained and compassionate pediatric epilepsy specialists around. One of the most rewarding aspects of my day-to-day work is serving as the surgeon for the OHSU Doernbecher pediatric epilepsy center and working with these terrific and dedicated specialists.

Monday, July 30, 2012

The Best and Brightest Come to Doernbecher



Doernbecher is not the country’s largest children’s hospital, but I think it is one of the best. The reason? Great people.

That is why I was so proud to be joined by one of the top young pediatric neurosurgeons in the country, who began her practice at Doernbecher Children’s Hospital today.

Dr. Lissa Baird graduated from Brigham Young and earned her MD degree from Columbia University College of Physicians and Surgeons. She underwent residency training at the University of California, San Diego, during which time she also completed an infolded fellowship in skull base neurosurgery at Louisiana State University, Shreveport (where I originally met her while a visiting professor there). She just finished as the 2011-12 Shillito Fellow in pediatric neurosurgery at Boston Children's Hospital. 

Dr. Baird has clinical and scientific interests in pediatric brain tumors and in new approaches using an endoscope to remove some tumors through the nose.

It would be an understatement to say that pediatric neurosurgeons are in demand around the United States. Dr. Baird was a top faculty candidate this year. I am proud that the opportunities, collegiality, and clinical and scientific talents evident across the institution attracted her to join the faculty at Oregon Health & Science University.

I think she will be a terrific addition to the program and will advance the goals and values we have been working on, most particularly technically excellent and compassionate care of Oregon’s children, and those of the region and nation.

Dr. Lissa Baird


Saturday, July 21, 2012

Looking Back, Reaching Forward


In the United States, July is a time for celebrating heritage. In Oregon and Southwest Washington, the Scottish community comes together every year on the 3rd Saturday at the Portland Highland Games. Today’s games, the 60th, hark back to clan celebrations in the highlands a thousand years ago.

Around the world, the games today promote heritage and preserve the Scottish arts of piping, drumming, dancing and heavy sports. The games embody tradition, competition, and community.

Scots in America have contributed greatly to our larger national community, part of a tradition that has enabled the exceptional contributions of our society to the arts and sciences, and to the advancement of freedom around the world. Many cultures and societies have contributed to this unprecedented American success, and more are joining the ‘great experiment’ every year. The only invariable characteristics and requirements for participation are devotion to intellectual, political, and economic freedom.

Highland games also remind us of the tremendous contributions of Scots to American and world society. No fewer than nine Scots are amongst the 56 signers of the Declaration of Independence. Among them was Rev. John Witherspoon, who immigrated to New Jersey from Edinburgh, and served as the first President of Princeton University.

The foundations of modern society are inextricably linked to Scots, both at home and in the Scottish diaspora around the world. Carnegie and dozens of other Scots were central to the advances of the industrial revolution. Malthus and other Scottish philosophers created entire fields of modern thought. Neil Armstrong (a humble and brave pilot I had the privilege of spending time with when his son and I were classmates and dorm mates at Stanford) was the first human being to walk upon another world.

Modern medicine was largely invented and for 150 years found its greatest expression in the medical schools of Edinburgh and Glasgow. We think of my field, neurosurgery, as being founded by British and American surgeons, such as Victor Horsley and Harvey Cushing. In reality, the daring Scottish surgeon Sir William Macewen was the the true pioneer of modern neurosurgery. In 1876, Macewen operated on a young woman with right sided motor seizures based on clinical findings alone, identifying and removing a left frontal meningioma and granting her 8 further years of useful life. This was the first successful craniotomy for a non-traumatic, intracranial process in history.

By ancestry, I am not a Scot. My progenitors hail from the Welsh borders of England (where, generations ago, they were weavers), and Germany. Through my children, though, I have developed a love for the Scottish culture and people, and in the tradition of American and Scottish inclusiveness, count myself amongst them. My wife’s ancestors, the McIlrath’s, were artists and warriors from the western isles, allied to the MacDonald Clan. Their ancestral homelands are among the most beautiful places on earth (and not dissimilar to Oregon, where many Scots including the “founder of Oregon,” Dr. John McLoughlin, have settled).

So it is with considerable pleasure that I joined 10,000 or so of my compatriots at the Portland Games today. It was also with great pride that I watched my daughters compete in the highland dances and my son in highland bagpipes.

Scots promote tradition, competition and community. They welcome us to their grand tradition. They remind us how a great nation was built.

Scottish Highland Bagpipes (Playing a 2-4 March for the Judges)

Scottish Highland Dancing

Scottish National Dancing

500 Scottish Highland Pipers and Drummers Thunder Forward in a "Massed Band" at the 2012 Portland Highland Games!

Friday, July 20, 2012

Magnets and Shunt Valves


In 1955, a child with severe spina bifida and hydrocephalus, or water on the brain, was born to John W. Holter, a toolmaker in Stamford, Connecticut, and his wife. Charles Casey Holter, like other children at the time, did not survive this severe congenital disorder. His condition, however, prompted his father to invent the first hydrocephalus shunt valve, allowing the excess cerebrospinal fluid (CSF) in the brain to be diverted to other parts of the body and absorbed.

Although not a cure for hydrocephalus, Holter’s valve system was the first effective treatment. Descendants of the first Holter valve have saved the lives of millions of children. I used one just this morning to treat a tiny baby here at Doernbecher Children’s Hospital.

Modern shunt valves work on basically the same design, over 50 years later. There have, however, been improvements. Some valves, for example, have different settings to slow down or speed up the flow of CSF, making adjustments for a particular patient’s condition. Before these ‘programmable’ valves, neurosurgeons like myself had to perform an operation to change a valve setting (by going under the skin and changing the entire valve!). Now, we just use a magnetized programming device to non-invasively change a valve’s setting.

Like everything, programmable valves have drawbacks. One is that magnetic fields out in the day-to-day patient environment can accidentally reset a valve, and cause headaches or even dangerous shunt failure and return of acute hydrocephalus.

According to some manufacturers, accidental resetting should not generally occur from exposure to most day to day magnetic fields, such as security scanners at the airport, home kitchen microwave ovens, and smart phones (http://www.medtronic.com/for-healthcare-professionals/products-therapies/neurological/shunts/strata-nsc-lumboperitoneal-adjustable-pressure-shunts/indications-safety-warnings/index.htm).

Recently, though, physicians have reported accidental valve resets by a number of day-to-day devices. My friends and colleagues at the University of Michigan have just reported that iPad 2s can reset some valves (although only if placed within a couple of inches of the valve): http://thejns.org/doi/full/10.3171/2012.3.PEDS1211.

A Japanese group has even reported valve resets caused by the Nintendo DS video game: http://www.ncbi.nlm.nih.gov/pubmed/21946726.

Unfortunately, which valve might be reset by which magnet, at what distance, and under what circumstance, is often unknown. So what should patients and parents do?

My advice is: when in doubt, play it safe. Keep toy magnets or electronic devices with magnetic fields, away from a programmable shunt valve whenever possible. If you are unsure, ask your doctor’s office. Most importantly, if a patient with a hydrocephalus shunt and a programmable valve experiences symptoms of shunt malfunction (for example, severe headache, change in mental function, altered level of consciousness, or sudden loss of vision), seek immediate medical attention.

Hydrocephalus shunt valves, including magnetically programmable ones, are terrific advances, especially when safely and properly used.

Hydrocephalus - 'water on the brain'



Friday, July 6, 2012

Making Safety and Education Go Together



I graduated from medical school in the early 1990’s, and went to work in a major US hospital to train as a neurological surgeon. Like my compatriots around the country, within a few weeks of starting training, I began to perform invasive procedures needed by patients in the hospital. The first spinal tap I performed was on an actual patient. The first time I drilled a hole in the skull to relieve pressure … also an actual patient. Passing a catheter deep inside the brain to drain excess fluid? A patient.

Everyone doctor will have to get past his or her first of any procedure they need to perform in practice. And we need to train the next generation of doctors. So how can we do it, without sacrificing patient safety and the highest quality of care?

As the director of residency training in neurosurgery at OHSU, I have thought about this problem a lot. Having residents in the hospital 24 hours a day, seconds away from a patient’s bedside in the intensive care unit, has saved countless lives. But the emergency bedside procedures we do are some of the most impactful and risky in medicine.

In 2009, my colleagues and I hosted a ‘Boot Camp’ for 19 brand new neurosurgical trainees, only a few weeks out from medical school graduation. They came from 5 residency programs in the Pacific NW and California. We used a skills lab to teach, so the first skull drilling, the first lumbar puncture, the first fluid drain, were all carefully taught and mastered in a safe, simulated environment. While we had them all together, we also taught the residents about our perspectives on professionalism, careers, and respectful, effective communications with patients.

Three years later, the descendants of that first effort, the Society of Neurological Surgeons PGY1 Boot Camp Courses, are a universal part of residency training at all 100 neurosurgery training programs in the United States. They are endorsed by the American Council for Graduate Medical Education (ACGME), and they have been funded for 5 years by an unprecedented $1.9 million grant. Six courses are held each July, during the first few days of practice by new residents, at 6 centers around the country. OHSU continues to host the western region course and stay involved in curricular leadership of the courses nationally.

Today, OHSU for the 4th year hosted the Western Region PGY1 Bootcamp. What a great event!

OHSU is proud to share advances in safety and education with our colleagues around the US. Read more about the results at:


Dr. Nate Selden with SNS PGY1 Boot Camp residents








Wednesday, July 4, 2012

Independence Day, Ideals, and Optimism

Happy 4th of July my fellow Americans!

I hope that everyone has a wonderful holiday, like me, with friends and family, in beautiful sunlight, enjoying a calm afternoon breeze, an American flag overhead, and the safety, security, and well being that our forbearers have earned us.

We are very blessed to be here, and with this blessing comes responsibility: to contribute to our communities, to treat each other with respect, to do the right thing, and to help others in the world achieve the type of fair and principled society we live in.

We spend a lot of time, particularly around the 4th, thinking about the way the world views us. I have been lucky to spend 4 years of my life living in two other countries, learning clearly about their view of ours. I spent three years as a graduate student in England, and a year as an overseas undergraduate in Italy. Even when I heard a particular American action or policy questioned, I never once heard American ideals, nor America's founding principles, questioned. That is a particularly remarkable statement given that we fought a brutal war against the British for independence and founded our nation in opposition to their system of constitutional monarchy.

The American experiment of republican self-government, freedom of ideas, and adherence above all to principled ideals, has been a sublime success. While not yielding perfection, our system has provided a history (including a record of generosity around the world) that I believe is objectively unmatched. It is certainly reasonable, and eminently rational, to evaluate our nation's principles by comparison to other systems and their results. I think the comparison speaks volumes in favor of the United States.

Like many others, we may have come late to cleansing the scourge of slavery from our nation, but we eventually adopted the spectacular ideals and vision of Dr. Martin Luther King, Jr., and made them part of our national fabric, while electing an American president of African descent far before even the most enlightened of our international peers. Our troops, like every army in human history, have on incredibly rare occasions engaged in atrocities, but hundreds of thousands of Americans have selflessly given their lives in two world and countless other just wars to protect and extend freedom far beyond our own economic or cultural spheres. As I write this, incredibly brave young Americans are far from home today defending my family, and my American ideals. Thank you.

The other characteristic opinion of America held in other nations is particular to our citizens. Even the most skeptical Britons I encountered during my three years, filled with disdain for 'loud' or 'arrogant' Americans, were more than willing to admire our nearly universal optimism, and all the positive achievements it has led to.

I got an example of that today. I went in to Doernbecher Children's Hospital to make rounds on a few patients I have in the hospital over the holiday. While I was there, I stopped by the University Hospital operating room where my younger partner, Dr. Nicholas Coppa, was carrying out a complex procedure with great skill and dedication. In the midst of a sunny holiday morning, all I heard from Dr. Coppa and our colleague and Chair of the Anesthesia Department, Dr. Jeffrey Kirsch, was enthusiasm and high expectations for the results of their work. Outstanding and talented physicians putting their professionalism forward in all circumstances to help others are emblematic of America, and of the ideals I grew up with. I am proud to count such people as my colleagues, and most of all today, I am proud to be an American!


Saturday, June 30, 2012

Campagna Chair of Pediatric Neurosurgery



Mario and Edie Campagna are a precious commodity in our state. Committed Oregonians, they have worked hard their entire lives to build a wonderful state and then continued watching out for Oregon through wise and active philanthropy.

Mario Campagna was educated at the (then) University of Oregon Medical School here on Marquam Hill. Successful in school, he was called to the Mayo Clinic to train in neurological surgery, a new but cutting edge specialty requiring the greatest dedication and skill. Mario and Edie were so attached to their home state, though, that they returned to Oregon. After initiating his career here in Portland, Mario and Edie made a dramatic choice that would transform neurological care in Southern Oregon and help build the Medford community. Mario opened the first major neurosurgical practice between Portland and San Francisco.

For decades, Mario and Edie were respected leaders of the Medford community and medical world. Mario built a neurosurgical and neurological practice that was the mainstay of a huge region of Southern Oregon and Northern California. One of his four children also attended OHSU, and went on to train in Pediatrics at Doernbecher Children’s Hospital and to serve Oregon as a pediatrician. Mario and Edie became philanthropic leaders in Southern Oregon.

Imagine the pride I have had, then, since 2005, serving as the Mario and Edie Campagna Professor of Pediatric Neurosurgery, the only endowed position for a pediatric neurosurgeon in the state. During this time, Mario and Edie’s personal mentorship, advice, and guidance have been a wonderful part of my career and the growth of our program.  Thus, June 29th, 2012 is a special day that will always have special meaning for neurosurgery at Doernbecher. I flew with Dr. Stacy Nicholson, Credit Unions for Kids Professor and Physician in Chief of Doernbecher to Medford to celebrate the launch of the Campagna Chair of Pediatric Neurosurgery with Mario, Edie and other friends and family. Mario and Edie’s generosity means that pediatric neurosurgery will now receive tremendous additional support and will be able to attract a national program leader, in perpetuity. The Campagna Chair is the first endowed chair in neurological surgery in the state (and the 2nd endowed position overall).

The Chair celebration was, most of all, a wonderful opportunity to visit with two individuals who are not just wise philanthropists that have devoted their careers and lives to Oregon and raised their families here. It was also a chance to spend time with now dear friends, who have a deep and tremendous sense of the value of Oregon and of Oregonians, and a clear vision of why we should all work to better their interests now and in the future.

Nathan R. Selden
Mario and Edie Campagna Chair of Pediatric Neurosurgery
Oregon Health & Science University





OHSU Neurosurgery Residency 2012 Match


It is a true pleasure to announce the very strong results of the OHSU 2012 Neurosurgery Residency Program Match. For the first year ever, OHSU entered the match with three residency slots, and filled all three positions with top applicants.

Dr. Kunal Gupta, MB, ChB, holds both the British equivalent of an MD (the bachelor of medicine and surgery, ‘chirurgiae’) and a PhD from the University of Cambridge, England. During his research training, Dr. Gupta did basic work on oxidative stress in astrocytes, as well as extensively studying risk factors in British society for the occurrence of brain tumors. A tennis player and skier, Dr. Gupta is also a competitive ballroom dancer.


Dr. Katie Krause, MD, PhD, undertook both her medical and scientific training at the Medical College of Wisconsin, Milwaukee. Dr. Krause’s thesis work and extensive publications investigated the respiratory control function of the brainstem Kolliker-Fuse nucleus. She is a pianist, experienced piano teacher, and an outdoor enthusiast.


Dr. Tristan Stani, MD, studied Philosophy, Classics and the History of Science at St John’s College before matriculating at the Warren Alpert School of Medicine at Brown University. He returns to OHSU for residency training after spending the summer here as the 2009 Mario and Edith Campagna Scholar. His research work has concentrated on mitochondrial diseases and, at OHSU, on the effects of deep brain stimulation for tremor on precision grip. Dr. Stani is also an outdoor enthusiast.


The Residency Program in Neurosurgery is proud of the outstanding quality of trainees who come to OHSU from around the country, and the world. The Program trains a group with exceptional creative and scientific accomplishments, of diverse background, and including one of the highest proportions of women in any U.S. training program.

Nathan R. Selden, MD, PhD
Campagna Chair
Residency Program Director

Announcing the 2012 Campagna Scholar in Neurological Surgery!



Dr. Mario and Mrs. Edith Campagna are long time members of the Oregon community. Mario pioneered neurosurgical care in southern Oregon, and Edie supported his incredibly busy practice and raised their family here in the state.

The Campagnas have also been visionary philanthropists, and maintain close ties with neurosurgery and neurosurgical education at OHSU.

One of the most innovative programs the Campagnas have initiated is the Campagna Scholarship in Neurological Surgery. After a raft of applications from medical schools around the country and consideration by a committee within the Department of Neurological Surgery at OHSU, we have named the 2012 Campagna Scholar, the 5th Scholar to matriculate into the program.

Gustavo Mendez is a medical student at OHSU, the first internal candidate selected in the national Campagna Scholars annual competition. With a BA in physics from Harvard University and post-BA pre-med studies at USC, plus extensive lab experience, Gustavo is a start student. He has already greatly impressed the faculty at OHSU, and has begun a project under the supervision of Neurosurgery Asst. Professor, Dr. Brian Ragel.

Previous scholars have conducted research leading to numerous publications in the peer reviewed neurosurgical literature. Already, two have fulfilled Dr. Campagnas vision to encourage the best and brightest to enter neurosurgical training: they have earned coveted spots in neurosurgical training residencies after medical school.

Many have also presented their work at national neurosurgical meetings. Here are two scholars, just after their presentations at the Congress of Neurological Surgeons meeting in Washington, D.C., in October of 2011: The 2010 Scholar, Susan Wozniak, and the 2011 Scholar, Michael Strong. Also pictured are OHSU Neurosurgery Resident, Dr. Eric Thompson, and myself (the Campagna Professor of Pediatric Neurosurgery – but I’ll leave that story to another entry!).

It is my privilege each summer to visit Medford for the day with the current scholar. Here is a photo of Susan Wozniak and myself with the Campagnas. I am greatly looking forward to the next trip with Scholar Gustavo Mendez this summer!

Nate Selden, Edith Campagna, Mario Campagna, Campagna Scholar Susan Wozniak

Campagna Scholar Michael Strong, OHSU Resident Eric Thompson, Nate Selden, Campagna Scholar Susan Wozniak

Inspiring the Next Generation



Inspiring the next generation of physicians, researchers and other health personnel is a big part of OHSU’s mission. There is lots of ways to do this.

Catlin Gabel is a local Portland school with a long and distinguished history of experiential learning. Every year Catlin puts on a unique event to interest students in science and health care. Sixty 6th grade students at Catlin participate in ‘surgery day’ and have an opportunity to handle and utilize real surgical equipment, meet surgeons and other specialist physicians, and get a ‘peek’ into what modern medicine is about.

The kids use tiny titanium plates to repair “fractures” on bone models, thread tiny catheters into simulated blood vessels, put on casts, and perform over a half dozen other realistic surgical and medical activities, under the watchful eye and tutelage of Portland area surgeons who volunteer time and equipment for the program, which is almost 20 years old.

At the 2012 surgery day, two Doernbecher faculty, Dr. Dana Braner (the Alice Fax Professor and Head of Critical Care Medicine) and your correspondent, Dr. Nathan Selden (the Campagna Professor of Pediatric Neurosurgery) joined in the fun. Braner worked at a station teaching the middle school students to sew up lacerations (using pigs feet from the market place), and I used a real surgical navigation computer and drills to show students how to perform emergency neurosurgical drainage procedures.

As you can see from these photographs, Braner and I had as much fun as the kids! Education, at all levels, is a core part of our mission and our professional satisfaction at OHSU, and is a major reason that OHSU is a vital part of the Portland, Oregon, and Pacific Northwest communities.

Thanks also go to industry suppliers and partners who loaned key equipment for the program, including Medtronic who brought the items for the neurosurgery station I taught at. Thanks also to Dr. Karen Selden (not a coincidence, and the reason I was first invited to participate!), who organizes surgery day for Catlin.
 

Doernbecher Intensive Care Head, Dr. Dana Braner, and Surgery Day organizer, Dr. Karen Selden, with middle schoolers

Doernbecher's Campagna Chair of Pediatric Neurosurgery, Dr. Nathan Selden, with middle schoolers

National Accreditation Renewal, New Positions, and Special Recognition for OHSU Neurosurgery Residency



Oregon Health & Science University is one of only 100 medical centers in the nation to train the next generation of neurosurgeons, as part of our mission to advance cures for neurological disease.

In order to maintain the highest standards of education and patient safety, the American Council of Graduate Medical Education (ACGME) performs a thorough records review and site visit of every residency program every 5 years. Our program spent months preparing documents and then underwent our site visit in June, 2011.

The results were better than we hoped for. In addition to a clean bill of health and full 5-year accreditation period, our residency complement was increased from 14 to 18 trainees. The review committee recognized the strong training environment, nationally recognized faculty, and tremendous opportunities to learn in a safe and supportive environment for patients and trainees in making these decisions.

To top it off, the OHSU Program was also commended for overall quality, and became the first neurosurgery residency program in the country invited to share a ‘notable educational practice’ with other programs nationally. The practice cited is a new call schedule arrangement that shortens the length of duty shifts for the doctors working through the night in the OHSU Neurosciences ICU, taking care of the sickest patients. The schedule makes sure a well rested and focused doctor is only seconds to minutes away from the bedside of critically ill patients. It also provides for optimal care ‘handoffs’, so that shorter shifts do not result in confusion about patient status or recent events.

The new schedule was developed by a group of educators and trainees in our Program, who could see all angles of each challenge and potential solution. Kudos to key players, Dr. Brian Ragel, Assistant Professor of Neurological Surgery, and Dr. Mark Piedra, Senior Neurosurgical Resident!

OHSU’s innovative schedule will soon be reported in the medical literature, and has been posted at the ACGME’s education innovations website.


New Technology to Treat Parkinson’s Disease and Tremor with More Comfortable Asleep Surgery



For patients who do not respond well to medication, surgery for Parkinson’s disease and severe tremor has been a mainstay since the 1950s. In fact, Dr. Kim Burchiel, the John Raaf Professor and Chair of Neurological Surgery, performed the first operations in Oregon using the most modern technique, implantation of deep brain stimulation electrodes. Dr. Burchiel has also been a pioneer in improved techniques and outcomes for brain stimulation operations.

Dr. Burchiel
One of the biggest barriers for patients to undergo deep brain stimulation surgery has been anxiety and discomfort. Typically, patients must be awake for the surgery, which uses a large metal frame clamped to the skull to direct the electrode. The only way to be sure the electrode was in the right spot was to turn it on and measure the effects in the patient … while they were awake!

Now, however, Dr. Burchiel has pioneered a new technique here at OHSU. He uses special intra-operative CT imaging to guide the electrodes to the exact spot deep in the brain needed, while the patient rests comfortably under a general anesthetic. Especially for some older and more fragile patients with Parkinson’s disease, this new technique is a real blessing, and may open up access to surgery for some patients who could not consider it before.

See how the new surgery works:


The Changing Face of Neurosurgery: OHSU Helps Lead the Way



Neurosurgery as a specialty was founded in 1920, when our George Washington, Dr. Harvey Cushing, founded the Society of Neurological Surgeons and began to share techniques with an elite group of burgeoning brain surgeons around the United States. Central to the new specialty was training, and our passage of knowledge from generation to generation has shaped us ever since.

Until very recently, the faces in neurosurgery residency training programs were mostly pretty similar, and virtually all male. When I trained, about 5% of incoming residents were women. Just 4 or 5 years ago, that percentage had only reached about 10%. In just the last few years, though, more women are entering neurosurgery and beginning to change the specialty. In the last two years, about 1 in 5 new trainees has been a woman.

I am proud that OHSU Neurosurgery is in the vanguard of this new trend. Currently, 5 of our 15 residents are women, an unusually high 33%. Our 2011 class of new residents included Dr. Frances Hardaway and Dr. Kelley Bridges, both of whom were among the top U.S. medical school graduates in 2011.

Our experience has been that a reputation for a supportive and positive environment for women trainees (and in fact all trainees) has given us access to some of the best applicants available. Soon, having a neurosurgical workforce that reflects the diversity of the neurosurgical patient population will start having a positive, and profound, impact.


Minimally Invasive Brain Tumor Surgery at Doernbecher



Doernbecher has a distinguished record for removing some of the most difficult tumors faced by pediatric neurosurgeons.

One of the toughest, a rare tumor called craniopharyngioma, is tucked deep in the center of the head, between the carotid arteries emerging from the skull base, the vision nerves, the most sensitive areas of the base of the brain, and the brainstem (see an example, below). Our novel report of using a newer skull base surgical approach in children to remove craniopharyngiomas, while preserving visual function at record high rates, was highlighted on the cover of the leading Journal of Neurosurgery: Pediatrics, in 2009.

Modified orbitozygomatic craniotomy for craniopharyngioma resection in children

Now, for some smaller craniopharyngiomas, an even newer, more innovative approach is available at Doernbecher: using an endoscope to enter the skull base through the nose and remove the tumor minimally invasively, and completely. Remarkably, this trans-nasal surgery leaves no scar at all.

Some larger tumors are still removed using the open skull base approach Doernbecher helped develop in children. Along with our superb brain tumor program colleagues, these innovations offer the best odds for children with one of the most difficult to treat pediatric brain tumors.