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Neurological Surgery

Innovation + Technology

Innovation + Technology

Surgeon using technologyThrough its affiliation with University Hospitals Cleveland Medical Center and the UH Neurological Institute, the Department of Neurological Surgery brings innovation to a new level by not only introducing new ideas in clinical and surgical methods and devices but new ideas in patient care.

The Department of Neurological Surgery has a rich legacy of clinical innovation:

  • Northeast Ohio's first designated neurological institute
  • Northeast Ohio's first and only Comprehensive Stroke Center
  • Working with Cleveland-based Surgical Theater, developed the Surgery Rehearsal Platform, which allows neurosurgeons rehearse complex procedures using real three-dimensional diagnostic images
  • First in the world to test the diaphragm pacing stimulation system on patients with amyotrophic lateral sclerosis (ALS)
  • First in North America to perform deep brain stimulation of the thalamus to successfully treat symptoms of Tourette syndrome
  • One of only nine hospital centers in the world experienced in using NeuroBlate for minimally invasive brain tumor surgery
  • First in Ohio to offer both Gamma Knife and CyberKnife® in our Stereotactic Radiosurgery suite
  • Neuroscience Intensive Care Unit is one of only 25 centers in the nation offering fellowships in neurocritical care
  • One of the region's first providers of pterygoid botox injections for the treatment of movement disorders
  • One of Ohio's first physician-led Brain Attack programs - now one of the largest in the nation with 24/7 availability for emergency transfers
  • One of only 25 centers in the United States offering surgical therapy for dystonia 
  • First comprehensive pediatric autonomic lab in the country
  • Only program in the United States offering multiple hippocampal transections for the treatment of epilepsy

The Department of Neurological Surgery offers the highest quality medical and surgical expertise and the latest in innovative technology, including:

 

Neuroblate scanThe NeuroBlate uses MRI-guided lasers to destroy tumors without damaging the surrounding healthy tissue. Approved by the U.S. Food and Drug Administration in 2009, this revolutionary technology and minimally invasive approach is especially effective in treating glioblastoma, one of the most aggressive and difficult-to-treat brain cancers. University Hospitals Cleveland Medical Center is one of only nine hospital centers in the United States using this technology.

 

The NeuroBlate procedure is performed with the patient in a standard 3T MRI scanner. The treating physician visualizes and controls the treatment procedure in real-time. The thin probe is inserted into the tumor through a small “burr hole” in the skull. The probe tip emits laser energy sideways (radially) to heat tissue in one direction while cooling to remove heat from all other directions. The unidirectional focus enables the physician to “steer” the heat to the tumor and avoid neighboring healthy tissue.

 

MRI signals measure temperature in and around the tumor, enabling the physician to “see” the tumor and the thermal damage as it happens. The real-time feedback information gives the physician the ability to precisely control the treatment. Various positioning and monitoring devices enable the physician to precisely control the procedure remotely and without moving the patient in the MRI.

 

The combined technologies enable physicians to selectively treat the tumor tissue they want to kill while avoiding damage to other tissue.

 

Radiosurgery is a non-invasive technique for treating benign and malignant conditions by using precise, targeted doses of radiation. The Department of Neurological Surgery is the first academic neuroscience program in Ohio to offer both Gamma Knife® and CyberKnife® in its Stereotactic Radiosurgery suite.

 

Gamma Knife®

Surgeon using gamma knife on female patientThe most accurate form of stereotactic radiosurgery for the brain, the Gamma Knife® focuses numerous beams of radiation directly on a targeted area while sparing the surrounding healthy tissue. Gamma Knife® radiosurgery has revolutionized the treatment of a wide spectrum of brain tumors and vascular malformations, many of which were previously considered untreatable.

 

The noninvasive procedure replaces the surgeon's scalpel with nearly 200 narrow beams of cobalt gamma radiation that are precisely focused on a single target. The tissue being treated receives the highest dose of radiation, while surrounding tissue is left minimally affected.

 

 CyberKnife®

Cyber knife machine

The CyberKnife® targets tumors anywhere in the body from more than 1,200 angles with sub-millimeter accuracy. This non-invasive technology gives a pain-free alternative to traditional open surgery or radiation therapy. The tumor receives a high dose of radiation to destroy tumor cells but leaves the surrounding healthy tissue unharmed.

 

The CyberKnife® gives new hope for successful treatment of tumors and lesions previously diagnosed as untreatable or inoperable. Advanced age or coexisting medical conditions do not affect the ability to receive CyberKnife treatment. The CyberKnife System is based on radiosurgery technology that has been proven for over 30 years. More than 40,000 patients have been successfully treated with the CyberKnife System.

 

In combination with traditional surgery and radiation therapy, Gamma Knife® radiosurgery can increase the survival rate for patients with malignant brain tumors that cannot be completely removed through conventional means. Because it is a non-invasive technique, Gamma Knife treatment has proven especially beneficial for patients who are considered poor surgical candidates because of age, health factors (such as diabetes or hypertension), or inability to tolerate general anesthesia.

 

Surgeon using gamma knifeThe most accurate form of stereotactic radiosurgery for the brain, the Gamma Knife focuses numerous beams of radiation directly on a targeted area while sparing the surrounding healthy tissue. Gamma Knife radiosurgery has revolutionized the treatment of a wide spectrum of brain tumors and vascular malformations, many of which were previously considered untreatable.

The noninvasive procedure replaces the surgeon's scalpel with nearly 200 narrow beams of cobalt gamma radiation that are precisely focused on a single target. The tissue being treated receives the highest dose of radiation, while surrounding tissue is left minimally affected.

In combination with traditional surgery and radiation therapy, Gamma Knife radiosurgery can increase the survival rate for patients with malignant brain tumors that cannot be completely removed through conventional means. Because it is a non-invasive technique, Gamma Knife treatment has proven especially beneficial for patients who are considered poor surgical candidates because of age, health factors (such as diabetes or hypertension), or inability to tolerate general anesthesia.

 

The CyberKnife® targets tumors anywhere in the body from more than 1,200 angles with sub-millimeter accuracy. This non-invasive technology gives a pain-free alternative to traditional open surgery or radiation therapy. The tumor receives a high dose of radiation to destroy tumor cells but leaves the surrounding healthy tissue unharmed.

 

The CyberKnife gives new hope for successful treatment of tumors and lesions previously diagnosed as untreatable or inoperable. Advanced age or coexisting medical conditions do not affect the ability to receive CyberKnife treatment.

 

The CyberKnife System is based on radiosurgery technology that has been proven for over 30 years. More than 40,000 patients have been successfully treated with the CyberKnife System.

 

The Department of Neurological Surgery offers Deep Brain Stimulation (DBS) for the three most common movement disorders: Essential tremor, Parkinson's disease and dystonia.

 

DBS is a surgical procedure in which a medical device called a brain pacemaker is implanted in the brain. The device is programmed to send electrical impulses to specific parts of the brain. The impulses block the brain signals that cause shaking.

 

For some conditions, DBS can result in consistent relief of symptoms and significant reductions in the side effects some patients experience with prolonged use of standard drug treatments. In addition to tremors, DBS has been shown to relieve other motor dysfunctions such as rigidity, bradykinesia (slow movement), dyskinesia (involuntary movement), and gait and balance problems.

 

DBS has significantly improved the quality of life for many patients, allowing them to regain their independence and resume many normal activities. In clinical studies, at least eight out of 10 Parkinson's patients experience a significant improvement in functional ability with DBS. For patients with essential tremor, up to 90 percent achieve significant relief from their incapacitating tremor. For patients with dystonia, up to 75 percent will experience benefit.

 

The Department of Neurological Surgery, in conjunction with the University Hospitals Epilepsy Center offers a full spectrum of surgical solutions using the latest technologies to patients beset with epilepsy.

 

Seizures that do not respond to medications may be reduced or eliminated through surgery. Surgery should not be considered only as a last resort. Advances in surgical techniques and technologies now offer surgical options to a significantly larger percentage of epileptic patients.

 

By careful testing before surgery, we identify those areas of the brain to avoid during the operation so that crucial functions, such as talking, are not damaged. After surgery, seizures may be stopped completely or see a significant reduction.

 

Surgical options offered include:

  • Temporal lobe resection 
  • Extratemporal resection 
  • Corpus callosal section 
  • Lesionectomy 
  • Selective amygdalo-hippocampectomy 
  • Multiple subpial transection 
  • Multiple hippocampal transection
  • Hemispherectomy

 

The new robotic system (RP7) allows a physician 30 miles away to directly link to another hospital and patient. The developing technology eventually will allow physicians to perform physical exams on patients off-site, leading to better treatments and potentially less hospital time for patients.

 

The Case Critical Care Bioinformatics project is a collaboration between University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine. The team focuses on integrated data acquisition, complex processing and innovative visualization in the intensive care unit. The mission of the project is better insight into complex physiology, early detection of secondary insults, a reduction in medical errors, improved efficiency and better patient outcomes.

 

Neurosurgeons at University Hospitals Cleveland Medical Center have helped develop a surgical rehearsal simulator that allows for interactive run-throughs of brain surgeries prior to complex procedures -- such as microsurgery for clipping brain aneurysms.

 

Led by Dr. Warren R. Selman and developed by Cleveland-based Surgical Theater LLC, the Surgical Rehearsal Platform (SRP) uploads and transforms medical images, such as CT and MRI scans, into life-like, dynamic and interactive 3D models SRP enables surgeons to plan and rehearse surgeries by seeing and interacting with an accurate replica of what they would experience when operating on the patient.

 

The virtual tissues and blood vessels react realistically to actions taken by the surgeon, allowing the surgeon to make critical decisions in a risk-free environment before entering the operating room. The SRP also allows surgeons in different locations to connect virtually, share best practices and jointly perform a virtual surgery in a collaborative surgical theater.