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Brainstorm

By wmadministrator

When eight University of Louisville neurosurgeons – the entire department – left last spring to start the Norton Neuroscience Institute, many declared it a disaster for Kentucky health. The University of Louisville would lose its Level 1 Trauma Center rating and never be able to recruit staff in the hypercompetitive national market for neurosurgeons.

What happened over the course of the spring, however, allowed the University of Louisville to snatch victory from the jaws of defeat. It freed up funds, recruited nine new board-certified neurosurgeons from around the nation and retained its gold-standard trauma center rating. Meanwhile, the new Norton Neuroscience Institute will staff 13 neurosurgeons as a start, investing $100 million for research and facilities over the next 10 years. The goal is to make Norton a “world class” center for treatment, research and training of the next generation of neurosurgeons, the hospital says.

Now that the dust has settled, Louisville and the surrounding region will have more than doubled its capacity in neurosurgery, spawned countless new research efforts yet to be seen, and hopefully, become a larger mecca for neurosurgeons in training.

Not a moment too soon
Strong services in neurology and neurosurgery are critical to the area’s health, experts say. Neurosurgeons treat more than just traumatic head and spine injuries. They remove brain tumors and aneurysms, repair damage after strokes, and help correct birth defects of the brain and spinal cord. Together with neurologists, they help treat problems such as epilepsy, multiple sclerosis, Alzheimer’s, Parkinson’s disease, neuromuscular and related diseases, as well as chronic pain or illness with a neurological basis such as severe depression and obsessive-compulsive disorders.

To get a sense for the scope for Kentucky’s neurosurgical need, one only has to look at Dr. Thomas Moriarty, MD, Ph.D., who has served for years as chief of pediatric neurosurgery at Kosair Children’s Hospital, now a part of the Norton Neuroscience Institute. By industry average, most pediatric neurosurgeons see 250 cases a year. For the last few years, Moriarty has averaged 500 yearly cases.
He was the only pediatric neurosurgeon in the area – one of only two in Kentucky.

When a child with a life-threatening tumor showed up in the emergency room at Kosair Children’s Hospital, he would have to cancel his whole day’s appointments. “The parents (of scheduled patients) were disappointed,” he said in a recent interview. “Some of them would have to endure a long wait to get on my schedule, then they would be cancelled.” Now, with Norton’s addition of Vanderbilt-trained neurosurgeon Dr. Charles B. Stevenson to the roster, he has somewhere to send those patients when emergency strikes – and vice versa.

Norton expects the additional staff will attract a whole new group of patients. Dr. Moriarty specializes in anomalies of the spine. Stevenson has expertise in the surgical treatment of epilepsy, using an endoscopic technique to excise tumors, remove scarring or position catheters. Dr. Christopher Shields, president of the Norton Neuroscience Institute, predicts the new activity will create a need for a third pediatric neurosurgeon in the near future.

What a $100 million investment will buy
The eight neurosurgeons transferring over from UofL represent the Neurosurgical Institute of Kentucky (NIKY), and are the largest practice of neurosurgeons in the area. This summer, Norton announced it has recruited five additional neurosurgeons, with specialties ranging from interventional endovascular neurosurgery, spine, functional/movement disorders, epilepsy, pediatrics, trauma and radiosurgery. Three more are in the process of recruitment for 2009/2010.

“There are approximately 125 neurosurgeons who graduate nationally each year, and we have five of them joining us. They are coming from the top institutions in the United States, and will have completed advanced training fellowships before they come. Considering how competitive the market is, that’s remarkable,” Shields said. “By consolidating our resources under the Institute, we’re able to attract more talent, and hopefully, reverse the recent trend of neurosurgeons leaving Louisville.”

Those neurosurgeons will practice in a new, expanded NIKY facility on East Broadway across from Norton Hospital. With more than 30,000 s.f., the former AAA building has twice the space of the practice’s former site. It cost $2.26 million and is undergoing a $2 million-plus conversion to patient care rooms, physician offices and research and conference space.

The group hopes to hire nine nurse practitioners and several more researchers to work with them at the facility.

Norton also has plans to upgrade facilities for the neurosurgeons at its downtown Kosair, Audubon and Suburban campuses in the next couple years. One of the world’s most technologically advanced operating rooms, BrainSuite®, will be a crown jewel. This high-tech operating center will allow surgeons to see continuous magnetic resonance imaging (iMRI) during surgery along with other visualization technologies, projected in giant detail on a digital readout wall. The technology is said to help reduce the number of repeat surgeries when physicians fail to remove all diseased tissue on a first procedure.

Growing the pot of research money
The Department of Neurological Surgery at UofL has one of the largest research agendas at the School of Medicine. As of this year, Norton had committed $4 million in research funds to UofL, which attracted $6 million more in matching funds from state and other sources. This allowed the department at UofL to attract $36 million to date in grants from the National Institutes of Health, ranking it No. 8 in the amount of NIH grants going to an neurosurgical educational institution. This investment will largely stay with the University of Louisville.

Meanwhile, Norton is pursuing grant money from private sources with great success. In just a few months, it has attracted $5 million for its research projects, which are in development. The hope, officials say, is that the expanded neurosurgical assets in Louisville will attract an even larger “pie” of research money from which both organizations can get bigger slices.

UofL – larger staff, larger facilities
UofL has recruited nine new board-certified neurosurgeons, and it is in the midst of a national search for its department chair and director for the neurosurgery residency program.

The university, meanwhile, is investing $143 million in a new, 287,000-s.f. research center for the medical school. Though it will house labs for the university’s cancer center, hepatology and pulmonology departments, the move will free up much-needed lab space throughout the campus for neurology and neurosurgery research. This spring, the university announced the opening of a six-bed critical care unit for stroke patients, allowing them to move more quickly out of the emergency room and into specialized nursing care and treatment.

The school continues to make headlines in the world of brain and spinal cord research as it studies aggressive new treatments. Irene Litvan, MD, recruited from Bethesda, Md., is leading a neurologist team studying of movement disorders, hoping to shed light on the neurological causes of diseases such as progressive supranuclear palsy. For this study, three full-time neurologists were hired – meaning area patients with Parkinson’s, Lou Gherig’s disease and other movement disorders won’t have to wait more than a year to be seen.

The school is also home to the Kentucky Spinal Cord Research Center, led by Dr. Scott Whittemore, Ph.D., and funded with $4.7 million in grants from the commonwealth’s Bucks for Brains program. The team is experimenting with gene therapy and undifferentiated precursor cells – stem cells’ successors – pursuing the goal of helping the body to boost neuron regeneration after brain or spinal cord injuries. Their findings could help people suffering the aftereffects of stroke, Huntington’s disease, Alzheimer’s and other movement disorders.
Susan Harkima, Ph.D., the school’s rehab research director, is doing nationally recognized work with locomotor training, studying how to help patients retrain their spine after injury and heal more quickly.

The university also is hot on the trail of treatments for autism. Dr. Manuel Casanova leads a team that has proven the use of low-frequency magnetic fields directly on the brain can lessen autism symptoms. His work is based on the team’s discovery of mirror neurons, which help humans feel empathy and learn by watching the others’ actions. Cassanova’s team showed the area of the brain with the most mirror neurons is the area most affected by autism – a key clue into the root causes.

Dr. Larry Cook, executive vice president of health at UofL, said the university should be proud of its accomplishments, but it still has a long way to go.

“Kentucky has one of the worst profiles for stroke and many other diseases, and the need is only going to increase with the coming age(-ing population) wave.
… We’ve successfully passed through this (faculty departure) crisis and recruited a top-notch staff that will see us through. But we are still only halfway to where we intend to be,” he said. “We will need more faculty, more residents … and a doubling of staff to meet the future need. We’re committed to being that full-service bank of resources for our community.”

Louisville’s Neuroscientist Lineup

Norton Neuroscience Institute
Christopher B. Shields, MD
George H. Racque Jr., MD
Steven J. Reiss, MD
Thomas Moriarty, MD, Ph.D.
Todd Vitaz, MD
Wayne G. Villanueva
John E. Harping, MD
Joseph E. Finizio, MD
(Arriving in 2009-2010)
Shervin R. Dashti, MD
Kimathi Doss, MD
Todd S. Shanks, MD
Charles B. Stevenson, MD
Tom L. Yao, MD

University of Louisville Department of Neurosurgery
Jonathan Hodes, MD, interim chair and director
Thomas Becherer, MD
Timir Banerjee, Ph.D.
Michael Doyle, MD
Andrieves Dzenitis, MD
Patricia Fernandez, MD
Haring Nauta, MD, Ph.D.
Atom Sarkar, MD, Ph.D.
Robert Sexton Jr., MD

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