Transcription:
Innovations in Neurosurgery

Caitlin Whyte: New minimally invasive and image guided diagnostic and treatment techniques are transforming our ability to treat patients who require complex brain and spinal surgery. Joining us today to talk about the innovations in neurosurgery and what is available at Maimonides are Dr. Amit Schwartz, the director of neurosurgery and Dr. Daniels. the director of vascular neurosurgery. This is my mom. I talk, I'm your host, Caitlin white. So doctors start off hearing a bit about who each of you are and what you do. I'll have you go first.

Amit Schwartz, MD: Dr. Schwartz. So my name is Amit Schwartz. I'm the director of neurosurgery at Maimonides medical center in Brooklyn.

My division consists of all fellowship trained neurosurgeons with expertise in the various specialties of neurosurgery. So that includes spine herniated, disc stenosis, brain tumors, pituitary tumors. We manage hydrocephalus various. Facial pain syndrome is like trigeminal neuralgia. We do a fair amount of skull-based surgery, which is deep tumors and pathologies of the brain.

And we also have a very large subdivision of vascular and endovascular neurosurgery that deals with the blood vessels of the brain.

Caitlin Whyte: And Dr. tell us a bit about you.

Daniel Zumofen, MD: So my name is Daniel. I'm the chief of vascular neurosurgery here at Maimonides vascular surgeons are doctors that treat disorders of the blood vessels in your brain or your spinal cord, such as stroke or brain aneurysms.

In fact here at Maimonides, we have one of only two comprehensive stroke centers in Brooklyn. Comprehensive means that we have the highest degree of certification by the government. In fact, the federal government tranq does as a top hospital in the entire United States for our outstanding stroke, survival rates for you.

It is basically means that we have the latest and most advanced treatment methods available 24 seven. For instance, we have a very new, uh, clot-buster medication that dissolves blood clots in your brain before permanent damage occurs. We also have a state of the art by plain x-ray suit for mechanical thrombectomy.

This minimally invasive technology allows us to remove even very large blood clots from your brain, with the smallest snares that we get there from inside the blood vessels, from a small puncture site, that the level of your groin, I. Nowadays see many patients that come in unconscious or that cannot move or cannot talk.

And with these new treatment methods, uh, many patients in fact starts talking or moving, stayed in the operating room. As soon as we remove the clot from their brain and happy us or happy patients, many of these patients then return home while being neurologically normal.

Caitlin Whyte: Now doctors a muffin, what are a couple things that are exciting you right now in the world of minimally invasive and image guided diagnostics?

Daniel Zumofen, MD: So I like technology a lot and I really think that technology has so much changed over the last 10 years in neurosurgery. For instance. Nowadays, I do have a software tool that allows me to extract the information from your MRI and to create a 3d model of your brain or your spinal cord. Uh, this 3d model.

I can then visualize it on my computer, turn it around, start yet until I really understand where exactly your brain tumor is located. This. 3d model also allows me to simulate my procedures. In fact, until I really understand and find a way to safely remove the brain tumor from your brain, then during surgery, um, we have the technology, the computers that track my instruments during surgery and projected into that 3d model.

You can think of it like a. GPS system for neurosurgeons when they work inside your brain. I also think that over the last years there has been a really big. Change of culture in neurosurgery or in surgery in general? I think nowadays it's all about patient safety, especially here at Maimonides. And in fact, we follow safety protocols and checklists, very similar to a pilot flying a large passenger aircraft.

I think all these. Things have made sprain surgery much safer for our

Amit Schwartz, MD: patients

Caitlin Whyte: and Dr. Schwartz. How about you? What are you excited about these days?

Amit Schwartz, MD: So since Dr. ZoomInfo covered a lot of our technology available for the brain, I will mention a few things with regards to the spine. I could tell you we've been doing spine surgery for many years.

But we're not doing spine surgery. Like we were doing 15, 20 years ago. That technology we have now is quite incredible. We now, once patients are asleep, able to. Take an image of their entire spawn in three dimensions once they're asleep. And essentially that data goes into the computer that essentially is guiding our entire operation, uh, through this technology, which means any screw going into the spine is now navigated by the computer, which makes our surgeries a.

Much safer as now all the hardware is going in with a much higher degree of precision for that specific spine. It is happening much quicker because of the technology we have. The incisions are much smaller, smaller, and once all the hardware's in the spine, we can now re image in three-dimension the spine to make sure everything is perfect.

Yeah. Before we close any incisions or wake the patient up. So that minimize the risk of a patient waking up and then having to bring them back to the operating room, to revise part of the operation that is not perfect. And this was not available, you know, several years ago. And the technology just gets better and better things that just more and more precise.

And that leads to. Shorter operations, smaller incisions, quicker recovery, less blood loss for the patient and better patient outcomes.

Caitlin Whyte: Dr. Schwartz, that leads me into my next question. How are all of these options really better for patients? What have you seen change?

Amit Schwartz, MD: So there's no question. Now, the patients have shorter anesthesia times and much quicker recoveries for the same operation done.

Several years ago, patients may have several weeks of pain after surgery. And now I see patients after surgery in my office and their recovery is so much quicker. They require less pain medication and they get back to their prior life and their jobs so much faster than they used to be. And they're essentially doing better.

Right. And long-term, they do better as well with less issues of other parts of the spine. What we call adjacent level disease. When you do too much surgery, it puts at risk the part of the spine next to where you just operated. But now that things are so much less invasive, we see a lot less of that. And patients overall are just doing better.

Caitlin Whyte: And Dr. Schwartz, we'll stick with you for the last question here. What should patients do or consider if they, or a loved one are diagnosed with a brain or a spinal condition that requires surgery like this?

Amit Schwartz, MD: So I think for me, from a patient perspective, the most important thing is to understand that the majority of the time, the procedure you may need is not an emergency.

That you need to take time to consider your options. If a patient feels that they are being pressured into an operation to book a surgery with that specific surgeon, that should be a red flag patients. Most of the time have the luxury of leaving the office, thinking of what the recommendation is consider whether they have enough trust and whether they need a second opinion.

Because I encourage second opinions. I see many patients in second opinion who are recommended surgery and many of them, I managed non-operatively whether it's a brain tumor that has benign and can be watched that there's no urgency to remove right now, whether it's a spine problem that I think can resolve itself over time without surgery or with a less invasive surgery.

So patients should. Take the time to figure out whether this is something they really need to do urgently, or they have more time to think about it. I think that's number one. Number two is in our institution. We really have only one mission. And that's our patient, our number one focus and mission is purely on the patient's safety and outcome.

And because that is our only mission we put together our team for every surgery that we feel will maximize the patient's outcome. And that often involves two attending neurosurgeons. And that may be me and Dr. Zuma fi operating together to ensure. That there's the highest level of skill and for that particular surgery.

So the patient has the best chance of doing well. So I think where you have your surgery done, who will be operating on you other than the one surgeon you are meeting is an important fact that the patient should be aware of Dr. Zuma. Fine. You may want to discuss one of the patients we recently did together.

Daniel Zumofen, MD: Yes. Thank you. I meet, in fact that reminds me of a recent case V. The surgery together. It was the case of a very deep seated benign brain tumor. I think in many centers, his tumor would have been removed through a very larger skin incision covering. Most of the patients had in fact, here at Maimonides, I teamed up with.

Dr. Schwartz. And we applied a very advanced, minimally invasive and imaging guided methods. And we succeeded in removing that brain tumor through a small skin incision, hidden within the eyebrow. Uh, the patient left the operating room with only a little bandage and. Discharged the following day, he had already fully recovered.

So I really think that here at Maimonides, we really can team up also attending brain surgeons, working together for the same case on the same case and combining techniques. I feel this greatly increases safety and this certainly leads to better results for our patients.

Caitlin Whyte: Absolutely. Well, Dr. any last thoughts to wrap up here?

Daniel Zumofen, MD: So last words, I think in neurosurgery, many things are non urgent as Dr. Schwartz said, however, stroke. Is very different there every minute counts. I think that if you or someone you knows, develops a sudden weakness in your face or in your extremity, he may very well have developed a stroke. In that case, I really urge you to call nine one one.

And I really urge you to have this patient transferred to a comprehensive stroke centers, such as here at Maimonides. I know that not all centers have all the technology 24 seven available. And as I said, this really can make a difference.

Caitlin Whyte: Great. And Dr. Schwartz, was there anything you wanted to add that.

Amit Schwartz, MD: There is a great fear in many patients about neurosurgery, whether it's the brain or the spine, just thinking you may need brain surgery, or you may need spine surgery elicits a deep fear in patients. But I want to reassure patients that in the right hands. Brain surgery and spine surgery can be very, very safe and patients can do very well.

This is not brain and spine surgery of 20 years ago or 30 years ago. We're in a new world right now. And patients can do very well, but their surgery and they should, while some fear before surgery is normal, they should be reassured that there has been a revolution making brain and spine surgery much safer than it used to be.

Caitlin Whyte: Absolutely. Well, that's always good to hear. Thank you so much doctors for taking some time to be with us and tell us about what's going on in the Maimonides neurosurgery department. Find out more about us online at dot org. This has been my Mohammad talk. I'm your host, Caitlin white stay well .