Penn State Hershey Neuroscience Institute, has a global perspective when it comes to providing quality, multi-disciplinary care. This is best represented by the Institute’s expansive global exchange program among neuroscience clinicians and researchers, spanning four continents. Every neurosurgical resident is given the opportunity to hone his or her skills abroad, and almost half choose to do so. The primary exchange program is with the Bureau of Public Health in Tianjin, China, a formal relationship that began in 2006. Through a grant funded by Integra Foundation, eight Penn State Hershey Medical Center faculty members have studied there, while thirty-four exchange students have learned alongside Penn State College of Medicine faculty.
The exchange program functions as part of a developing program to encourage collaboration between clinicians and researchers at Penn State Hershey Medical Center and Tianjin’s largest hospitals. These reciprocal relationships enable providers to share best practices and advanced technology to improve patient outcomes. From a clinical standpoint, foreign physicians can gain experience with virtually every neurosurgical procedure that is currently performed at Penn State Hershey Medical Center. In the research arena, groundbreaking studies are being conducted through the Center for Neural Engineering and Penn State Hershey Neurosurgery laboratory. Research is ongoing in neurodegenerative disease, brain iron deficiency, brain tumors, epilepsy, and brain-machine interfaces. Physicians from the US and China also collaborate on clinical trials, mutually benefiting with shared data from their genetically disparate populations. Continue reading
Robert Harbaugh, M.D., professor and chair of Penn State Department of Neurosurgery and director of Penn State Hershey Neuroscience Institute, encourages all members of his department to take an active role in the field. “One thing we encourage in our residency training, aside from the usual missions of education, patient care, and research, is involvement in organized neurosurgery.” As they train new residents, Penn State Hershey Neurosurgery faculty members also encourage younger physicians to pass on their knowledge and adopt a citizenship role in the field.
Harbaugh himself holds multiple leadership positions, including president of the Society of Neurological Surgeons. He previously served as immediate past president of the American Association of Neurological Surgeons and director and member of the Advisory Council of the American Board of Neurological Surgery. Harbaugh has traveled extensively to lecture on various topics, including his clinical specialty of cerebrovascular neurosurgery and his research work on computer modeling of intracranial aneurysms.
Robert E. Harbaugh, M.D., FAANS, FACS, FAHA
Director, Penn State Hershey Neuroscience Institute
Distinguished Professor and Chair, Department of Penn State Hershey Neurosurgery
Professor, Department of Engineering Science and Mechanics
RESIDENCY: Neurological Surgery, Dartmouth Hitchcock Medical Center
MEDICAL SCHOOL: Penn State College of Medicine
Brad E. Zacharia, M.D., M.S.
FELLOWSHIP: Surgical Neuro-Oncology, Memorial Sloan-Kettering Cancer Center, New York
RESIDENCY: Neurosurgical, New York Presbyterian Hospital- Columbia University, New York
INTERNSHIP: Surgical, New York Presbyterian Hospital- Columbia University, New York
MEDICAL SCHOOL: Columbia University, New York
CLINICAL INTERESTS: Brain tumors, endoscopic skull base surgery, Gamma Knife® radiosurgery
Brad E. Zacharia, M.D., M.S., brings new techniques to Penn State Hershey Neurosurgery, to improve the safety and effectiveness of brain tumor surgery, including functional brain mapping and endoscopic skull base surgery. Please call 717-531-3828 with questions or to schedule an appointment for your patients.
UP TO 50 PERCENT OF BRAIN TUMORS RESISTANT TO STANDARD CHEMOTHERAPEUTIC AGENT TMZ
When a patient presents with a malignant glioblastoma, the current standard therapy is total resection surgery followed by radiation, either alone or in combination with temozolomide (TMZ) chemotherapy.1 Used to treat several types of cancer, orally-administered alkylating agent TMZ is known to inhibit cell reproduction by blocking the replication of DNA.2 Although it is less toxic than other alkylating agents, TMZ does not display efficacy in as many as 50 percent of brain tumors.3 Because of this, as well as the high rate of chemotherapy resistance in recurrent brain malignancies, there is an urgent need for new drugs for treatment-resistant tumors.4 Continue reading
DECREASED STROKE RISK CITED AS PRIMARY BENEFIT OF REGIONAL ANESTHESIA, ESPECIALLY IN OLDER PATIENTS
Carotid endarterectomy (CEA) has long been used in selected patients with carotid stenosis, especially in those with 70 to 99 percent stenosis of the internal carotid artery.1 The majority of those surgeries are performed under general anesthesia; however, an increasing number of neurosurgeons believe that performing the procedure under regional and local anesthesia results in superior outcomes. Assistant Professor of Neurosurgery, Scott Simon, M.D., strongly agrees. In fact, he and Robert Harbaugh, M.D., professor and chair of the Department of Neurosurgery, insist that all CEA patients receive regional anesthesia, in the absence of mitigating factors.
As Simon states, “Most of our patients have already had a stroke, and there’s evidence that putting a brain that’s already been injured under general anesthesia can cause cognitive limitations when the patient wakes up.” When asked about the landmark CREST (Carotid Revascularization Endarterectomy versus Stenting Trial), which appeared to indicate that stenting offers similar outcomes to surgery, Simon points out that the data clearly indicate a much lower risk of postoperative stroke with CEA (2.3 percent versus 4.1 percent with stenting),1 a significant indicator of patient quality of life post-procedure. Further, of more than 2,500 patients in the CREST trial, only 10 percent received regional anesthesia.1 Continue reading
NOVEL PROGRAM OFFERS PATIENTS LESS INVASIVE TREATMENT OPTION
Spinal column reconstruction for the management of adult spinal deformity (ASD) is technically challenging and has been associated with high complication rates,1 which may explain why few locations perform it. However, at Penn State Hershey Medical Center, specialists perform the correction using a posterior-only approach, as opposed to the more traditional anterior-posterior approach.2 Assistant Professor of Neurosurgery, John P. Kelleher, M.D. states, “This minimizes the need for next-day staging of the procedure. However, when staging is necessary, we use a minimally invasive extreme lateral approach which causes minimal blood loss and leads to rapid recovery.”
Patient unable to stand for a significant time, secondary to excruciating pain with sagittal imbalance. On the right are standing films of the same patient after multilevel surgery correction of the sagittal imbalance.
The major surgical procedure required to reshape the spine in cases of ASD typically requires an inpatient stay of between seven and ten days, followed by robust support in the weeks thereafter, making it unrealistic for many patients and their families. However, Kelleher has joined the Penn State Hershey Neurosurgery team to spearhead the spinal deformity surgery program in collaboration with colleague J. Christopher Zacko, M.D., who also uses this less invasive approach. Continue reading
The American Heart Association/American Stroke Association has recognized Penn State Hershey Medical Center for its high-level care of stroke patients. The Medical Center has received the Get With The Guidelines®-Stroke Gold-Plus Quality Achievement Award for the sixth consecutive year by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients.
The award is the highest level of recognition available for treatment of patients with stroke and recognizes Penn State Hershey for implementing specific quality improvement measures outlined by the AHA/ASA for the treatment of stroke patients.
Penn State Hershey also received the association’s Target: Stroke Honor Roll for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA.
Penn State Hershey is one of only seven Comprehensive Stroke Centers in Pennsylvania, the only one in Central Pennsylvania, and one of only seventy-eight in the country.
Open communication between participants enhances the success of the Penn State Hershey LionNet telestroke system.
Penn State Hershey Medical Center spearheads a sophisticated telestroke system, LionNet, expanding the capabilities of partner hospitals. By exposing more patients to specialized neurological care, LionNet can dramatically increase positive outcomes for patients with both ischemic and hemorrhagic stroke.
Using advanced computer systems with webcams, LionNet allows a Penn State Hershey stroke neurologist or neurosurgeon to consult in real-time with an ED doctor at a partner facility. The specialist examines the patient remotely, reviews scans, and makes a recommendation regarding whether to begin intravenous tPA therapy or transport the patient for possible neurosurgical intervention at Penn State Hershey Medical Center.
Robert Harbaugh, M.D., professor and chair of Penn State Hershey Neurosurgery and director of Penn State Hershey Neuroscience Institute, has been chosen as president-elect of the Society of Neurological Surgeons (SNS). The SNS is the oldest neurological society in the world and includes leaders in neurosurgical residency education. Harbaugh also serves as president of the American Association of Neurological Surgeons and as vice-chair of the American Board of Neurological Surgery.
L to R: Kevin Cockroft, M.D., Jennifer Humbert, R.N., and Ray Reichwein, M.D.
LionNet, Penn State Hershey’s regional stroke care network, offers real-time video consults with doctors in area emergency departments (EDs) and Penn State Hershey specialists, providing faster diagnosis and treatment of strokes for patients throughout central Pennsylvania.
“When patients come to an ED with suspected stroke, they need immediate evaluation by a specialist who can confirm the diagnosis and make treatment recommendations,” said Jennifer Humbert, R.N., Penn State Hershey LionNet coordinator. Continue reading