Neurosciences Care From a Team of Specialists
Wednesday, June 29, 2011
Providing patients with multidisciplinary, team-based neurological services, Geisinger’s Neurosciences Institute offers “big-city” care set in beautiful Central Pennsylvania.
Photo: Steven Toms, M.D., M.P.H., FACS
Geisinger’s Neurosciences Institute is a comprehensive program offering a wide range of services, like endoscopic skull-base surgery, brain tumor removal and cerebrovascular care. Patients from Northeast, Central and Western Pennsylvania benefit from a team of specialists offering epilepsy management and functional neurosurgery, pediatric neurosurgery and spine care.
“At Geisinger’s Neurosciences Institute, we have a superb group of surgeons who trained at some of the nation’s best hospitals, as well as internationally in Europe and Canada,” says Steven Toms, M.D., M.P.H., FACS, Co-Director, Neurosciences Institute and Director of Neurosurgery for Geisinger Health System. “An exceptional group of support staff is also in place, including brain tumor and epilepsy nurse navigators, and all the services are provided in an environment that supports high-quality care. From our surgeons to our nursing staff and nurse navigators, Geisinger’s Neurosciences Institute delivers care that is equivalent to what you would find at the finest university hospitals.”
Effective Epilepsy Management
Under the guidance of Frank Gilliam, M.D., Co-Director, Neurosciences Institute and Director of Neurology for Geisinger Health System, a multidisciplinary program is in place to provide cutting-edge evaluation and treatment of epilepsy. The key to this program is collaboration between neurologists and neurosurgeons.
When patients first present for a consultation, they undergo electroencephalography (EEG) monitoring, a neuropsychiatric assessment and imaging modalities — including MRI and PET scanning — which help to identify the epileptogenic zone.
“The most common, surgically amenable location is temporal lobe epilepsy that results from mesial temporal sclerosis,” says Dr. Toms. “Temporal lobe epilepsy can also be caused by a brain tumor, brain trauma or neurodevelopmental disorders.”
In the event of temporal lobe epilepsy, additional monitoring is generally indicated. This involves placing subdural electrodes in or on the brain to identify the location of epilepsy focus. Patients who require this invasive monitoring will often spend several days to a week in the Epilepsy Monitoring Unit at Geisinger to map the location of speech or motor neurons. Once monitoring is complete, treatment usually involves resection of the epileptogenic zone.
“Geisinger’s Neurosciences Institute performs 70 to 80 craniotomies each year and has an outstanding epilepsy surgical program in place, with outcomes boasting few complications and high rates of cure or improvement,” says Dr. Toms.
Advances in Neuro-Oncology
Home to two of Pennsylvania’s fellowship-trained neuro-oncologists, Geisinger’s team specializes in malignant brain lesions. This program is divided into two areas — care for metastatic brain tumors and care for brain lesions, such as gliomas. Treatment options for these types of brain tumors include access to the latest therapies and clinical trials.
Currently, Geisinger’s Neurosciences Institute is one of only 20 centers in the United States to participate in the NovoCure Phase III Tumor Treating Fields trial for treatment of glioblastoma. Several multicenter Radiation Therapy Oncology Group and National Comprehensive Cancer Network trials are also available.
Therapies available for treatment of malignant brain lesions include a full spectrum of chemotherapy modalities as well as stereotactic radiosurgery, which is an especially beneficial treatment for brain and spinal metastases originating from cancers of the lung, kidney and liver.
Surgical Care for Benign Brain Lesions
For benign brain lesions that lie close to the skull base, such as pituitary tumors, meningiomas and craniopharyngiomas, endoscopic skull-base surgery provides an innovative alternative to the traditional craniotomy in suitable patient candidates.
“Using endoscopic skull-base surgery, we can remove some of the tumor through the nostrils and sinuses,” says Amir R. Dehdashti, M.D., Director of Cerebrovascular and Skull-Base Surgery at Geisinger’s Neurosciences Institute. “This technique has proven successful in 95% to 97% of cases — even in cases where removal of a very large pituitary tumor was needed.”
A minimally invasive procedure, endoscopic skull-base surgery requires no incision and allows for reduced manipulation of the brain. Less pain and swelling after surgery, as well as shorter hospitalizations and recovery periods, are additional advantages of this technique. Dr. Dehdashti performs approximately 75 endoscopic skull-base surgeries each year at Geisinger.
For cases of lesions not amenable to minimally invasive surgery — such as acoustic neuromas, which must be treated using an open skull-base technique — Dr. Dehdashti also offers open craniotomy procedures.
Cutting-Edge Cerebrovascular Services
Geisinger’s Neurosciences Institute offers a full spectrum of cerebrovascular services, including stroke management and treatment of brain aneurysms, arteriovenous malformations and cavernous malformations. The program offers patients the ability to receive the most complex cerebrovascular surgical services without having to drive to Pittsburgh, Philadelphia or New York City.
Geisinger provides cerebrovascular surgery for the treatment of stroke and ischemic disease, as well as the use of cerebral revascularization for treating aneurysms that are not amenable to surgical clipping and certain instances of ischemic disease.
“The cerebral revascularization (bypass) is a unique service provided at Geisinger’s Neurosciences Institute,” says Dr. Dehdashti. “Few centers in the United States offer this procedure, and we perform 10 to 12 revascularization procedures annually.” Geisinger also offers state-of-the-art surgical technology, including intraoperative ICG angiography.
Enhancing Outcomes Through Collaboration
A cornerstone of Geisinger’s Neurosciences Institute is the multidisciplinary approach that is applied to care. Physicians routinely work together to provide treatment options that offer the best possible outcome for the patient.
In terms of cerebrovascular care, continuous collaboration among the endovascular team, which includes three neuroradiologists who are involved in every case, is emphasized. At the Cerebrovascular Clinic, all cases are discussed with the care team to ensure efficacy and safety during surgical procedures. Additional physicians are also available during surgery in the event that an angiogram becomes necessary.
The neurology and functional neurosurgery teams also employ a collaborative approach to care. Multidisciplinary clinics are in place for neurology, epilepsy and neuroendocrinology. In both epilepsy management and brain tumor removal, a broad range of physicians from various specialties, including radiology, pathology, psychiatry, neurosurgery and neurology, all meet to develop the best treatment plans for complex cases.
Patient-Centric Care
Geisinger’s outstanding group of physicians has a specially trained support staff, including epilepsy and brain tumor nurse navigators, who assist with patient education and help patients navigate the care process. Providing a high level of support services, these health care professionals help make care more convenient and accessible for the patient. Now that’s peace
of mind.
For more information about services provided through Geisinger’s Neurosciences Institute, visit www.geisinger.org/neuro.
Geisinger’s Neurosciences Institute
MD News June/July 2011, Central Pennsylvania
I am a brain tumor survivor(anaplastic astrcytoma) diagnosed in 2000 of Jan. and i am trying to contact Dr. Steven Toms who performed my surgery in Nashville Tn. @ the Vanderbilt Hospital in 2000 of Jan..Just wanted him to know that i am doing wonderful!! And to say Thank you to him and his team!! 270-438-8056 if he ever gets this message!!!