Friday, October 28, 2011
Houstonian Tries Heart-Transplant Alternative
In the news: a neurostimulator being used to help a patient's heart pump better versus having a heart transplanted. http://abclocal.go.com/ktrk/video?id=7639446
WJMC received five-star rating from HealthGrades
As reported recently by Martin Cover, Advertising Reporter for Times Picayune (http://www.timespicayune.com/), West Jefferson Medical Center in Marrero has received new five-star ratings and awards of excellence from HealthGrades, a nationally respected, independent source for information on doctors and hospitals. Amongst attending physicians to accept the hospital's Neurosurgery Excellence Award from HeathGrades were Drs. Erich Richter, Robert Dawson III and Frank Culicchia. A scan of this article (apologies for the poor quality) is available to the right.
Thursday, October 8, 2009
LSU Becomes a New Center for the Treatment of Obsessive-Compulsive Disorder
Medtronic Reclaim™ DBS therapy is becoming available at the LSUHSC-NO Department of Neurosurgery as an FDA approved procedure under a Humanitarian Device Exception for the treatment of chronic, severe, treatment-resistant OCD.
Saturday, June 20, 2009
A Question about Cyberknife for Trigeminal Neuralgia
"I did not know where to put this. I had a question about Cyber Knife. Has it been used at West Jefferson/LSU to treat TN successfully?I'm post Gamma Knife and am considering Cyber Knife as my next move."
Great question. Radiosurgery in general has gotten quite a bit of attention over the past several years as a treatment for Trigeminal Neuralgia (TGN), a severe disorder of facial pain.
Unfortunately, the information isn't always unbiased, and the companies that make and buy the radiosurgery units have often done a really good sell job.
That's not to say that radiosurgery isn't an important option, just that many people have chosen it out of a fear of surgery, with an unrealistic expectation from the radiosurgery.
To make things more complicated, people aren't even really clear on the term "trigeminal neuralgia" and they aren't always talking about the same thing.
Traditionally, neurosurgeons have limited the term "trigeminal neuralgia" or "classical trigeminal neuralgia" to a very specific disorder in which the pain is "lancinating" or stabbing. In classical trigeminal neuralgia, the rest of the time everything is completely normal. There is no constant pain. There is no numbness. This kind of pain usually responds fairly well to medications, particularly a seizure medicine called Tegretol. Many people, however, have side effects on the doses that they need to stop the pain. In these people, we offer surgery. There are two main kinds of surgery -- usually the cause is a small artery bumping up against the nerve, so we tend to offer "Microvascular Decompression" (MVD) where we make a small hole in the back of the skull and put a tiny foam pad alongside the nerve to protect it. This cures better than 8 out of 10 people, tends to last pretty well, and rarely causes any numbness in the face. Most of us really find this to be the best option in young healthy people.
In those who are older or not healthy enough to undergo anesthesia, the other primary options are different ways of passing a needle into the nerve under xray guidance to burn it or crush it. This leaves the face somewhat numb, but stops the pain in the high ninety percents.
Radiosurgery is more like the latter. The disadvantage over the needle procedures is that it can take up to 6 months to take effect. Since the effect typically lasts for less than 2 years, the difference is substantial. It can leave the face numb, and can lead to a condition called "anesthesia dolorosa" in which the face is numb and in pain at the same time, which is extremely difficult to treat. The biggest problem we've seen is that people get radiosurgical treatment for face pain that does not meet the criteria for classic TGN, but is now being called TGN type II. Unfortunately, the success rates in type II are very poor, essentially no benefit by 2 years.
Cyberknife and Gamma Knife each have their strong adherants who think one is better than the other, but there's essentially no data to back that up. The Cyberknife provides a comfort advantage, as you don't have to have your head pinned in a frame for the procedure.
For the type II pain, the most successful procedure appears to be none of the above, but something called motor cortex stimulation.
All in all, the answer depends on the specifics of your case. Your best bet is to talk to an expert in all the treatments for TGN, both radiosurgical and otherwise. Because of our affiliation with WJMC and the Cyberknife unit, most LSU neurosurgeons see their patients now at the Cullicchia Clinic in Marrero. We'd be happy to make an appointment and talk about your options in detail.
Great question. Radiosurgery in general has gotten quite a bit of attention over the past several years as a treatment for Trigeminal Neuralgia (TGN), a severe disorder of facial pain.
Unfortunately, the information isn't always unbiased, and the companies that make and buy the radiosurgery units have often done a really good sell job.
That's not to say that radiosurgery isn't an important option, just that many people have chosen it out of a fear of surgery, with an unrealistic expectation from the radiosurgery.
To make things more complicated, people aren't even really clear on the term "trigeminal neuralgia" and they aren't always talking about the same thing.
Traditionally, neurosurgeons have limited the term "trigeminal neuralgia" or "classical trigeminal neuralgia" to a very specific disorder in which the pain is "lancinating" or stabbing. In classical trigeminal neuralgia, the rest of the time everything is completely normal. There is no constant pain. There is no numbness. This kind of pain usually responds fairly well to medications, particularly a seizure medicine called Tegretol. Many people, however, have side effects on the doses that they need to stop the pain. In these people, we offer surgery. There are two main kinds of surgery -- usually the cause is a small artery bumping up against the nerve, so we tend to offer "Microvascular Decompression" (MVD) where we make a small hole in the back of the skull and put a tiny foam pad alongside the nerve to protect it. This cures better than 8 out of 10 people, tends to last pretty well, and rarely causes any numbness in the face. Most of us really find this to be the best option in young healthy people.
In those who are older or not healthy enough to undergo anesthesia, the other primary options are different ways of passing a needle into the nerve under xray guidance to burn it or crush it. This leaves the face somewhat numb, but stops the pain in the high ninety percents.
Radiosurgery is more like the latter. The disadvantage over the needle procedures is that it can take up to 6 months to take effect. Since the effect typically lasts for less than 2 years, the difference is substantial. It can leave the face numb, and can lead to a condition called "anesthesia dolorosa" in which the face is numb and in pain at the same time, which is extremely difficult to treat. The biggest problem we've seen is that people get radiosurgical treatment for face pain that does not meet the criteria for classic TGN, but is now being called TGN type II. Unfortunately, the success rates in type II are very poor, essentially no benefit by 2 years.
Cyberknife and Gamma Knife each have their strong adherants who think one is better than the other, but there's essentially no data to back that up. The Cyberknife provides a comfort advantage, as you don't have to have your head pinned in a frame for the procedure.
For the type II pain, the most successful procedure appears to be none of the above, but something called motor cortex stimulation.
All in all, the answer depends on the specifics of your case. Your best bet is to talk to an expert in all the treatments for TGN, both radiosurgical and otherwise. Because of our affiliation with WJMC and the Cyberknife unit, most LSU neurosurgeons see their patients now at the Cullicchia Clinic in Marrero. We'd be happy to make an appointment and talk about your options in detail.
Friday, June 5, 2009
Neuromodulation for dystonia - moving forward!
Dr. Erich Richter has performed deep brain stimulation to treat a patient with severe dystonia. The case was performed at West Jefferson Hospital with great results! The electrode was implanted with the use of stereotactic head frame attached to the patient's skull. (This guidance system allows for accurate placement of electrode, which delivers stimulation to affected area of the brain). Patient's symptoms, that included extreme pain and muscle spasms, significantly improved. As a matter of fact, the benefits of DBS may take several months to achieve its full effect. The result achieved by neurosurgeon at LSUHSC at New Orleans looks promising and gives new hope to prospective patients!
Friday, May 22, 2009
Brodmann area 25 deep brain stimulation to control depression symptoms
An ongoing study (BROADEN™) supported by St. Jude Medical, Inc., shows promising results in the treatment of major depressive disorder. The study is based on a model of depression proposed by Helen Mayberg, in which Brodmann area 25 appears to be overactive in depressed people. 21 patients involved in this study demonstrated 92% improvement in depression symptoms at one year follow-up.
Visit http://www.medicalnewstoday.com/articles/150959.php for full article.
Usefull links: www.BROADENstudy.com; www.PowerOverYourPain.com
Visit http://www.medicalnewstoday.com/articles/150959.php for full article.
Usefull links: www.BROADENstudy.com; www.PowerOverYourPain.com
Sunday, May 10, 2009
New Resident Physician to Join LSU Neurosurgery
The LSUHSC-NO Department of Neurosurgery is pleased to announce that Dr. Durga Sure will join the housestaff on July 1st. Dr. Sure is currently completing a two year pre-residency fellowship in neurosurgery at Harvard. We look forward to his arrival and seeing his academic development over the years to come.
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