It’s been a little while since we had an Intriguing Image. This video illustrates a surgical technique for the treatment of medication-resistant temporal lobe epilepsy.
In this procedure, which is designed to minimize cognitive side effects, the surgeon carefully uses a laser probe to heat and ablate the regions of the brain doctors think are important for seizures. Magnetic resonance imaging allows the temperature in the brain to be precisely monitored. The video was provided by Robert Gross, MD, PhD, and accompanies an upcoming paper in the journal Neurosurgery. More discussion of this procedure here and here.
The epilepsy patient Henry Molaison, known for most of the 20th century as H.M., is one of the most famous in neuroscience. His case played an important role in telling scientists about structures of the brain that are important for forming short-term and long-term memories.
To control H.M.’s epilepsy, neurosurgeon William Scoville removed much of the hippocampi, amygdalae and nearby regions on both sides of his brain. After the surgery, H.M. suffered from severe anterograde amnesia, meaning that he could not commit new events to explicit memory. However, other forms of his memory were intact, such as short-term working memory and motor skills.
This classic case helps us understand the advances that neurosurgeons at Emory are achieving today. The surgeries now used to treat some medication-resistant forms of epilepsy are similar to what was performed on H.M., although they are considerably less drastic. Usually tissue on only one side of the brain is removed. Still, there can be cognitive side effects: loss of visual or verbal memory abilities, and deficiencies in the ability to name or recognize objects, places or people.
Neurosurgeon Robert Gross has been a pioneer in testing a more precise procedure, selective laser amygdalohippocampotomy (SLAH), which appears to control seizures while having less severe side effects. Neuropsychologist Daniel Drane reported at the recent American Epilepsy Society meeting on outcomes from a series of SLAH surgeries performed at Emory.
Don’t sweat the small stuff.
That’s the motto 36-year-old Jennifer Giliberto now lives by after recently welcoming a third child into the world. Late night feedings, diaper changes, mounds of dirty laundry and caring for two older boys (ages six and eight) would certainly be a challenge for most moms. But this mom is different.
Four years ago, Giliberto was diagnosed with a brain tumor – a slow growing Grade II astrocytoma located in her posterior right temporal lobe. The shocking diagnosis left Giliberto and her family with many choices and decisions to make.
Giliberto’s inspiring story was profiled on CNN on Aug. 16, 2011 in a special “Human Factor” segment, which takes a look at people accomplishing something significant after overcoming the odds.
The Long Road Ahead
After her second child was born in 2005, Giliberto began noticing a pattern of problems with her fine motor skills. Neurological testing revealed little, but an MRI (magnetic resonance imaging) revealed a lesion and possible tumor in the brain. Follow-up MRIs over the next year showed no new growth, but in June 2007, a definite brain tumor was detected by MRI.
While taking the watch and wait approach to determine if the tumor would grow, she became involved with the Southeastern Brain Tumor Foundation (SBTF) as a volunteer. She focused her efforts on raising money to support critical brain and spinal tumor research. She also met Emory neurosurgeon Costas Hadjipanayis, MD, PhD.
Hadjipanayis, an assistant professor in Emory’s Department of Neurosurgery, would soon become Giliberto’s physician. He confirmed her diagnosis and recommended surgical removal of the tumor.
On August 18, 2008, at Emory University Hospital Midtown, Hadjipanayis removed Giliberto’s brain tumor. “Jennifer underwent a craniotomy and had a gross total resection of the tumor, with no complications,” explains Hadjipanayis, who is chief of neurosurgery at the hospital. “She spent one night in the neurosurgical ICU and her recovery afterwards went well.”
Then he encouraged her to embrace life and live it to the fullest. Giliberto has taken her doctor’s orders to heart, and lives life with a new purpose than before.
To support and encourage other brain tumor patients, Giliberto serves as a patient and family advisor at Emory University Hospital Midtown. She visits with hospitalized patients and their families who are in similar situations as the young mother of three.
“This has been a very fulfilling experience and an outlet to give back,” says Giliberto. “Being a patient is lonely, even when you know you have support. Working to assist other patients and families and improve a system goes a long way to ease that lonely journey of the patient experience.”
Patient and family advisors also work to improve hospital processes and procedures from a patient perspective.
She also serves as vice president of the Southeastern Brain Tumor Foundation, continuing the mission to raise funds for research. The SBTF consistently funds innovative brain tumor research at Emory’s Winship Cancer Institute.
And she is a devoted wife and mother.
Last year, when Giliberto and her husband decided they would like to expand their family of four, she consulted with Hadjipanayis. He, once again, encouraged her to live life and move forward. They did, and their youngest child was born in July 2011.
While Giliberto has remained stable since her surgery in 2008, she continues to have MRI’s every six to nine months to check for any tumor recurrence. Astrocytomas, even once removed, can recur and can also become cancerous.
But for now, it’s on with life as she knows it – stable, moving ahead and enjoying every day with a new sense of hope.
And as for the small stuff – Giliberto’s learned there’s just no reason to sweat it at all.
As we watch the daily progress of Representative Gabrielle Giffords, many close observers have commented that her recovery has been moving along more quickly than expected, and took a big leap after the visit from President Obama. Related? Perhaps.
Emory Psychologist, Dr. Nadine Kaslow, says there is no question that love and support from family, friends, and others individuals a patient is close to, can make an enormous difference in the recovery process.
She explains that after people come out of a coma, they often seem to have a special connection to those who were there for them during the coma, even if they don’t actually remember anything in a conscious way. Efforts to communicate with the patient, she says, whether those be verbal or physical, can reinforce linking and communication. She adds patients who have physical contact from a loved one seem to visibly relax and engage more.
At Emory, as we move more and more to patient and family centered health care, we actively encourage loved ones to talk with the patient, read to the patient, touch and stroke the patient. Additionally, beds and shower facilities are provided so that family members can be with their loved ones around the clock.
Owen Samuels, MD, director of Emory University Hospital’s neuroscience critical care unit, reiterates that patient families are now recognized as central to the healing process and their presence can even reduce a patient’s length of stay. He says that in a neurology ICU, where the average length of stay is 13 days, but is often many, many more, this can be especially beneficial.
Emory’s Department of Neurosurgery recently hosted a two-day boot camp for first-year neurosurgery residents. The unique event was part of a new national course launched by the Society of Neurological Surgeons (SNS) in Atlanta and five other cities including Boston, Portland and Chicago.
The course focused on fundamental skills, patient safety, professionalism and communications. Day one was structured in a traditional lecture format, while day two placed participants in simulated operating room environments and neurosurgical procedures.
“This boot camp concept is the first of its kind in medicine providing interns with a strong foundation to learn basic concepts and procedures and helping to ultimately reduce the number of errors among training residents,” says Costas Hadjipanayis, MD, PhD, assistant professor of neurosurgery at Emory School of Medicine and chief of neurosurgery service at Emory University Hospital Midtown.
More than 90 percent of all incoming neurosurgery residents in the United States participated in the training at one of the sites. Emory neurosurgical faculty, fellows, and residents led intensive and interactive exercises oriented to fundamental bedside procedural and operative skills.
The exercises were designed to allow residents to familiarize themselves with the basics in an educational and risk-free environment. Skills relevant to all first-year residents were covered, such as line placement and suturing, as well as specific neurosurgical skills like drilling and performing a craniotomy.
According to Hadjipanayis, one of the Emory organizers and course directors, the group of 37 interns participating in the Atlanta training was the largest number nationwide. They were from universities across the region ranging from Virginia to Puerto Rico.
“This was definitely a great start to a course we will cultivate and enhance from year to year,” says Hadjipanayis. “Our goal is for continuous evaluation and improvement.”
Click here to view a CNN news story filmed at the Emory boot camp by CNN medical correspondent and Emory neurosurgeon, Sanjay Gupta, MD.
Although the size of a pea, the pituitary gland, located deep within the skull at the base of the brain, is indispensible.
Known as the master gland, it directs other glands to produce hormones that affect metabolism, blood pressure, sexuality, reproduction, and development and growth, as well as other bodily functions.
So when something goes wrong with the pituitary, such as the development of a tumor, the consequences can be serious, even life threatening. Relatively common, pituitary tumors initially can be difficult to diagnose and, once found, difficult to remove because they are surrounded by so many nerves, such as those that supply the eye with movement and vision and blood vessels that supply the brain with blood.
Emory’s Pituitary Center is one of a handful of medical centers across the country using the latest 3-D endoscope for removal of pituitary tumors, a delicate and precise procedure. Having the new 3-D endoscope is a tremendous aid for a surgeon when operating on a small organ at the base of the brain, says Emory neurosurgeon Nelson Oyesiku, MD, PhD.
Sanjay Gupta, MD, assistant professor of neurosurgery at Emory School of Medicine and associate chief of neurosurgery service at Grady Memorial Hospital, navigates a busy schedule as a practicing doctor and the internationally known face of health reporting for CNN.
Next week, on Nov. 18, Gupta shares his story and discusses his new book at a book signing event at Emory. His book is titled “Cheating Death: The Doctors and Medical Miracles that Are Saving Lives Against All Odds.”
In a recent article, Emory Magazine profiles Gupta and remarkable journey:
- Gupta can barely disguise the wonder he still feels when he ponders the complex circuitry of the human brain. And he can barely contain the wonder he feels when he is called upon to care for a patient, the way he saw doctors care for his grandfather.
- “I love the intellectual challenge of it. I love the technical challenge of it. But at the end of the day—if someone comes in with a tumor or some kind of chronic pain issue that I can help in some way—that’s a remarkable feeling,” he says. “I operated all day Monday, and I walked home and told my wife all about my day, and it’s one of the most satisfying things I can do.”
Barely sixteen when he was accepted into an accelerated program to enter medical school, Gupta fast-tracked his career along parallel yet complementary paths. He wanted to be a great doctor and a great communicator. He wanted to heal patients, and he wanted to hear them.
- Those interests synthesized when he joined CNN as its chief medical correspondent. With his straightforward yet reassuring manner, he has become the nation’s calm voice of medical reason—a doctor who possesses the rare ability to talk to the camera as if he were talking to a patient. He speaks, and somehow we believe he wouldn’t mind taking all the time in the world to help us separate facts from fears.