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  • 1. TABLE OF CONTENTS Faculty 2 Residents & Fellows 6 Message from the Division Head 8 Clinical Activities 9 Clinical / Research Coordinators 12 Clinical / Research Programs 13 Brain Repair Centre 25 Technology Programs 26 Research Activities 27 Educational Activities 36 Support Staff 41 Affiliated Neurosurgical Units 42 Cross-Appointed Faculty 44ANNUAL REPORT • 2007 1
  • 2. DIVISION OF NEUROSURGERY FACULT Y & R E S I D E N T S 2007 Back (left to right): M. Kis, S. Barry, P. Magown, S. Belkhair, K. Aal-Ali. Front (left to right): S. Christie, D. McNeely, D. Clarke, I. Mendez, S. Walling, R. Brownstone. Missing from photo: M. Hebb, C. Harraher, W. Howes, R. Holness, I. Fleetwood.2 HALIFAX • DIVISION OF NEUROSURGERY
  • 3. FACULTY I VAR ME NDE Z , MD, PhD, FRCSC, FACS Head, Division of Neurosurgery Professor, Departments of Surgery and Anatomy & Neurobiology Chairman, Brain Repair Centre Director, Neural Transplantation Laboratory Areas of Interest: Functional neurosurgery Neural transplantation Pain Robotics in neurosurgery DAV I D B. CLARKE, MDCM, PhD, FRCSC, FACS Vice Chair/Treasurer, Division of Neurosurgery Associate Professor, Department of Surgery Associate Professor, Department of Anatomy & Neurobiology Director, Neuron Survival and Regeneration Laboratory Areas of Interest: Epilepsy surgery Pituitary surgery Neurotrauma and injury prevention S I MO N WALLI NG, MBChB, FRCSC Program Director, Neurosurgery Residency Training Program Assistant Professor, Department of Surgery Areas of Interest: Neurotrauma Neuro-oncology Pediatric neurosurgery Injury prevention Surgical educationANNUAL REPORT • 2007 3
  • 4. FACULTY RO BE RT BRO WNSTONE, MD, PhD, FRCSC Professor, Departments of Surgery and Anatomy & Neurobiology A Assistant Dean, Research-Clinical Departments, Faculty of Medicine Director of Research, Division of Neurosurgery Fellowship Director, Stereotactic and Functional Neurosurgery C Co-Chair, Neuro-oncology, Cancer Care Nova Scotia Areas of Interest: A Functional neurosurgery Movement disorders Complex pain syndromes Epilepsy surgery Intrinsic brain tumours W WI LLI AM HO W ES, MD, FRCSC C Chief, Pediatric Neurosurgery, IWK Health Centre A Associate Professor, Department of Surgery A Areas of Interest: Pediatric neurosurgery Epilepsy surgery Vascular and skull base surgery RE NN HO LNE S S, MD, FRCSC Professor, Department of Surgery Director of Education, Department of Surgery Areas of Interest: A Surgical education and methods of evaluation International neurosurgical education Pituitary and skull base surgery Vascular neurosurgery4 HALIFAX • DIVISION OF NEUROSURGERY
  • 5. FACULTY HE RMAN HUGENHOLTZ, MD, FRCSC Professor, Department of Surgery Areas of Interest: Spinal surgery Ethics I AN G . FLE E TWOOD, MD, FRCSC Assistant Professor, Department of Surgery Director, Cerebrovascular Surgery Co-Director, Stereotactic Radiosurgery Areas of Interest: Vascular neurosurgery Radiosurgery DANI E L MCNEELY, MD, FRCSC Assistant Professor, Department of Surgery Areas of Interest: Pediatric neurosurgery Pediatric epilepsy surgery Spacticity Spinal dysraphism S E AN CHRI S T IE, MD, FRCSC Assistant Professor, Department of Surgery Areas of Interest: Minimally invasive spinal surgery Complex spinal surgery Neurotrauma Sport-related neurological injuriesANNUAL REPORT • 2007 5
  • 6. RESIDENTS RI CHARD RE ID, MD P Postgraduate Year 6 M MD Memorial University Newfoundland, Canada N MATTHE W HE BB, MD, PhD Postgraduate Year 6 MD University of Toronto Ontario, Canada PhD Dalhousie University Nova Scotia, Canada CI ARA HARRA HER, MSc, MD Postgraduate Year 4 MSc Dalhousie University Nova Scotia, Canada MD McMaster University Ontario, Canada MI HALY KI S , MD Postgraduate Year 4 MD Queen’s University Ontario, Canada6 HALIFAX • DIVISION OF NEUROSURGERY
  • 7. RESIDENTS P HI LI P P E MAG OWN, MD Postgraduate Year 3 MD McGill University Quebec, Canada KHALE D AAL-ALI, MD P Postgraduate Year 3 M MBBS United Arab Emirates University U United AE S E AN BARRY, MD Post Graduate Year 2 MD Dalhousie University Nova Scotia, Canada S I RAJ E DDI N B ELKHAIR MD Post Graduate Year 1 MD Garyounis University Behgahzi, LibyaANNUAL REPORT • 2007 7
  • 8. MESSAGE FROM THE DIVISION HEAD 2007 was a year of significant growth for the Division. New technologies such as the remote presence robotics program, 3D intraoperative imaging using the O-Arm and the establishment of a comprehensive database system for Neurosurgery were added to our neurosurgical infrastructure. These technologies allow us to provide the best care possible to our patients. This goal could only be accomplished by the commitment and dedication of our neurosurgical team that includes professionals in the areas of nursing, information technology, biomedical engineering, neuro-imaging, occupational therapy, research and administration. These individuals push the boundaries in their areas of activity to achieve excellence. Their dedication is reflected in the continued growth of clinical services, research and teaching. This past year the funding for the Life Sciences Research Institute Building was completed and construction is imminent. The Brain Repair Centre signed formal agreements of research collaboration with Harvard University and Cardiff University in the UK. Academic productivity has increased in the number of grants and published papers in the basic and clinical sciences. Our Neurosurgical Residency Training Program has maintained full accreditation by the Royal College of Physicians and Surgeons of Canada. The endeavors of members of the Division have been reflected in the graduation of neurosurgeons who have accepted positions throughout Canada and have tremendous potential to contribute to Canadian neurosurgery. The multidisciplinary approach of the Division has been expanded to reach 27 cross-appointees from all disciplines who provide a full spectrum of expertise to neurosurgical patients. In 2007, six of our senior nurses retired. These dedicated professionals had a combined experience of 112 years of service. We want to pay a special tribute to these individuals who have been crucial members of the neurosurgical team and have provided exemplary patient care with competency and compassion. The Division of Neurosurgery has built a strong platform for continued growth in the coming years and we face the future with optimism. IVAR MENDEZ MD, PhD, FRCSC, FACS8 HALIFAX • DIVISION OF NEUROSURGERY
  • 9. CLINICAL ACTIVITIES ADMISSIONS Total: (1088 adults + 136 pediatric) = 1224 AMBULATORY CARE VISITS Total: (4512 adults + 883 pediatric) = 5395 SURGICAL PROCEDURES Total: (1182 adults + 119 pediatric) = 1301 NEUROSURGERIES 2007 Pediatric Craniotomy 9% 20% Other 26% Va s c u l a r Spine 7% Stereotactic 25% 13%ANNUAL REPORT • 2007 9
  • 11. CLINICAL ACTIVITIES NEUROSURGERY INPATIENT UNIT & AMBULATORY CARE CLINIC Mary Keating The inpatient and ambulatory care units have had a very busy and productive year. Both areas have seen an increase in patient volumes and our very dedicated nursing staff continues to provide excellent care. Our multidisciplinary care team participated in the Canadian Council of Health Services Accreditation, which provided an opportunity for team members to evaluate the quality of our service. As part of this process, areas of improvement were identified and a quality improvement plan was developed for the Neurosurgery service. We look forward to receiving feedback from the Accreditation review team and implementing our plan in 2008. Educational activities continued to expand with 2610 hours of nursing education provided this year. Several staff attended the CANN conference in Edmonton, with Carole-Ann Miller, Specialty Nurse Practitioner, presenting on Carotoid Endarterectomy. As well, Debra Beveridge RN, commenced her year as National President of CANN. Maureen Merchant, Speech Language Pathologist, received a Comfort and Care Grant to develop a communication tool for ventilated patients with tracheostomies was the 1st place winner for her poster “Giving Voice to Patients”. She also presented the “Nursing Dysphagia Protocol” at a conference in November. Kim MacNeil, Occupational Therapist attended the Braintree Conference in Boston. Nursing staff on our inpatient unit received a grant to purchase chair beds allowing family members the opportunity to stay overnight with their loved ones. In 2007, six of our senior nurses retired, their combined time represented 112 years of service. We would like to thank our senior nurses for their years of dedicated service and wish them all the best in their retirement: Margaret Dodsworth, Diane Pottie, Penny Thomas, Patricia Dunn, Elsie Comeau and Penny Mulcahey.ANNUAL REPORT • 2007 11
  • 12. COORDINATORS Back (left to right): R. Murphy, G. Thibault-Halman, C. Roberts, E. Reardon White, L. Fenerty Front (left to right): P. Chiasson, L. Clarke, S. Rahey Missing from photo: S. Nelis PA U L A C H I A S S O N , MSC, OT Neuromodulation Program Coordinator LINDA CLARKE, RN, CNN Brain Tumour Clinical Coordinator Halifax Skull Base Program Coordinator Halifax Neuropituitary Program Coordinator LY N N E F E N E R T Y, R N , C N C C Neuro-Trauma/Injury Prevention Coordinator G I N E T T E T H I B A U LT- H A L M A N , RN Neuro-Trauma Coordinator RALEEN MURPHY, RN Neurosurgery Spine Program Coordinator S U S A N R A H E Y, B S c , R E T, R T ( E M G ) Epilepsy Program Coordinator E L I Z A B E T H R E A R D O N W H I T E , C I T, R N , B A Cerebrovascular Coordinator SHEELAGH NELIS & CARLA ROBERTS Research Assistants12 HALIFAX • DIVISION OF NEUROSURGERY
  • 13. PROGRAMS NEUROMODULATION PROGRAM Paula M. Chiasson Team Members & Collaborators: Dr. Brownstone, Neurosurgeon Sheelagh Nelis, Research Assistant Dr. D. King, Division of Neurology Dr. Mendez, Neurosurgeon Paula Chiasson, Program Coordinator Dr. K. Schoffer, Division of Neurology Dr. I. Beauprie, Anaesthesia DBS for Intractable Depression Group Ron Hill, Technology Coordinator Dr. J. Fisk, Department of Psychology The Neuromodulation program at the QEII is unique to Atlantic Canada and continues to be a national leader in the field of neuromodulation. The overall goal is to provide our patients with treatments that lead to an overall improvement in the quality of their lives. The program includes deep brain stimulation (DBS) for movement disorders such as Parkinson’s disease, essential tremor, multiple sclerosis and dystonia. As well, implantation of spinal cord stimulation (SCS), motor cortex stimulation (MCS) and peripheral nerve stimulation (PNS) systems are used to treat chronic neuropathic pain conditions such as failed back surgery syndrome, angina, occipital neuralgia and complex regional pain syndrome. Advancements in technology have lead to re-chargeable systems that last a minimum of 9 to 10 years, a significant improvement for patients who previously required surgery to replace depleted batteries annually. Rechargeable systems accounted for 35% of all the generators implanted in the past 2 years. New indications for DBS are evolving, and include DBS for refractory depression, a collaborative effort with our colleagues in psychiatry. Multidisciplinary rounds are regularly held to review all neuromodulation patients. Research: There are 616 patients enrolled in our databases; 259 patients in the Movement Disorder database and 357 patients in the Chronic Pain database. Of those, 311 patients have implanted systems and are actively followed by our team members (116 patients DBS systems for movement disorders and 195 patients with systems to treat pain). Follow-up visits and outcome measures are compiled at regular intervals. Each patient has consented to participate in our divisional database with involvement in the National Chronic Pain Database for the Canadian Neuromodulation Society. Patients with complex pain syndromes are seen by both a neurosurgeon and anesthetist in the Multidisciplinary Pain Clinic, alleviating extensive wait time for these patients. Forty-eight new patients from throughout Atlantic Canada were seen in these clinics in 2007, which provides them with efficient care. In 2005 we initiated a blinded multi- centered trial studying the effects of motor cortex stimulation in the treatment of s specific pain syndromes; enrolment continued in 2007. 200 Accomplishments: Acc The QEII neuromodulation team continues to play a leadership role in the Canadian Neuromodulation le Society. At the AGM in 2007, Dr. Ivar Mendez was Soc elected President-elect and Paula Chiasson was ele elected to the Board of Directors, representing ele program coordinators across the country. Dr. Rob pro Brownstone is the President of the Canadian Section Bro of S Stereotactic and Functional Neurosurgery. Dr. I. Mendez, R. Hill, Dr. I. Beauprie, P. Chiasson, Dr. R. BrownstoneANNUAL REPORT • 2007 13
  • 14. PROGRAMS BRAIN TUMOUR PROGRAM Linda Clarke Team Members & Collaborators: Neurosurgeons: Drs. Brownstone, Walling, McNeely, Dr. L. Mulroy, Radiation Oncology Christie, Mendez, Fleetwood, Howes, Holness & Clarke Dr. M. McNeill, Medical Oncology Dr. Kirby, Neurology Marlene Sellon, Pharmacist Linda Clarke, RN, Research Coordinator Colleen Kelly, RN, Radiation Oncology Carole-Ann Miller, Specialty Nurse Practitioner Trudy Gordon, RN, Medical Oncology Dr. R. Macaulay, Pathology & Laboratory Medicine Lynda Eastham, RN, Radiation Oncology Dr. A. Easton, Pathology & Laboratory Medicine Ellen Crawley, RN, Radiation Oncology Dr. D. Rheaume, Radiation Oncology Tara Shaw, RN, Research Coordinator All neurosurgeons are involved in the care of patients with brain and spinal tumours. In addition, the multidisciplinary nature of our program is reflected in the patient management conferences of the Neuro-oncology Site Team of Cancer Care Nova Scotia, chaired by Dr. Brownstone and Dr. Kirby (Neurology). These weekly conferences involve neurosurgeons, medical neuro-oncologists, radiation neuro-oncologists, neuropathologists, nurses, and trainees of each of these disciplines. In addition to patient management recommendations, this team organizes visiting speakers and rounds, and is responsible for the development of clinical guidelines for the management of patients with brain and spinal tumours. Research: • Prospective epidemiology Brain Tumour Database continues: 1800 patients have been entered. 227 patients were entered in 2007 with 171 craniotomies and 32 biopsies performed. The most common diagnosis is malignant glioma with 40 confirmed glioblastoma multiforme patients in 2007. • CE5 - Low Grade Glioma Trial has registered five patients and randomized one. This trial includes registration while the tumour is stable and then randomization to either radiation treatment or chemotherapy with Temozolomide (TMZ) at progression. As part of this trial, team members were involved in the development and implementation of an enhanced quality of life study which looks at the impact of the tumour and its treatment on work-life and significant relationships. • Rescue Trial: A phase II trial of continuous 28/28 days, dose intense TMZ after progression on conventional 5/28 days, TMZ in patients with recurrent malignant glioma. Currently seven patients are enrolled. • XERECEPT – Three patients are enrolled in this Dexamethasone sparing study comparing Human Corticotropin-Releasing Factor (hCRF) to placebo for control of symptoms associated with peritumoural brain edema in patients with malignant brain tumour who require chronic administration of high dose dexamethasone. • IND162- One patient is registered for our newest trial. A Phase I study of Temozolomide and RAD001C (an mTor inhibitor) in patients with malignant glioblastoma multiforme. • 1231-Iodo-Alpha-Methyl Tyrosine SPECT study: Together with Dr. S. Burrell in the Department of Diagnostic Imaging (nuclear medicine), we have funding for a project in which we will use 123IMT to study patients with metastatic brain tumours. We are awaiting approval of the compound, which has not yet been used in Canada. Events & Accomplishments: • Collaboration established with the Cape Breton Cancer Centre for obtaining follow-up information on patients treated at that centre. • Brain Tumour Spring Sprint Fundraiser with 120 participants raised $28,000 • Fourth successful Patient Information Day - over 150 Back (left to right): Dr. D. McNeely, Dr. R. Macaulay, Dr. D. Rheaume, Dr. R. Brownstone, L. Clarke, Dr. R. Reid, Dr. M. MacNeill, Dr. A. Easton. Front (left to right): Dr. R. Holness, Dr. S. Kirby, Dr. S. Walling, C-A. Miller, T. Gordon.14 HALIFAX • DIVISION OF NEUROSURGERY
  • 15. PROGRAMS patients and family members attended with presentations from visiting speakers, Dr. Rolando Del Maestro, Dr. Joseph Megyesi and local speakers, Dr. Ian Fleetwood and Dr. Bruce Crooks. • Private members Motion M-235, introduced by Independent M.P. Bill Casey (Cumberland-Colchester-Musquodoboit Valley) was passed in the House of Commons. This motion stated that “the Minister of Health should continue to work collaboratively with Statistics Canada, the provincial and territorial cancer registries, and key stakeholders towards the ultimate goal of creating uniform national standards and guidelines for the surveillance of all malignant and benign brain tumours, including data collection, analysis and reporting.” The efforts of Jennifer Dempsey, a member of the Canadian Alliance of Brain Tumour Organizations (CABTO), and her son Brandon, a pediatric brain tumour survivor from Amherst NS, need to be acknowledged for spearheading the campaign to introduce and pass this important motion. • Dr. Normand Laperriere, Radiation Oncology, Princess Margaret Hospital Toronto, presented at Neuro-0ncology Grand Rounds and Dr. Sarah Kirby, Linda Clarke and Carole-Ann Miller attended the Society of Neuro-oncology Meeting in Dallas, Texas. • Our neuropathology capabilities were expanded with the introduction of fluorescent in situ hybridization techniques. HALIFAX NEUROPITUITARY PROGRAM Linda Clarke Team Members & Collaborators: Neurosurgeons: Lisa Tramble, RN, Endocrinology Dr. E. Massoud, Otolaryngology Drs. Clarke, Fleetwood & Holness Paula Sinclair, RN, Endocrinology Neuroradiology Dr. A. Imran, Endocrinology Eric Grouse, Pituitary Clinic Coordinator Nova Scotia Eye Centre Dr. E. Ur, Endocrinology Dr. D. Rheaume, Radiation Oncology Linda Clarke, RN, Research Coordinator Dr. L. Mulroy, Radiation Oncology This program, unique in Canada, provides comprehensive care to patients with pituitary and sellar region tumours. Multidisciplinary biweekly clinics that involve collaboration with the Stereotactic Radiosurgery Group, and surgical collaboration with Otolaryngology to develop endoscopic surgery, ensure comprehensive assessment, state of the art treatment and coordinated follow-up. Research: We continue to expand the Neuropituitary Database, with over 500 of the approximately 900 patients we follow now entered. Several research projects are underway: • The role of visual field testing in the follow-up care of patients with pituitary adenomas • Rate of re-growth of non-functioning pituitary adenomas • Visual fields preservation in acromegalic patients treated with Stereotactic Radiotherapy • Short term outcome of stereotactic radiation therapy in patients with acromegaly • Managment of patients with prolactin-secreting adenomas during pregnancy Events & Accomplishments: • Atlantic Endocrine Society Meeting held June 16, 2007 in Wolfville, NS, with a half day focused on the management of pituitary tumours. Dr. David Clarke spoke on “Surgical Approaches to Pituitary Tumours”. • The Halifax Neuropituitary Program (HNPP) Pituitary/Parasellar Tumour Classification system was implemented as a standard evaluation tool. • Endoscopic-assisted transsphenoidal surgery for pituitary and sellar region tumours continues to be developed with the collaboration of Otolaryngology (Dr. E. Massoud). • The Acromegaly Support GroupANNUAL REPORT • 2007 15
  • 16. PROGRAMS facilitated by Lisa Tramble and Paula Sinclair is the only group of its kind in Canada. Held biannually, patients from all of the Maritime Provinces attend. Dr. Clarke spoke at the 2007 spring meeting: “Surgical Management of patients with Acromegaly”. • Extensive revision of our patient database, coordinated by Linda Clarke. Back (left to right): L. Tramble, Dr. L. Mulroy, E. Gross, Dr. D. Rheaume, L. Clarke, P. Sinclair. Front (left to right): Dr. A. Imran, Dr. D. Clarke, Dr. E. Ur. ATLANTIC LATERAL SKULL BASE PROGRAM Linda Clarke Team Members & Collaborators: Neurosurgeons: Linda Clarke, RN, Program Coordinator Jackie Seagers, Clinic Assistant Drs. Walling, Holness, & Fleetwood Belinda Nicoll, Administrative Assistant Dr. D. Rheaume, Radiation Oncology Dr. M. Bance, Otolaryngology Jean Lessell, Administrative Assistant Dr. L. Mulroy, Radiation Oncology Dr. D Morris, Otolaryngology Eleanor Young, Administrative Assistant Nova Scotia Hearing and Speech The Atlantic Lateral Skull Base Clinic is a collaborative initiative bringing together Neurootology (Division of Otolaryngology), Neurosurgery and the Stereotactic Radiotherapy Group. The clinic provides coordinated care to patients with a range of lateral skull base tumours including vestibular schwannomas, other cerebellopontine angle tumours, lesions of the petrous apex and jugular foramen. Patients are carefully followed, and tumours are assessed for growth before intervention. Over 50% of our vestibular schwannomas are treated with a conservative “watchful waiting” approach. When treatment is required, the experts on our teams provide a full range of treatment options, including surgery, and Stereotactic Radiation Therapy (SRT). Monthly clinics are held at the Halifax Infirmary. Regular team meetings provide an opportunity to review patients, discuss the direction of program development and the planning of research initiatives. Research: • The program has established an extensive database capturing approximately 320 patients including 250 patients with vestibular schwannoma. • Vestibular Schwannoma: How Much Residual J. Seagers, Dr. S. Walling, Dr. M. Bance, A. Ho, L. Clarke, Dr. D. Morris16 HALIFAX • DIVISION OF NEUROSURGERY
  • 17. PROGRAMS Hearing is Useful? • Acoustic Neuroma Management: Conservative Management vs. Stereotactic Radiotherapy and Subsequent Hearing Preservation at 6 Months and 1 Year • Hearing Changes in Conservatively Treated Non-Growing Vestibular Schwannoma Patients Events & Accomplishments: • Comprehensive Audiogram database- a unique program to monitor changes in serial hearing evaluations • Revision of the clinic patient assessment tool • Acoustic Neuroma Association of Canada Conference/AGM was held in Halifax, June, 2007 with presentations by Dr. Manohar Bance and other local specialists • Quality of Life assessments introduced to clinic visits assessing hearing, tinnitus and dizziness handicap • Four successful multidisciplinary clinics were held. Patients were seen by the Stereotactic Radiation team as well as Neurosurgery and Neuro-otology in one visit. • Members of the Skull Base Team attended and presented at the 5th International Conference on Vestibular Schwannoma and other CPA lesions in Barcelona Spain, June 2007. NEURO-TRAUMA PROGRAM Lynne Fenerty Team Members & Collaborators: Neurosurgeons: Carla Roberts, Research Assistant Population Health Research Unit Dr. Clarke , Dr. Walling IWK Health Centre Department of Psychology Dr. J. Tallon, Trauma Program NS Rehabilitation Centre Department of Community Health and Lynne Fenerty, Research Manager NS Trauma Program Epidemiology Ginette Thibault-Halman, Emergency Medicine Research Coordinator Critical Care The Neuro Trauma Program is supported by the traumatic brain injury (TBI) database and includes the brain trauma outcomes (BTO) study. We continue to expand our existing programs and wish to acknowledge our ongoing provincial, national and international partnerships as we strive to provide excellence in Neuro Trauma care. Research: TBI database has 497 patients entered to date. The BTO study (prospective arm): Patients with a major head injury (initial GCS 3-12) have been considered for enrollment in the BTO study. Screening and enrollment was complete on June 30, 2007, with 52 patients participating. These patients are examined in follow-up for assessment of qualitative and quantitative outcomes at 6, 12 and 24 months post injury. Scoring and analysis of these outcome scores is underway. Completion of patient follow-up will be in June 2009. The BTO study (retrospective arm): Full data sets and care pathways have been created from multiple sources covering the continuum of brain trauma care. Investigators continue to analyze this large amount of data. Dissemination of this research occurred in 2005, 2006 and 2007. Accomplishments: • The Nova Scotia Head Injury Guideline has been published (Canadian Journal of Surgery) • An article concerning marijuana use and Head Injury is being prepared for publication • Presentation of BTO study was done at the Provincial Trauma Tele-Health Back (left to right): Dr. S. Walling, Dr. J. Tallon, Dr. D. Clarke, L. Fenerty Front (left to right): G. Thibault-Halman, A. Purdy, A. Schappert, K. ButlandANNUAL REPORT • 2007 17
  • 18. PROGRAMS INJURY PREVENTION PROGRAM Lynne Fenerty Team Members & Collaborators: Neurosurgeons: Helmet Safety Action Committee (HSAC) Drs. S. Walling & D. Clarke ThinkFirst/AVIVA Canada Joe Lively, VIP ThinkFirst Nova Scotia Department Health Promotion and Protection Lynne Fenerty, Research Manager Partners in Policing (HRM /RCMP) Ginette Thibault-Halman, Research Coordinator Canadian Paraplegic Association (CPA) Jennifer Roberts, Research Admin. Coordinator IWK Child Safety Link Nova Scotia Trauma Advisory Council (NSTAC) Brain Injury Association of Nova Scotia ( BIANS) We continue to expand the injury prevention program within the Division and wish to acknowledge the strong partnerships that exist in the Nova Scotia Injury Prevention community. Education: The Division hosted Noggin’ Knowledge, an innovative program done in partnership with Police enforcement where an injury prevention session is used as an alternative to paying the summary offence ticket ($135.75) for not wearing a helmet while cycling, skateboarding, rollerblading or using a scooter. Accomplishments: • The Division of Neurosurgery Injury Prevention Program was selected by Health Promotion and Protection to: research sport and recreation activities that are not currently included in the helmet legislation, prepare a policy paper and propose recommendations for Nova Scotians based on currently available research. • The report: “Non-Legislated Sport and Recreation Helmet Policy Paper for Nova Scotia” has been submitted to the department of Health Promotion and Protection. • In partnership with Department of Health, Promotion and Protection implemented helmet rewards, helmets for families of need, Noggin’ Knowledge (Halifax and Antigonish) with the Nova Scotia RCMP and Halifax Municipal Police. • Developed slogan “Helmets work… What a perk!” • Reach of brain and spinal cord injury prevention message for 2007 is estimated at 110,875 people with: ThinkFirst school programs (1800), community/ professional concussion programs (650), community events, displays ( 2075), helmet activities, rewards (5500), helmets to children in need (800), ThinkFirst/AVIVA Float , Parade of Lights (100 000 plus East Link TV coverage). • Secured funding from the Nova Scotia Department of Health Promotion and Protection and ThinkFirst/AVIVA Canada. Back (left to right): W. Jackson, L. MacDougall , J. Bessonette, C. Daniel, J. Roberts. Front (left to right): A. Purdy, K. D. Butland, M. Dauphinee, L. Fenerty, H. McKay, R. Reede, T. Phillips18 HALIFAX • DIVISION OF NEUROSURGERY
  • 19. PROGRAMS NEUROSURGERY SPINE PROGRAM Raleen Murphy Team Members & Collaborators: Neurosurgeons: Drs. Christie, Holness, McNeely, Walling, Howes Dr. W. Oxner and Dr. D. Alexander, Orthopedic Surgery Raleen Murphy, Research Coordinator Chronic Pain Management Ginette Thibault-Halman, Research Coordinator NS Rehabilitation Centre The Neurosurgery Spine Program has experienced further expansion this past year under the direction of Dr. Sean Christie. The team continues to focus its research efforts on improving the care of patients with spine-related pathologies. The complex needs of this diverse and abundant group of patients are addressed by members of the neurosurgery spine program through: • rapid detection of the problem • collaborative decision-making regarding conservative versus surgical treatment options • skilled surgical techniques that minimize trauma to the patient • utilization of a multidisciplinary approach • education about injury and re-injury prevention • close follow-up of post-surgical patients • effective communication between tertiary and primary care providers Research: • The Spine Program was one of the programs chosen to pilot the Divisional database and we began entering patient information this year. formation year • We continue to screen patients with odontoid fractures for enrollment in the study “Management of Type II Odontoid Fractures: A Prospective Randomized Comparison of Primary Anterior Screw Fixation Versus Halo Vest Immobilization” • We are undergoing research ethics approval for the collection of data for the Rick Hansen Spinal Cord Injury Registry Accomplishments: A Grant monies were awarded to the Spine G Program to: P • purchase a bladder scanner for the in-patient unit. A small research project is to be carried u out to determine the scanner’s effect on rates of o urinary tract infection and catheterization in our u spinal cord injury population s • create an information website for spine patients as part of the Improving Nursing p Practice Grant P • develop research projects focusing on minimally invasive spine surgeries mANNUAL REPORT • 2007 19
  • 20. PROGRAMS EPILEPSY PROGRAM Susan Rahey Team Members & Collaborators: Neurosurgeons: Drs. Clarke, Brownstone, McNeely, Howes Shirley Munk, Psychometrist Dr. M. Sadler, Neurologist Biomedical Engineering Susan Rahey, Coordinator Social Work EEG Technologists Neuroradiology Dr. J. McGlone, Neuropsychologist The Epilepsy Program is a collaborative service supported by the Divisions of Neurology and Neurosurgery. Epilepsy patients have access to comprehensive care including: • specialty outpatient clinic which includes support from Psychology, Psychiatry, and Social Work • two bed inpatient Video-EEG Telemetry monitoring unit (including use of invasive techniques) • surgical techniques ranging from cortical resection, lesionectomy, corpus callosotomy to vagus nerve stimulator implantation Research: Team members are engaged in clinical research, including trials of investigational drugs. Dr. Sadler is the PULSE Study (a primarily European trial of Vagus Nerve Stimulation) National Coordinator for Canada. The local team includes Dr. David Clarke and Susan Rahey. Accomplishments: During the 2007 calendar year: • over 600 patients were seen in the Epilepsy outpatient clinic • there were 40 admissions to the Video-EEG Telemetry Monitoring Unit (including 5 admissions for invasive recording) • 16 patients benefited from epilepsy surgical procedures (including resections and vagus nerve stimulator implants). • educational opportunities were made available to community groups, nursing, technical and medical students and staff and to colleagues attending various national meetings Back (left to right): R. Hill, C. Roberts, P. Godwin, Dr. B. Pohlmann-Eden, S. Rahey, M. Whitehead, Dr. D. McNeely. Front (left to right): Dr. R. Brownstone, Dr. D. Clarke, Dr. W. Howes, Dr. M. Sadler.20 HALIFAX • DIVISION OF NEUROSURGERY
  • 21. PROGRAMS CEREBROVASCULAR SURGERY PROGRAM Elizabeth Reardon White Team Members & Collaborators: Neurosurgeons: Dr. G. Gubitz, Neurologist Dr. R. Vandorpe, Neuroradiologist Drs. Fleetwood, Holness, Clarke, Howes Dr. S. Phillips, Neurologist Dr. E. Versnick, Neuroradiologist Elizabeth Reardon White, Research Coordinator Dr. D. Kydd, Neuroradiologist Carole-Ann Miller, Specialty Nurse Practitioner Dr. W. Maloney, Neuroradiologist Halifax is the referral centre for the treatment of cerebrovascular disorders in Atlantic Canada with extensive experience in surgical and endovascular management of aneurysms and arteriovenous malformations (AVM), and the only centre with a stereotactic radiosurgery program for the treatment of AVMs. The cerebrovascular team, directed by Dr. Ian Fleetwood, meets weekly to review clinical cases from all of the Atlantic Provinces, and discuss recommendations for a multidisciplinary evidence-based approach to patient care. Research: We have had an active year in research: • CONSCIOUS-2 for the prevention of cerebral vasospasm after aSAH was submitted to the REB for review. • STASH - Simvastatin in aneurysmal subarachnoid haemorrhage for the prevention of cerebral vasospasm was approved by the REB and will open to enrollment in 2008. • The 3 year follow-up study ISUIA III (International Study of Unruptured Intracranial Aneurysms) was completed, and the results will be released in 2008. We also have several ongoing local research projects and presented platform presentations at the Canadian Neurological Sciences Federation Meeting and the European Stroke Conference: • SCECH-2 regarding the timing of carotid endarterectomy (Dr. Harraher, Resident) • Long Term Non-Operative Mortality Among Patients Who Had Carotid Endarterectomy (Dr. Belkhair, Resident) • Analysis of the Role of Lumbar Puncture in the Diagnosis of Subarachnoid Hemorrhage (Natalie Parks, medical student) Presentations: Dr. Fleetwood delivered educational presentations in 2007 at the National Stroke Conference, Canadian Stroke Review Course for Residents, Canadian Neurological Sciences Federation Meeting, Cape Breton Stroke Conference and Atlantic Clinical Neurosciences Society addressing management of carotid artery stenosis, intracerebral hemorrhage, subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Events & Accomplishments: The focus of the 2007 Atlantic Clinical Neurosciences Society meeting was controversies in the management of cerebrovascular disorders. Cerebrovascular and stroke nurse practitioners and research coordinators were invited to this event for the first time. The Brain Aneurysm Support Group has been meeting regularly since October 2006. This group has been developed as an opportunity to share information, give and receive emotional support, educate each other, identify needs and access resources. Members have enjoyed several guest speakers, including, Dr. Ian Fleetwood, Dr. David Kydd, and Dr. Sherri Carter. Te Support Group is a significant addition to our program and serves as an invaluable resource to patients. The endovascular waitlist has been greatly reduced as a result Back (left to right): Dr. E. Versnick, Dr. W. Howes, Dr. I. Fleetwood, Dr. W. Maloney, Dr. D. Kydd, Dr. of additional anesthesia time. R. Vandorpe. Front (left to right): Dr. G. Gubitz, E. Reardon White, Dr. S. Phillips.ANNUAL REPORT • 2007 21
  • 24. PROGRAMS PEDIATRIC NEUROSURGERY Dr. Dan McNeely Dr. W.J. Howes - Chief, Pediatric Neurosurgery Dr. P.D. McNeely Dr. S. Walling We have continued to offer a strong neurosurgery presence at the IWK Health Centre in 2007, with 136 admissions and 883 outpatient visits. In addition to the general pediatric neurosurgery outpatient clinics, we have continued to participate in the following “thematic” multi-disciplinary clinics: Craniofacial Clinic: We have held these clinics on a quarterly basis in conjunction with Dr. Craig Hurst from the Division of Plastic Surgery. Brain Tumour Clinic: These clinics occur twice a month. Also participating are Drs. Bruce Crooks & Peggy Yhap from Pediatric Hematology Oncology, Dr. Rob Rutledge (Radiation Oncology), and Dr. David Gaskin (Neuropathology). Nurse- coordinators Ann Chapman and Irene Spares have continued to play invaluable roles in the smooth running of these clinics. Spina Bifida Clinic: These clinics are held twice a month. Patients are seen by Pediatric Orthopedics (Drs. Leahy, Hyndman, and Cook), and Pediatric Urology (Drs. Anderson, Schwartz, and McLellan) in addition to all of the allied health services. Spasticity Clinic: This was a new initiative in 2007. We have collaborated with Dr. Ellen Wood (Pediatric Neurology) and Dr. Ron El-Hawary (Pediatric Orthopedics) in seeing patients in a combined setting. We are optimistic that this service will enhance the care to our patients who suffer from spasticity from a variety of causes. Colleen O’Toole, RN and Kim Fraser, LPN both continue to assist C us in particular with the general pediatric neurosurgery clinics, the u Craniofacial Clinic, and the Spina Bifida Clinic. C We have enjoyed an ongoing collaboration with Dr. Peter Camfield W in the surgical management of patients with medically refractory i epilepsy. Another important collaboration is with Dr. Naeem Khan, e neuroradiologist who has continued to work towards improving the n quality of imaging available to our pediatric patients. We expect to q have capability for diffusion tensor imaging available at the IWK in h the near future. t Renovations in the pediatric operating rooms began in June 2007 and are therefore currently well underway. This has meant that a much of our equipment has been stored in temporary carts and in m the hallways of the OR. We are looking forward to having our new t “integrated” operating room in the spring of 2008. We were also “ quite pleased to take delivery of the AxiEM electromagnetic image q guidance system in September of 2007. This purchase was made g possible by a generous gift from Brainchild – a group of parents/ p families who have shared the common experience of caring for a f child with a brain or spinal cord tumour. c24 HALIFAX • DIVISION OF NEUROSURGERY
  • 25. BRAIN REPAIR CENTRE HIGHLIGHTS FROM THE BRAIN REPAIR CENTRE (BRC) Lorne Ferguson Division of Neurosurgery BRC members: Dr. Mendez (chair), Dr. Brownstone and Dr. Clarke This past year saw several new faces join the BRC: Dr. Jim Fawcett, Canada Research Chair in Molecular Neurobiology of Brain Repair; Mr. Lorne Ferguson, Executive Director Brain Repair Centre; Dr. Harold Robertson, Director of Research and Chair of the Research and Education Committee and the External Scientific Advisory Committee; Ms. Lynn McKenna, Administrative Assistant; Bruce Brown, Project Manager, Atlantic Innovation Fund Atlantic Innovation Fund Round III – Building Research and Commercialization Capacity This $3 million three-year project started and is now well under way. The overall goal of the present project builds on the experience of the Brain Repair Centre Team in cell restoration strategies to enhance scientific research and bench-to- bedside translation of brain repair therapies to treat incurable neurological diseases and injury in Atlantic Canada. This goal will be achieved in three complementary phases: 1) Building research capacity and knowledge for brain repair; 2) Building research infrastructure with state-of-the art equipment; and 3) Building research infrastructure with the creation of a state-of-the art research facility. Each of these achievements will enhance the research capacity in Atlantic Canada to attract research personnel, national and international collaborations, and commercialization potential. Canadian Foundation for Innovation - Brain Repair Centre: An integrative approach to functional restoration Led by Dr. Rob Brownstone, this $5.5 million project is in the first year of implementation. This award will provide support for facilities and compliment the establishment of the Life Sciences Research Institute (LSRI). Specific infrastructure will include: imaging, confocal microscopy and stereology, a real-time mass spectrometer, and a fluorescence-activated cell sorter. Facilities will include general and transgenic animal care, cell and tissue culture and molecular biology support. This important new infrastructure will enable BRC researchers and collaborators to take concepts from the clinic to the laboratory, and then translate discoveries to the treatment of people with often devastating neurologic disorders. Life Sciences Research Institute: The ongoing work of the BRC, spearheaded by, Dr. Ivar Mendez, means that the vision of building a new LSRI is now about to become a reality. With the confirmation of $15 million from the federal government, close to $42 million for this research and commercialization facility has been raised. As a result, on October 19th Dr. Ivar Mendez, Premier Rodney MacDonald, Minister Peter MacKay and Dr. Tom Traves officially announced the LSRI’s construction phase, with a “virtual” ground breaking ceremony held at the Sir Charles Tupper Medical Research building. The LSRI will be a world-class physical infrastructure with state-of-the-art equipment, laboratories and facilities which will expand research collaborations and scientific capacity, industry partnerships and investment. As a strategic partnership of Dalhousie University, CDHA and the IWK, the BRC will be the anchor tenant of the LSRI. BRC Achievements to Date The BRC’s membership has grown and now includes 20 Dalhousie, CDHA and IWK researchers and clinicians; BRC researchers have developed over 200 research collaborations locally, nationally and internationally. Over the past five years the BRC has attracted over $60 million in new research and development funding. L. Ferguson, B. Brown, J. Tusia, L. McKennaANNUAL REPORT • 2007 25
  • 26. TECHNOLOGY PROGRAMS TECHNOLOGY PROGRAM Ron Hill Neurosurgery continues to enhance our service with advances in technology. Our most recent contribution of an intra-operative fluoroscope, “O-Arm” is capable of producing CT- like 3D images. The addition of 3-Dimensional imaging in the operating suite improves visualization of the spine and has enhanced our minimally invasive program. In addition, the ability to integrate Image Guided Surgical planning and traditional instrumentation techniques now enables us to perform complex procedures with greater accuracy, and at the same time reduce radiation to the patients and staff. Automated Micro Injector We continued our development of the Automated Cell Injector with Nova Scotia Community College (NSCC). The bulk of the design and construction was completed by students at the community college in the spring of this year. Overall mechanical and electrical systems were streamlined and a touch panel display was added for ease of use. In the fall, a post doctoral fellow was hired to refine the electronic and programmed interface. Dr. Murray Hong and Ron Hill continue with refinement of the mechanical design. Final development and lab testing is scheduled for 2008. Robotics Our Robotics Program continued to expand and, in early in 2007, we acquired the first remote presence robot in Canada. This is now working in the Halifax Infirmary and is used primarily for patient consultation by the surgeons when they are unable to be at the bedside personally. Reception by the patient population has been very positive and it is becoming a familiar “face” on the floor. The second robot was provided by Joe Shannon, of Shannex Inc., to extend the reach of the Halifax specialist into Cape Breton. This robot is in the emergency department of the Cape Breton Regional Hospital.26 HALIFAX • DIVISION OF NEUROSURGERY
  • 27. RESEARCH ACTIVITIES MESSAGE FROM THE DIRECTOR OF RESEARCH Dr. Robert Brownstone As can be seen in the pages of this Annual Report, research in the Division of Neurosurgery continues to flourish. This is in large part due to the “culture of research” engrained in our Division. Our productivity in 2007 includes papers in wide-ranging fields, including basic science, clinical studies, ethics, and the history of neurosurgery. Productivity within the three basic science laboratories in the division continues to increase, reflected by an increase in the number and value of external peer-reviewed grants. The collaborations developed with basic scientists have been fruitful. Together, we provide an excellent, broad-based research training environment which includes a range of undergraduate and graduate students, as well as post-doctoral fellows. Funds have been obtained to build the Life Sciences Research Institute, with construction expected to start in 2008. This new institute, a joint effort of Dalhousie University, Capital Health, and the IWK-Grace Hospital and located on the Faculty of Medicine campus, will include a new Animal Care facility and several Brain Repair Centre laboratories. The development of this new building was spearheaded by the Brain Repair Centre, with funds obtained from private donors and the provincial and federal governments. Some of the funds from our recently-awarded Canadian Foundation for Innovation grant will be used for building “fit-up,” with the remaining being used to obtain new state-of-the-art equipment for our research programs. The clinical research projects could not be accomplished in the absence of the support from our research coordinators and biomedical technology coordinator. Each of these individuals, highlighted on these pages, has been responsible for the necessary vigilance in collecting clinical data. There is little doubt that our clinical research output will continue to expand in the coming years. We are looking forward to another productive year in 2008.ANNUAL REPORT • 2007 27
  • 28. RESEARCH ACTIVITIES MOTOR CONTROL LABORATORY Sir Charles Tupper Building Dalhousie University www.motorcontrol.med.dal.ca Robert M. Brownstone, MD, PhD, FRCSC The goal of the lab is to identify the mechanisms by which the nervous system controls movement, in particular locomotion. Diverse approaches are used to study brain stem and spinal cord networks. To do this, we use electrophysiology, two photon microscopy/calcium imaging, anatomy, molecular biology and computer modeling techniques. The main areas of focus are: 1. Regulation of motoneuron properties (funded by CIHR, NSHRF, and Project A.L.S.) 2. Functional analysis of defined spinal interneurons (funded by CDRF and CIHR) 3. Function of embryonic stem cell-derived motoneurons (funded by Project A.L.S.) Back (left to right): P. Mitra, F. Bretzner, R. Browntone, A. Alcos, T. Bui. Front (left to right): N. Farbstein, B. Roy, J. Strong Misssing from photo: J. Wilson, D. Yohn, M. Gilmour, E. Thompson, A. Musca, J. Hegedus Post-Doctoral fellows: Graduate Student: Underergraduate Research Technicians: Gareth Miles, PhD Damien Yohn (MSc) Students: Angelita Alcos Pratip Mitra, PhD Megan Gilmour, BSc Nadia Farbstein Frederic Bretzner, PhD Elizabeth Thompson, Batika Roy Tuan Bui, PhD BSc Jennifer Wilson, PhD Jennifer Strong, BSc Janka Hegedus, PhD Angela Musca, BSc28 HALIFAX • DIVISION OF NEUROSURGERY
  • 29. RESEARCH ACTIVITIES NEURAL TRANSPLANTATION LABORATORY Sir Charles Tupper Building Dalhousie University www.neuraltransplantation.dal.ca Ivar Mendez, MD, PhD, FRCSC Projects: 1. Stereological assessments of transplanted human neural precursor cells for spinal cord injury and Parkinson’s disease 2. Effects of serotonergic cells on the efficacy of neural transplantation strategies for Parkinson’s disease 3. Optimal timing of transplantation in cell restoration strategies for Parkinson’s disease 4. Strategies to improve transplanted fetal dopaminergic cell survival in cell restoration strategies for Parkinson’s disease 5. Neural transplantation for Parkinson’s disease 6. Transplantation of neural precursor cells for traumatic spinal cord injury 7. Neural precursor cell transplantation strategies for Parkinson’s disease and spinal cord injury Back (left to right): S. Nelis, R. Hill, T. Vukoja, G. McMullin, M. Gibberd Middle (left to right): M. Quinn, C. Haughn, R. Ulalia, B. Barro, R. Thompson, M. Yorke Front (left to right): D. Sadi, I. Mendez, P. Chiasson, K. Mukhida Graduate Student: Undergraduate Students: Research Technicians: Karim Mukhida (PhD) Christopher Haughn, BSc Damaso Sadi Gillian McMullin, BSc Ruperto Ulalia Timothy Phillips, BSc Matthew Quinn, BSc Brett Barro, BSc Robert Thompson, BScANNUAL REPORT • 2007 29
  • 30. RESEARCH ACTIVITIES NEURON SURVIVAL AND REGENERATION LABORATORY Sir Charles Tupper Building Dalhousie University David B. Clarke, MDCM, PhD The Neuron Survival and Regeneration Laboratory focuses on understanding the neuronal response and developing strategies aimed at enhancing the survival and regeneration of injured neurons. Projects are funded by CIHR, NSERC and NSHRF. Projects: 1. The effects of altering heat shock protein expression on neuron survival and regeneration 2. The role of the neural cell adhesion molecule in central nervous system neuron survival and axonal plasticity 3. Activation and characterization of neural precurser cell populations in the adult mammalian eye 4. Mammalian Muller glia up-regulation of progenitor and neuronal phenotypes Back: Dr. Clarke Front (left to right): M. Luke, A. Davies, T. Chase Post Doctoral Fellows: Graduate Students: Undergraduate Students: Research Technicians: Brent McGrath, PhD. Phil Nickerson (PhD) Andrew Schappert, BSc Margaret Luke Teena Chase, Ph.D. Jeremy Murphy (PhD) Jenna Shand, BSc Tanya Myers Anna Davies, BSc (Hon.) Wilson Wong, BSc30 HALIFAX • DIVISION OF NEUROSURGERY
  • 31. RESEARCH FUNDING ESTIMATED TOTAL FUNDING 2007 = $ 7 344 962 Note: This total represents an estimated total funding for one year Principal Investigator: R Brownstone (Co-investigators: I. Mendez, V. Rafuse, J. Fawcett, H. Robertson, G. Robertson) Agency: Canadian Foundation for Innovation Title: Brain Repair Centre: An integrative approach for functional restoration Date: 2007 - 2010 Amount: $13 943 657 Co- Principal Investigator: R. Brownstone Agency: Project A.L.S. Title: Genetic and physiological analysis of cholinergic synapses on motoneurons: a “synaptic stripping” hypothesis for ALS Date: 2007 - 2009 Amount: $80 000 Principal Investigator: R. Brownstone Agency: Canadian Institute of Health Research Title: Control of Movement: The role of V2 interneurones in locomotion Date: 2006 - 2009 Amount: $351 400 Principal Investigator: R. Brownstone Agency: Canadian Institute of Health Research Title: Control of Movement: Regulation of Motoneurone Excitability Date: 2005-2010 Amount: $553 110 Principal Investigator: R. Brownstone Agency: Christopher and Dana Reeve Foundation Title: Functional Characterization of Identified Spinal Cord Interneurons Date: 2005-2007 Amount: $193 141 Principal Investigator: R. Brownstone Agency: Project A.L.S. Title: Physiology and function of ES cell derived motor neurons Date: 2007-2009 Amount: $80 000 Co- Investigator: R. Brownstone (P.I.: S. Burrell) Agency: Nova Scotia Health Research Foundation Title: 1231-Iodo-alpha-Methyl Tyrosine SPECT: a new method for evaluation of brain metastases Date: 2005-2008 Amount: $146 466 Principal Investigator: R. Brownstone Agency: Nova Scotia Health Research Foundation Title: Modulation of the electrical properties of motoneurones Date: 2004-2007 Amount: $124 093ANNUAL REPORT • 2007 31
  • 32. RESEARCH FUNDING Co- Investigator: R. Brownstone (K. Semba & 8 other investigators) Agency: Canadian Institute of Health Research Title: Technical support for maintenance of multi-user microscopy and digital imaging facility Date: 2004-2007 Amount: $75 212 Principal Investigator: S. Christie Agency: Medtronic Sofamor Danek Title: Statistical Development of Spinal Research Protocols Date: 2007 Amount: $14 500 Principal Investigator: S. Christie Agency: Canadian Paraplegic Association (Nova Scotia) Title: Use of a Bladder Scanner in the Management of Neurogenic Bladder Secondary to SCI Date: 2007 Amount: $10 000 Principal Investigator: S. Christie Agency: Rick Hansen Wheels in Motion Title: Prospective Database of Acute Spinal Cord Injuries in Nova Scotia Date: 2007 Amount: $24 066 Principal Investigator: D. Clarke (with J. Tallon) Agency: Nova Scotia Health Research Foundation Title: Brain trauma outcomes in Nova Scotia Date: 2003-2007 Amount: $150 000 Co- Investigator: D. Clarke Agency: Canadian Institute of Health Research Regional Partnership Title: The role of heat shock protein 27 in the survival and regeneration of adult aging rodent retinal ganglion cell Date: 2006-2008 Amount: $265 680 Co- Investigator: D. Clarke (P.I.: Dr. Gail Eskes) Agency: Capital Health Research Fund Title: Development of presurgical functional MRI protocol for mapping sensorimotor and language regions: a pilot study Date: 2006-2007 Amount: $15 000 Principal Investigator: D. Clarke Agency: Natural Sciences and Engineering Research Council Title: Influence of cell adhesion molecules on neuron survival and plasticity I the adult central nervous system Date: 2006 - 2010 Amount: $132 500 Principal Investigator: I. Mendez (Co-investigators: R. Brownstone, H. Robertson, S. Barnes) Agency: Atlantic Innovation Fund Title: Development of stem cells for brain repair Date: 2004-2007 Amount: $2 100 00032 HALIFAX • DIVISION OF NEUROSURGERY
  • 33. RESEARCH FUNDING Principal Investigator: I. Mendez (Co-investigators: R. Brownstone, D. B. Clarke) Agency: Atlantic Innovation Fund Title: Brain Repair Centre, stem cells for brain repair Date: 2006-2010 Amount: $3 000 000 Principal Investigator: I. Mendez Agency: National Centres of Excellence, Stem Cell Network Title: Stem Cells for the Treatment of Parkinson’s Disease Date: 2005-2007 Amount: $457 000 Principal Investigator: I. Mendez Agency: UK Parkinson’s Foundation Title: Preparation of Cells for Transplantation in Parkinson’s Disease Date: 2007 Amount: $119 509 Principal Investigator: S. Walling Agency: Office of Health Promotion and Protection Nova Scotia Title: Injury Prevention Date: 2007 Amount: $61 000 Principal Investigator: S. Walling (L. Fenerty) Agency: ThinkFirst/Aviva Canada Title: Injury Prevention Date: 2007 Amount: $8000 Principal Investigator: S. Walling (L. Fenerty) Agency: Rick Hansen Foundation/Canadian Paraplegic Association Title: Spinal Cord Injury Prevention Date: 2007 Amount: $3474ANNUAL REPORT • 2007 33
  • 34. PUBLICATIONS ARTICLES Alemdar, A.Y., Sadi, D., McAlister, V. and Mendez, I. (2007) Intracerebral co-transplantation of liposomal tacrolimus improves xenograft survival and reduces graft rejection in the hemiparkinsonian rat. Neuroscience; 146: 213-224. Al-Mosawie, A., Wilson, J. M. and Brownstone, R. M. (2007) Heterogeneity of V2-derived interneurons in the adult mouse spinal cord. European Journal of Neuroscience, 26:3003–3015. Borgal, L., Hong, M., Sadi, D. and Mendez, I. (2007) Differential Effects of Glial Cell Line-Derived Neurotrophic Factor on A9 and A10 Dopamine Neuron Survival In Vitro. Neuroscience; 147: 712-719. Brownstone, R. M. and Wilson, J. M. (2007) Strategies for delineating spinal locomotor rhythm generating networks and the possible role of Hb9 interneurons in rhythmogenesis. Brain Research Reviews (In Press). Brownstone, R. M. (2007) Take your PIC: motoneuronal persistent inward currents may be somatic as well as dendritic (editorial). Journal of Neurophysiology; 98:579-580. Hebb, M. O., Chiasson, P., Lang, A. E., Brownstone, R. M., Mendez, I. (2007) Sustained relief of dystonia following cessation of deep brain stimulation. Movement Disorders; 22:1958-62. Hebb, M. O., Clarke, D.B. and Tallon, J.M. (2007) Development of a population-based guideline for the acute management of adult and pediatric patients with isolated head injuries. The Canadian Journal of Surgery; 50 (3):187-194. Hebb, M. O., McArthur, D. L., Alger, J., Etchepare, M., Glenn, T. C., Bergsneider, M., Martin, N., Vespa, P.M. (2007) Impaired percent alpha variability on continuous electroencephalography is associated with thalamic injury and predicts poor long-term outcome after human traumatic brain injury. Journal of Neurotrauma; Apr; 24(4):579-90. Imran, S. I., Clarke, D.B., Ur, E. (2007) Managing prolactin-secreting adenomas during pregnancy. Canadian Family Physician; 53:653-658. Master, Z., McLeod, M., and Mendez, I. (2007) Benefits, risks and ethical considerations in translation of stem cell research to clinical applications in Parkinson’s Disease. Journal of Medical Ethics; 33:169-73 Mendez, I. and Mukhida, K. (2007) In Memoriam: Dr. W.D. Stevenson 1913-2006: Atlantic Canada’s pioneer neurosurgeon. Canadian Journal of Neurological Sciences; 34: 259. Mislow, J. M. K., Proctor, M. R., McNeely, P. D., Greene, A.K., Rogers, G.F. (2007) Calvarial defects associated with neurofibromatosis type 1. Journal Neurosurgery; 106:484-489. Miles, G., Hartley, R., Todd, A. J., Brownstone, R. M. (2007) Spinal cholinergic interneurons regulate the excitability of motoneurons during locomotion. Proceedings of the National Academy of Sciences; USA. 104:2448-53. Mukhida, K., Baghbaderani, B. A., Hong, M., Lewington, M., Phillips, T., McLeod, M., Sen, A., Behie, L. A., Mendez, I. Survival, differentiation and migration of bioreactor-expanded human neural precursor cells in a rat model of Parkinson’s disease. Neurosurgical Focus (In Press). Mukhida, K., Mendez, I., McLeod M., Kobayashi N., Haughn C., Milne B., Baghbaderani B., Sen A., Behie L.A., Hong M. (2007) Spinal GABAergic Transplants Attenuate Mechanical Allodynia in a Rat Model of Neuropathic Pain. Stem Cells; 25:2874-2885. Mukhida, K., and Mendez, I. (2007) W.D. Stevenson: Atlantic Canada’s first neurosurgeon. Canadian Journal Surgery; 50: 485-489. Murphy, J. A., Franklin, T. B., Rafuse, V.F., Clarke, D.B. (2007) The neural cell adhesion molecule is necessary for normal adult retinal ganglion cell number and survival. Molecular and Cellular Neuroscience; 36:280-292. Murphy, J. A., Nickerson, P.E.B., Clarke, D.B. (2007) Injury to retinal ganglion cell axons increases polysialylated neural cell adhesion molecule (PSA-NCAM) in the adult mouse superior colliculus. Brain Research; 1163:21-32. Nickerson, P.E.B., Emsley, J.G., Myers, T., Clarke, D. B. (2007) Proliferation and Expression of Progenitor and Mature Retinal34 HALIFAX • DIVISION OF NEUROSURGERY
  • 35. PUBLICATIONS Phenotypes in the Adult Mammalian Ciliary Body following Retinal Ganglion Cell Injury. Investigative Ophthalmology and Visual Science; 48:5266-5275. Wilson, J. M., Cowan, A., Brownstone, R. M. (2007) Heterogeneous electrotonic coupling and synchronization of rhythmic bursting activity in mouse Hb9 interneurons. Journal of Neurophysiology 98; 2370–2381. Wilson, J.M., Dombeck, D. A., Diaz-Rios, M., Harris-Warrick, R. M., Brownstone, R. M. (2007) Two-photon calcium imaging of network activity in XFP expressing neurons in the mouse. Journal of Neurophysiology; 97:3118-25. ABSTRACTS Bashor D. P., and Brownstone, R. M. (2007) One clock produces alternating flexion and extension: further models of one leg walking. Society for Neuroscience Abstract; 925.2 Boulton, P. G., Easton, A. S., Clarke, D.B. (2007) A supratentorial primitive neuroectodermal tumor (PNET) in an adult male, Canadian Journal of Neurological Sciences; 34(No.2):S56. Chase, T., Luke, M. P., Clarke, D.B. (2007) Gene expression and RNAi mediated silencing of hsp27 in retinal ganglion cells, Society for Neurosciences Abstract; 377.2. Fleetwood, I.G., Clarke, D.B., Clarke, L., Imran, S.A., Ur, E., Rheaume, D.E., Mulroy, L.A. (2007) Visual fields are preserved in acromegalic patients treated with SRT, Canadian Journal of Neurological Sciences; 34(No.2):S9. Harraher, C.D., Dawson, C., Fleetwood, I.G., Gubitz, G.J., Phillips, S.J., MacKean, G. Expediting carotid endarterectomy via a rapid access neurovascular clinic. (2007) Canadian Journal of Neurological Sciences; 34(Suppl 2): S30. Harraher, C.D., Dawson, C., Fleetwood, I.G., Gubitz, G.J., Christian, C., MacKean, G., Phillips, S.J. (2007). The challenge of timely carotid endarterectomy for women with symptomatic carotid stenosis. Cerebrovascular Disease; 23(suppl 2): 52. Mukhida, K., Hong, M., McLeod, M., Miles, G., Kobayashi, N., Bahgdaderani, B., Sen, A., Behie, L., Brownstone, R. M., and Mendez, I. (2007) Enhancement of sensorimotor behavioural recovery in parkinsonian rats with a multitarget basal ganglia dopaminergic and GABAergic transplantation strategy. Canadian Journal Neurological Society Abstract; H-06 (Suppl. 2):S24. Murphy, J. A., Clarke, D. B. (2007) Target Tissue Supports the Survival of Adult Retinal Ganglion Cells in NCAM -/- Mice. Investigative Ophthalmolology Visual Science; 48: E-Abstract 231. Nickerson, P. E. B., Da Silva, N., Myers, T., Clarke, D. B. (2007) Growth factor responsiveness in cultured Müller glia: implications for neurogenesis in the adult mammalian retina, Society for Neurosciences Abstract; 455.5. Windisch, B. K., Archibald, M. L., LeVatte, T. L., Chase, T., Clarke, D. B., Chauhan, B. C. (2007) Retinal Ganglion Cell Loss and Heat Shock Protein 27 and 72 Induction After Acute Intraocular Pressure Elevation in Rats. Investigative Ophthalmolology Visual Science; 48: E-Abstract 4364. Yohn D. C., Miles G. B., Rafuse V. F., Brownstone R. M. (2007) Embryonic stem cell-derived motoneurons implanted into adult mouse tibial nerve form robust motor units and attenuate denervation-associated atrophy. Society for Neurosciences Abstract; 290.7. Zagoraiou L., Miles G. B., Martin J. F., Brownstone R. M., Jessell T. M. (2007) Genetic identification and physiological analysis of V0c cholinergic interneurons in mouse spinal cord. Society for Neuroscience Abstract; 188.9.ANNUAL REPORT • 2007 35
  • 36. PRESENTATIONS Centre National de la Recherche Scientifique, Université René Descartes Paris V, Paris. “Genes, dyes, and light: Toward understanding neurons and networks involved in the generation of rhythmic movement”. Dr. R. Brownstone Laboratoire Plasticité et Physio-Pathologie de la Motricité (P3M), CNRS & Université de la Méditerranée, Marseille, France. “Shedding some light on spinal cord networks.” Dr. R. Brownstone Biozentrum University of Basel, Basel, Switzerland. “Motoneuron inputs during fictive locomotion.” Dr. R. Brownstone Scuola Internazionale Superiore di Studi Avanzati / International School for Advanced Studies, Trieste Italy. “Dissecting rhythm generating networks in the lumbar spinal cord.” Dr. R. Brownstone Dalhousie University, Department of Medicine (Geriatrics) Grand Rounds. Halifax, NS. Balloon Kyphoplasty for the Treatment of Vertebral Compression Fractures. December 2007. Dr. S. Christie Dalhousie University Department of Surgery (Orthopaedics) Grand Rounds. Halifax, NS. Future Treatment Options for Symptomatic Vertebral Compression Fractures. November 2007. Dr. S. Christie Dalhousie CME lecture given in Amherst, NS. Assessing and Clearing the Injured Cervical Spine. October 2007. Dr. S. Christie The 6th Cape Breton Neurology Review. Sydney, NS. Management of Common Spinal Cord Diseases in the Office and the ER. September 2007. Dr. S. Christie The 42nd Annual Congress of the Canadian Neurological Sciences Foundation. Edmonton, AB. Spine Course: The Triage and Management of the Cervical Spondylotic Myelopathy Patient. Role of Minimally Invasive Techniques in Treating Cervical Stenosis. June 2007. Dr. S. Christie The 23rd Annual Meeting of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves as part of the Special Course: Care of Post-Operative Spinal Fusion. Phoenix, AZ. Spinal Fusion: Postoperative Complication Awareness and Avoidance. March 2007. Dr. S. Christie The “Osteo Club”. Dartmouth, NS. Balloon Kyphoplasty. February 2007. Dr. S. Christie Atlantic Endocrine Society Annual Meeting, Wolfville, Nova Scotia. Surgical Approaches to Pituitary Tumors. June 2007. Dr. D.B. Clarke Acromegaly Support Group Meeting, Halifax, Nova Scotia. Surgical management of patients with Acromegaly, May 2007. Dr. D.B. Clarke Grand Rounds, Department of Medicine, Dalhousie University, Pituitary Emergencies. March 2007. Dr. D.B. Clarke Halifax Brain Tumour Information Day. Halifax, NS. Stereotactic Radiation for Benign Tumours: Acoustic Neuroma, Meningioma and Pituitary Adenoma. November 2007. Dr. I. Fleetwood Cape Breton Stroke Conference. Sydney, NS. Cerebral Hemorrhage Update. September 2007. Dr. I. Fleetwood National Stroke Conference. Calgary, AB. Subarachnoid Hemorrhage Workshop. September 2007. Dr. I. Fleetwood National Stroke Conference. Calgary, AB. Emergency Room Diagnosis of Subarachnoid Hemorrhage. September 2007. Dr. I. Fleetwood 42nd Congress of the Canadian Neurological Sciences Federation. Edmonton, AB. What’s New in Neurosurgery: Arteriovenous Malformations. June 2007. Dr. I. Fleetwood 11th Annual Atlantic Canada Oncology Group Symposium. Charlottetown, PE. Aggressive management of brain metastases: Stereotactic Radiosurgery. June 2007. Dr. I. Fleetwood Atlantic Clinical Neurosciences Society Meeting. Halifax, NS. Challenging Cases: Recurrent ACoA Aneurysm and Vertebro-vertebral Fistula. May 2007. Dr. I. Fleetwood36 HALIFAX • DIVISION OF NEUROSURGERY
  • 37. PRESENTATIONS Atlantic Clinical Neurosciences Society Meeting. Halifax, NS. Results of Stereotactic Radiosurgery for AVM patients. May 2007. Dr. I. Fleetwood Atlantic Clinical Neurosciences Society Meeting. Halifax, NS. Early Career Experience with Carotid Endarterectomy. May 2007. Dr. I. Fleetwood 7th Annual Stroke Review Course for Neurology Residents. Toronto, ON. Subarachnoid Hemorrhage and Intracerebral Hemorrhage. March 2007. Dr. I. Fleetwood 7th Annual Stroke Review Course for Neurology Residents. Toronto, ON. Carotid Endarterectomy and Stenting. March 2007. Dr. I. Fleetwood Banbury Center Conference on Cell Transplantation as a Therapy for Parkinson’s Disease. Cold Harbour, NY, USA. Neural Transplantation for Parkinson’s Disease: Methodological Issues and Surgical Techniques. December 2007. Dr. I. Mendez Humanities in Medicine – Dalhousie University, Halifax, Nova Scotia. Robots in Medicine: Is the bedside manner on life-support? October 2007. Dr. I. Mendez Killam Lecture, McGill University, Montreal, Quebec. New Horizons in Neurosurgery: Brain Repair & Robotics. October 2007. Dr. I. Mendez International Symposium of Stem Cell Therapies. McGill University, Montreal, Quebec, June 2007. Dr. I. Mendez Quebec/New Jersey Stem Cell Workshop, Montreal Neurological Institute, Montreal, Quebec. Neural transplantation for Parkinson’s Disease: Surgical Techniques and Stem Cells. June 2007. Dr. I. Mendez Cape Breton Regional Hospital, Sydney, Cape Breton. Robotic Applications in Emergency Neurosurgery. June 2007. Dr. I. Mendez Annual General Meeting, QEII Foundation, QEII Health Sciences Centre, Halifax, Nova Scotia New Technologies in Neurosurgery. June 2007. Dr. I. Mendez Parkinson’s Disease Society of the United Kingdom. Neural Transplantation in Parkinson’s Disease. May 2007. Dr. I. Mendez European Huntington’s Disease Surgical Working Group. London, England. GPI Stimulation for Huntington’s Disease. May 2007. Dr. I. Mendez Dalhousie University, Halifax, Nova Scotia. Medicine and Robotics. Dalhousie Humanities Program. May 2007. Dr. I. Mendez QEII Foundation, QEII Health Sciences Centre, Halifax, Nova Scotia. Robots in Neurosurgery. May 2007. Dr. I. Mendez Faculty of English, Dalhousie University, Halifax, Nova Scotia. Creativity in Medicine and Sciences. April 2007. Dr. I. Mendez QEII OR Nurses, QEII Health Sciences Centre, Halifax, Nova Scotia. Medicine in the Third World. April 2007. Dr. I. Mendez Faculty of Engineering, Dalhousie University. Halifax, Nova Scotia. Neurosurgery and the Biomedical Engineer. April 2007. Dr. I. Mendez Nova Scotia Awards of Excellence. Keynote Speaker. Halifax, Nova Scotia. Neurosurgical Technologies of the Future. April 2007. Dr. I. Mendez Hotchkiss Brain Institute, Calgary, Alberta. Halifax Experience in Parkinson’s Disease Research. April 2007. Dr. I. Mendez Ontario Neuromodulation Counsel, Toronto, Ontario. Neuromodulation for Chronic Pain. March 2007. Dr. I. Mendez International Health Office, Dalhousie Univeristy. Halifax, Nova Scotia. International Medicine. March 2007. Dr. I. MendezANNUAL REPORT • 2007 37
  • 38. PRESENTATIONS Centro Internacional de Restauracion Neurologica, Visiting Professor. Havana, Cuba. Stem Cells for Parkinson’s Disease. February 2007. Dr. I. Mendez Huntington’s Disease Surgical Working Group. London, England. DBS for Huntington’s Disease. January 2007. Dr. I. Mendez Parkinson’s Disease Society of the United Kingdom, London England. Surgical Techniques for Neural Transplantation in Parkinson’s Disease. January 2007. Dr. I. Mendez Dartmouth General Hospital Emergency Physicians. Concussion Guidelines. January 2007. Dr. S. Walling Hockey Coaches and Referees. Concussion Guidelines. February 2007. Dr. S. Walling Bridgewater Emergency and Family Physicians. Concussion Guidelines. March 2007. Dr. S. Walling NS Safety Conference. Protective Head Gear and Head Injuries. March 2007. Dr. S. Walling NS Ski Patrol. Helmets Head Injuries and Skiing. April 2007. Dr. S. Walling Knoggin Knowledge Head Injuries, Halifax. Helmets and Bikes. September 2007. Dr. S. Walling Knoggin Knowledge Head Injuries Helmets and Bikes, Antigonish. October 2007. Dr. S. Walling Injury Prevention Conference, Toronto. Think First Summit on Head Protection. November 2007. Dr. S. Walling Colchester Regional Hospital Emergency and Family Physicians. Concussion Guidelines. November 2007. Dr. S. Walling NS Emergency Nurses Conference. Concussion Guidelines. November 2007. Dr. S. Walling AWARDS Dr. I. Mendez Honorary Member Bolivian Neurosurgical Society Honorary Member Bolivian Academy of Sciences Twenty most influential Hispanics in Canada EDUCATIONAL SCHEDULE Atlantic Video Conferencen Rounds 1st Wednesday of month Neurosurgery Teaching Rounds Wednesday Clinical Neuroscience Rounds Wednesday Basic Science Rounds Wednesday Mortality & Morbidity Rounds 1st Wednesday of month Department of Surgery Grand Rounds 2nd Wednesday of month Neurosurgery Journal Review Club 1st Monday of month Multidisciplinary Journal Club 3rd Thursday of month Stereotactic Radiosurgery Case Conference Tuesday Brain Tumour Board Tuesday Cerebrovascular Rounds Wednesday Multidisciplinary Complex Pain Rounds Wednesday Pediatric Neuroscience Rounds every 2nd Thursday38 HALIFAX • DIVISION OF NEUROSURGERY
  • 39. EDUCATIONAL ACTIVITIES RESIDENCY TRAINING PROGRAM Dr. Simon Walling T The major objective of the Neurosurgery Residency Training Program at Dalhousie is the d development of skilled neurosurgeons in the clinical care of neurosurgical patients. This is a achieved by exposure to a broad range of technical problem solving and decision making a aspects of neurosurgery over a six-year period. Residents begin training with graduated levels of responsibility in the care of neurosurgical patients, assuming greater responsibility l of technical procedures and inpatient care as training progresses. The majority of o procedures are carried out by Resident staff under the supervision of attending staff. At the p Senior Resident level, independent clinical and operative decision making is promoted and S final year Residents achieve confidence in neurosurgical decision making and independent performance of operative procedures. p We strive to provide an academic environment in which Residents are continually W challenged to acquire adequate decision-making skills in neurosurgery. Regular teaching c rounds and seminars promote Resident involvement in discussion of current issues with r Dr. S. Walling, Director interaction between Residents and attending staff. The emphasis on academic components Residency Training Program in the program should prepare Residents for success in the Royal College Examinations and for laying down the foundation for those who want to develop an academic career. The Neurosurgery Residency Training Program at Dalhousie incorporates the use of the QEII Health Sciences Centre and the IWK-Grace in Halifax, Nova Scotia and the Saint John Regional Hospital, in Saint John, New Brunswick. This provides residents with exposure to a wide variety of neurosurgical problems, clinical approaches as well as excellent academic and clinical education and experiences. The Division of Neurosurgery promotes the role of research in residency training through research programs involving basic research and clinical investigation. There is a commitment to develop a multi-disciplinary approach to research involving clinicians and basic scientists. As well, Dalhousie University has a Clinician Investigator Program, which provides funding for those residents who want to pursue graduate studies during their residency, currently there are 7 Neurosurgery Trainees in our program: Dr. Matthew Hebb obtained his medical degree at the University of Toronto, graduating in 2002 and his PhD at Dalhousie University. Dr. Hebb recently completed his chief residency year and will complete his residency training with Dalhousie University in June 2008. Dr. Ciara Harraher obtained her medical degree at McMaster University in Hamilton, Ontario in 2004. Dr. Harraher is in her fourth year of residency and is currently completing her Masters Degree in Public Health at the Harvard University. Dr. Mihaly Kis obtained his medical degree at Queen’s University in Kingston, Ontario in 2004. Dr. Kis is in his fourth year of residency and is currently acting as chief resident. Dr. Philippe Magown obtained his medical degree at McGill University in Montreal, Quebec in 2005. Dr. Magown is currently in his third year of residency. Dr. Magown will be taking a leave from training to pursue graduate studies focusing on embryonic stem cell research. Dr. Khaled Aal Ali obtained his medical degree at the Faculty of Medicine and Health Science from the University of United Arab Emirates (UAE), graduating in 2002. Dr. Aal Ali plans to return to UAE to pursue his career as a neurosurgeon after completing his residency training with Dalhousie University in June 2011. Dr. Sean Barry obtained his medical degree at Dalhousie University in Halifax, Nova Scotia in 2006. Dr. Barry is currently in his second year of residency. Dr. Barry is expected to complete his residency training with Dalhousie University in 2012. Dr. Sirajeddin Belkhair obtained his medical degree at Garyounis University in Bengahzi, Libyan Arab Jamahiriya in 2002 and is in his first year of residency. Dr. Belkhair is expected to o complete his residency training with Dalhousie University in 2013. Beth Slade, Coordinator, Residency Training ProgramANNUAL REPORT • 2007 39
  • 40. VISITING SPEAKERS Dr. Monica Gorassini Dr. Edvin Koshi University of Alberta Department of Anaesthesia & Physical Rehab Medicine Title: Spasticity After Spinal Cord Injury: From Dish to Patient Dalhousie University January 2007 Title: CRPS: the New Paradigm to Treatment September 2007 Dr. Adam Hebb Professor, Department of Neurosurgery Dr. Joseph Berger University of Washington Professor, Department of Neurology Title: Low Grade Gliomas: Surgery and Prognosis University of Kentucky February 2007 Title: MS Misdiagnosis: A Case Series September 2007 Dr. F.G. Wormann Epilepsiezentrum Bethel, Bielefeld Dr. Paul Robertson Title: MRI Appearances and Optimum Imaging of Cortical Professor & Member of the Cultural Parliament, European Dysplasia in Epilepsy Community March 2007 Peninsula Medical School, United Kingdom Title: Medicine…Music…And The Mind: A Question Of Dr. Alejandra Valenzuela Interpretation Professor, Department of Ophthalmology September 2007 Dalhousie University Title: Orbital Tumours Dr. Ian R.A. MacKenzie April 2007 Professor of Neuropathology, Department of Pathology & Lab Medicine Dr. Tim Vartanian University of British Columbia Professor and Chief, Division on Demyelinating Diseases at Title: The Molecular genetics and Neuropathology of the Beth Israel Deaconess Medical Centre, Department of Frontotemporal Dementia; Recent Developments Neurology, Harvard Medical School September 2007 Title: Danger Theory in the CNS: What Are the Causes & Consequences of Microglial Activation Dr. Denise Figlewicz April 2007 Director of Research, ALS Society of Canada Title: ALS Research Directions: Past, Present, and Future Dr. Eric Sauvageau October 2007 Assistant Professor, Department of Neurology University of South Florida, College of Medicine Dr. Dongwook Lee Title: Symptomatic Intracranial Atherosclerotic Stenosis: Post –doctoral Fellow, Clinical Neuropsychology What Do We Know? Where Do We Go? Medical College of Wisconsin May 2007 Title: Lateralization & Localization of Language Functions in Epilepsy Dr. Ross J. Baldessarini October 2007 Professor, Psychiatry & Neuroscience Harvard Medical School Dr. Christopher Scherfler Title: Course and Morbidity in Bipolar Disorder: Things They Assistant Professor, Department of Neurology Did Not Teach Us in Residency Innsbruck Medical University May 2007 Title: The Image of Parkinson’s Disease: Voxel-Wise Analysis of Diffusion Weighted Imaging Reveals Disruption of the Dr. Murray Brown Olfactory Tract in Parkinson’s Disease Professor (retired), College of Pharmacy and the Department October 2007 of Community Health and Epidemiology Dalhousie University Dr. Steve Casha Title: Local Multiple Sclerosis Research Experiences Assistant Professor, Clinical Neurosciences June 2007 University of Calgary Title: Minocycline In Acute Spinal Cord Injury: An Old Hat That Dr. Jeannette McGlone Just May Fit Associate Professor, Department of Psychology October 2007 Dalhousie University Title: Self-Report of Memory Deterioration after Temporal Lobe Aidan Thomas & Meghan Ferguson Resection is the Exception Not The Rule Genetic Counsellors with MMGS, IWK Health Centre June 2007 Title: Genetics and Neurology: How Can We Help You? An Overview of Maritime Medical Genetics Services and Interesting Cases November 200740 HALIFAX • DIVISION OF NEUROSURGERY
  • 41. SUPPORT STAFF P E R I O P E R AT I V E N U R S I N G STERILE PROCESSING Back (left to right): J. Landry, E. Stoddard, M. Crummy, K. Russell. S. M L d and M. Murphy S MacLeod d M M h Front (left to right): S. Oivanen, S. Sullivan, S. Embree-Paris. Missing: K. Putman, J. Doyle, J. Barnes-Smith, M. Belliveau, A.Peros. A D M I N I S T R AT I V E A S S I S TA N T S Back (left to right): D. Amirault, D. Jardine, L. Hyland, M. Duke-Munden, C. Roberts Front (left to right): T. Vukoja, T. Smith, C. Caron, B. Slade Missing from photo: E. Young, P. Doucette, M. Holness, S. NelisANNUAL REPORT • 2007 41
  • 42. AFFILIATED NEUROSURGICAL UNITS THE MONCTON HOSPITAL MONCTON, NEW BRUNSWICK The year saw our department continue to enhance various aspects of delivering neurosurgical care to patients in the province and beyond. We established protocols for more effective and timely management of the explosion of referrals for degenerative spine problems that had occurred in recent years. We continued also to vigorously push for more operating room time and saw some headway in this towards the years end. It is obvious that more work needs to be done here to achieve expanded OR times consonant with our tertiary care status. Significant increases in all areas of clinical work occurred: clinic visits, admissions and all procedures performed. A three bed step-down unit was created to complement the Neurointensive Care Unit to facilitate patient transition from NICU to a regular ward. Dr. Dhany Charest remains the department Chairman and he continued with his work on a variety of national and provincial committees including the Regional Advisory Committee of the Royal College of Physicians and Surgeons of Canada, the Canadian Neurosurgery Society and the Canadian Brain Tumor Consortium. He was designated by the Canadian Neurosciences Federation to be a Neurosurgery Assessor for CME credits. He remained on the faculty of the University of Sherbrooke Medical School instructing medical students at the University of Moncton campus. Dr. Gilbert Quartey continues to have a focus on the management of complex pain problems with a particular interest in looking at the utility of neuromodulation as a pain control modality. He runs the Neurosurgical Pain Clinic and also, assisted by Mrs. Anita Ritchie, runs a clinic for patients implanted with spinal cord stimulators and intrathecally delivered drug pumps. Dr. Peter Gorman remains active with the New Brunswick Organ and Tissue Procurement program and as Director, coordinated protocols aimed at maximizing the efficacy of harvesting organs and tissues in the province for transplantation purposes. Dr. Robert Adams was appointed to the Provincial Clinical Services Committee, a body tasked with addressing timely access for surgical care throughout all surgical specialties in New Brunswick. He was also appointed to the Faculty of the University of Sherbrooke Medical School, teaching students at the Moncton campus. On the clinical front, he continues with managing not only patients requiring complex spinal instrumentations but also in collaboration with ENT colleges, utilized endoscopic techniques for management of skull based lesions. Dr. Brendan Kenny joined the department after having practiced for 14 years at the Sherbrooke University Medical Centre, the last six years as Chairman of Neurosurgery. He also was the Medical Director of the Gamma Knife program at that institution. He has particular interests in not only radiosurgery but also neurovascular diseases and hind-brain anomalies. He has proved to be a great addition to our program. Dr. Louis Juravsky worked closely with our group in developing the neuro-endovascular service. Coil embolization management for ruptured and unruptured cerebral aneurysms and AVM’s has been undertaken, as have been pre-operative embolization of brain and spinal tumors. We continue to work together for management of ischaemic cerebrovascular disease selecting patients for endovascular therapy as judged appropriate. Further, vertebroplasty and kyphoplasty services have been established. Provocative discography Back (left to right): Dr Charest Dr Adams Dr Dr. Charest, Dr. Adams, Dr. and spinal injection procedures as aids in diagnosing and managing Quartey Seated: Dr. Gorman Missing from photo: Dr. B. Kenny, Dr. L. Juravsky42 HALIFAX • DIVISION OF NEUROSURGERY
  • 43. AFFILIATED NEUROSURGICAL UNITS chronic spine-related pain are currently being undertaken. Clinical research in neuro-oncology was conducted throughout the year with Drs. Charest and Adams being the investigators for these trials. Other protocols of a basic science nature in neuro-oncology in the way of biochemical tumor markers are due to be initiated with collaborators at the University of Moncton. Weekly multidisciplinary Grand Rounds were conducted throughout the year, these affording ample opportunities for all caregivers to interact and make contributions geared to maximizing patient care. Additionally, the neurosurgeons continue to participate in the one-of-a-kind Regional Videoconference Rounds with colleagues from other centres in the Atlantic Provinces. These rounds represented an important forum for exchanges of ideas, again geared to enhancing delivery of care to neurosurgical patients. Toward the years end, we had a senior resident from the University of Sherbrooke Neurosurgery Program arrive to do a 3-month elective with us. We believe we have an environment here that is rich for residents to gain valuable experience. Looking ahead, we aim to not only maintain excellence in the delivery of neurosurgical care to patients referred to us but also play a pivotal role in the education of medical students and residents plus augment our research activities in the neurosciences. ATLANTIC HEALTH SCIENCES CORPORATION SAINT JOHN, NEW BRUNSWICK This Department is affiliated with the Division of Neurosurgery in Halifax. Faculty are members of the Department of Surgery at Dalhousie University. Our program in Saint John is organized according to a Program Management model. The Program Management team includes both neuroscience and rehabilitation, a combination that is working well for us. Our Neurosurgery Case Manager is responsible for helping with the management of our cases and also takes a great deal of time interacting with referring physicians at other facilities. This position has proved invaluable in the management of our patients. Our Clinical Nurse Specialist is primarily involved in the Acute Stroke Team here at the Saint John Regional Hospital l and is also involved in support for head injured patients. The residency program in Saint John is an elective for the residents in Neurosurgery from Dalhousie. We also host residents from the Royal College Emergency program and other surgical programs within the Dalhousie University family. Dr. Kolyvas is our Program Director here and takes part in the Residency Program Committee in Halifax. The videoconferences continue to be a source of stimulation and importance for the surgeons at the Regional Hospital Site. They offer an unparalleled opportunity in Canada for collaboration and exchange of ideas in the management of patients. We continue to have weekly multi-disciplinary rounds with our team of professional caregivers. Department meetings are held monthly and morbidity and mortality rounds are held periodically throughout the year.ANNUAL REPORT • 2007 43
  • 44. CROSS-APPOINTED FACULTY Dr. Ian Beauprie, MD, FRCPC Department of Anaesthesia Dr. Adam Law, MD, FRCPC Department of Anaesthesia Dr. Kirk MacQuarrie, MD, FRCPC Department of Anaesthesia Dr. Donald Morrison, MD, FRCPC Department of Anaesthesia Dr. Thomas Coonan, MD, FRCPC Department of Anaesthesia Dr. Orlando Hung, MD, FRCPC Department of Anaesthesia Dr. Michael Schmidt, MD, FRCPC Department of Anaesthesia Dr. Hugh Devitt, MD, FRCPC Department of Anaesthesia/Critical Care Dr. Robert Vandorpe, MD, FRCPC Department of Diagnostic Radiology (Neuroradiology) Dr. William Maloney, MD, FRCPC Department of Diagnostic Radiology (Neuroradiology) Dr. Eric Versnick, MD, FRCP C Department of Diagnostic Radiology (Neuroradiology) Dr. David Kydd, MD, FRCPC Department of Diagnostic Radiology (Neuroradiology) Dr. Ali Imran, MBBS, MRCP, FRCP C Department of Medicine (Endocrinology & Metabolism) Dr. Ehud Ur, MD, FRCP Department of Medicine (Endocrinology & Metabolism) Dr. Sarah Kirby, MD, FRCPC Department of Medicine (Neurology) Dr. Christine Short, MD, FRCPC Department of Medicine (Physical Medicine & Rehabilitation) Dr. Edvin Koshi, MD, FRCPC Department of Medicine (Physical Medicine & Rehabilitation) Dr. Sonya McVeigh, MD, FRCPC Department of Medicine (Physical Medicine & Rehabilitation) Dr. Alejandra Valenzuela, MD, FRCPC Department of Ophthalmology & Visual Sciences Dr. Alex Easton, MD, FRCPC Department of Pathology Dr. Robert Macaulay, MD, FRCPC Department of Pathology Dr. Liam Mulroy, MD, FRCPC Department of Radiation Oncology Dr. Dorianne Rheaume, MD, FRCPC Department of Radiation Oncology Dr. Bill Oxner, MD, FRCSC Department of Surgery (Orthopaedics) Dr. David Morris, MD, FRCS (ORL-HNS) Department of Surgery (Otolaryngology) Dr. Emad Massoud, MD, FRCSC Department of Surgery (Otolaryngology) Dr. Manohar Bance, MB, MSc., FRCSC Department of Surgery (Otolaryngology) Back (left to right): Dr R Holness Dr I Mendez Dr D McNeely Dr I Fleetwood Dr S Christie Dr. R. Holness, Dr. I. Mendez, Dr. D. McNeely, Dr. Fleetwood, Dr. S. Christie, Dr. D. Clarke Front (left to dight): Dr. E, Massoud, Dr. D. Rheaume, Dr. I. Beauprie, Dr. A. Easton ACKNOWLEDGEMENTS: Produced by: Lorraine Smith Thank you to Dr. David Clarke, Dr. Rob Brownstone, Dr. Ivar Mendez and Paula Ron Hill Chiasson for their invaluable feedback and editing advice. Also, a special Photography: Roy Dempsey thanks to all our contributing authors.44 HALIFAX • DIVISION OF NEUROSURGERY