By Katy Mena-Berkley
Monday, November 2, 2020
At the State University of New York Upstate Medical University, neurologists, neurosurgeons and neuroscience researchers work together to offer a robust spectrum of neurological solutions to the Central New York community.
Ruham Nasany, MD, is leading a multi-disciplinary team for the new Neuro-Oncology program.Located in Syracuse, Upstate is the region’s main referral center for specialized medical care and the only one to have a comprehensive neurological disorders program.
“Central New York is a large territory that covers one-third of the state and is home to one-tenth of New York’s population,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “In order to satisfy and meet the needs of our community, we have expanded our established programs to form the Upstate Neurological Institute. This is critically important at a time when neurology and neuroscience is the most sought-after specialty in the country.”
In the past 15 years, SUNY Upstate Medical University’s neuroscience offerings have expanded tremendously. Together, the departments of Neurology and Neurosurgery have doubled its number of faculty, recruiting the best and brightest clinical minds from all corners of the United States, and have also retained a significant portion of SUNY Upstate Medical University trainees and residents.
“Our clinical neuroscience program is the most advanced in the region, touching on the three pillars of neurological clinical care, education and research,” Dr. Mejico says. “We have invested a lot of effort into generating programs that provide the best care for our community, and we continue to expand and improve high quality care here in Central New York.”
Luis Mejico, MD, is the Chair of Neurology and is part of the multidisciplinary Neuro-Ophthalmology clinic, one of the dozen specialty clinics in the department.
Satish Krishnamurthy, MD, leads the Neurosurgery department and is a funded researcher. In Fall 2020 he received a $324,000 DOD grant to find a pharmacological solution for hydrocephalus instead of repeated shunt surgery.
Leading-Edge Solutions Close to Home
While people may need to travel for specialized operations such as neurosurgery, Upstate provides a more convenient option for patients and families in Central New York, as well as northern and western Pennsylvania.
“We cover the length and breadth of neurosurgery, offering the treatment options that our community needs,” says Satish Krishnamurthy, MD, MCh, FAANS, Professor and Interim Chair of the Department of Neurosurgery at SUNY Upstate Medical University. “The idea is to have the country’s best care right here in our patients’ backyard.”
Established in 1966, the Department of Neurosurgery has a long-standing history of training neurosurgeons to manage a wide variety of disorders found in the brain and spinal cord.
“Neurosurgery at Upstate has always catered to the sickest of the patients, while also contributing to education and making sure neurosurgeons not only do a good job, but provide the community with the best care possible,” Dr. Krishnamurthy says. “We have a specially trained team and high-end technology right here.”
Stroke Care and Telemedicine
Patients in rural communities who experience stroke can trust the board-certified stroke physicians at Upstate University Hospital to provide expert care via telemedicine. Using and interactive video conferencing, Upstate’s team can connect with emergency departments at partnering regional hospitals in real time. Each patient may see a consulting neurologist and Upstate’s stroke specialists. Together, this team provides timely medical evaluation and administration of tPA treatment to improve outcomes and minimize risk of long-term complications.
Upstate Brain & Spine Center is staffed by the largest team of neurosurgical specialists in Central New York, providing a spectrum of services to patients at Upstate University Hospital. The team also provides support to patients at multiple Upstate facilities, including its Level I trauma center — the only one in the region — Upstate Cancer Center, Upstate Golisano Children’s Hospital, neonatal care units and Upstate Comprehensive Stroke Center.
Intensive Care for Neurological Conditions
Upstate University Hospital is home to the only structured neurocritical care service in Central New York. The dedicated unit is designed to treat, manage and evaluate patients with the most severe and complex conditions affecting the brain and spine. During the past decade, Upstate’s Neuro ICU has nearly more than tripled in size, expanding from an eight-bed unit to a 27-bed unit.
“The expansion meets the growing needs of the region,” says Julius Gene Latorre, MD, MPH, Medical Director of the Upstate Comprehensive Stroke Center. “This was in part fueled by the advancement in acute stroke care and in medical advances in the management of neurosurgical conditions and traumatic brain injuries.”
The neurology specialists in the Neuro ICU typically treat patients with intercranial hemorrhage that may be related to a spontaneous hemorrhage of the brain or traumatic hemorrhage of the brain. They are also practiced in managing the care of patients experiencing brain injury related to loss of oxygen from cardiac arrest. Other conditions these specialists may see include uncontrollable seizures and complex neuromuscular conditions, such as Lou Gehrig’s disease.
In addition to technology and equipment commonly found in ICUs, the Neuro ICU at Upstate University Hospital also has monitoring equipment specially designed to monitor brain function, such as continuous electroencephalogram (CEEG) monitoring critical in the detection of non-convulsive seizures.
Julius Gene Latorre, MD, MPH, Medical Director of Upstate Comprehensive Stroke Center, the first in the region
Harish Babu, MD, Assistant Professor of Neurosurgery at Upstate, is one of the clinicians providing care to patients with surgical disorders of the brain and spine. Together with his colleagues, Dr. Babu provides intensive neurosurgery embracing sophisticated technologies. The neurosurgeons and neurosurgical researchers specialize in brain bleeds, brain tumors, hemorrhages, pediatric care, nerve and spine problems, and strokes. Upstate’s neurosurgical technologies include:
- Minimally invasive robotic surgery — Operating through small incisions, can avoid some complications associated with surgery that requires a larger opening. Using stereotactic laser ablation, the neurosurgery team can address multiple neurological conditions, including epileptic foci and tumors.
- Endoscope — “Using an endoscope, we are able to investigate the nooks and crannies of the brain in a manner that does not disturb surrounding tissue,” Dr. Babu says. “We can use endoscopes through the nose to reach the brain for surgeries. Then we can use pointed lasers to burn tumors. We also have computerized microscopic navigation techniques, which are like a GPS for the brain that allows you to target a specific pinpointed area.”
- Fluorescein-guided neurosurgery — Using a green-water soluble dye known as sodium fluorescein, neurosurgeons can more accurately investigate a tumor site. The dye accumulates on areas of the brain where the blood-brain barrier has been damaged, highlighting the tumor tissue more clearly.
“In some patients, we do not think that we can see every single cell with our eyes or an MRI machine,” Dr. Babu says. “When we inject the dye as part of surgery, the tumor cells will light up differently compared to the normal brain. That helps us remove those tumors and keep the normal parts of the brain in intact.” - Focused radiation Gamma Knife — This computerized treatment planning software helps neurosurgeons precisely locate targets in the brain and deliver concentrated doses of radiation to the affected area. As a result, surrounding tissue is spared. Gamma Knife radiation may be used to treat a variety of neurologic conditions, including benign brain tumors, such as meningiomas and pituitary adenomas, malignant brain tumors, such as primary brain tumors and metastatic tumors, blood vessel defects, such as arteriovenous malformations, and functional complications like trigeminal neuralgia. The region’s only Gamma Knife is considered to be patient friendly as it is a one-time outpatient procedure.
- Awake craniotomy — Using specialized anesthesiology techniques, neurosurgeons are able to operate while a patient is still awake. Neurosurgeons may ask a patient who is undergoing an awake craniotomy to perform an action, such as playing the violin or singing, during the surgery.
“We do this to make sure that the function of the brain is preserved, and we are not cutting into important brain tissue,” Dr. Krishnamurthy says.
Expert Epilepsy Care
A Level 4 comprehensive epilepsy center, Upstate University Hospital is equipped with the technology and expertise to deliver effective epilepsy care. The epilepsy program has expanded during recent years, increasing the monitoring unit in the hospital. If surgery is needed, fellowship-trained neurosurgeons can perform a range of procedures, including Robotic Stereotactic Assistance (ROSA) for localization and treatment of the epileptic foci using minimally invasive surgical methods.
Robert Beach, MD, monitoring patient Amyee Rodriguez of Gouverneur, New YorkAn Exploration of Possibility
The Brain Tumor Research Laboratory at SUNY Upstate Medical University is a unique resource that works hand in hand with the Department of Neurosurgery to enhance patient care and outcomes.
“The laboratory is a research unit, a self-contained research facility that is completely integrated with the clinical mission of the Department of Neurosurgery,” says Mariano Viapiano, PhD, Associate Professor of Neurosurgery and Neuroscience and Director of the Brain Tumor Research laboratory. “We support the work of the clinicians by allowing them to perform research activities with clinical specimens. That research allows them to receive better details about the clinical case of the patients and more information about the tumors, enabling a better diagnosis and prognosis.”
Frozen samples of brain cancer tumors can be carefully thawed, put in a nourishing medium and placed in a body-temperature incubator to bring them back to life at Upstate’s Brain Tumor Research Laboratory.Dr. Viapiano works with a multidisciplinary team of experts in the laboratory, including two senior scientists who are biochemists, two research fellows, one junior trainee and a laboratory manager, Sharon Longo.
“Sharon has been lab manager for 24 years,” Dr. Viapiano says. “I am fortunate to have her here. She runs day-to-day operations, and we have an outstanding relationship.”
Together, the specialists in the Brain Tumor Research laboratory facilitate a bench to bedside pipeline to support clinical experts treating tumors associated with primary brain cancer, including glioma, neuroblastoma, rare tumors, skull-based tumors and brain metastases.
For this pipeline, a clinician may collect a tumor specimen, with patient consent, during surgery to send to the lab. Dr. Viapiano’s team performs genetic and molecular analysis on the specimen and can even reproduce the tumor. The research team can further investigate by administering experimental therapies.
“We generate a wealth of information that we can provide back to the clinicians to improve the patient’s diagnosis and prognosis,” Dr. Viapiano says. “We can provide that information to pathologists, and they can initiate therapeutic strategies based on that data.”
The Brain Tumor Research Laboratory also has an established protocol for tissue collection, allowing the team to collect specimens from every patient who consents to provide tumor tissue for research.
Expert Neuro- Oncologic Care
Upstate University Hospital is pleased to welcome Ruham Alshiekh Nasany, MD. A graduate of Upstate’s residency program, Dr. Nasany serves as Assistant Professor of Neurology, Director of the Brain Tumor and Neuro-Oncology program at the Upstate Cancer Center.
“Dr. Nasany completed her neuro-oncology fellowship at Memorial Sloan Kettering Cancer Center in New York City, which is a major cancer institute in the world,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “She has special training in neuro-oncology, which allows us to develop a program that will inspire new protocols.”
“Collecting those specimens has helped us to create a large repository or tumor bank that we can use for research purposes.”
Additionally, if a physician thinks that a unique tumor case would be of particular importance, the lab may set up a protocol to reproduce the tumor in animal models or in vitro.
“We are proud to have the best technology at the national level to provide care and the expertise we provide adds a whole component that allows us to evolve brain cancer care,” Dr. Viapiano says. “If you refer your patients to Upstate, you can count on not only the highest standard of care but also the best standard of analytical services in diagnostic prognosis and research.”
Upstate Neurological Institute
SUNY Upstate Medical University Interim President Mantosh Dewan, MD, has announced the formation of the Upstate Neurological Institute.
The new Institute unites two prominent departments — Neurology and Neurosurgery — to create the largest team dedicated to neurological disorders in Central New York.
In addition to patient care within these core departments, the Neurological Institute membership will expand to include collaboration with the 14 other clinical and basic science departments at Upstate Medical University, which have services or research to improve the health of persons with neurological disorders.
The setting supports the endeavor with many services that are one of a kind in the region. Upstate University Hospital has an entire hospital floor dedicated to patients with brain injuries. It was the region’s first comprehensive stroke center and has a level-4 level epilepsy center. Advanced neurosurgical technologies include intra-operative MRI, minimally invasive robotic and laser surgery tools, and the region’s only Gamma Knife. The Institute also is part of a medical university that offers robust neuroscience research aimed at treatments and cures.
SUNY Upstate Medical University Interim President Mantosh Dewan, MD
