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Introduction

The Section of Neurosurgeryenjoyed a very successful year,c o n t i nuing to build uponstrengths growing in importantareas, both clinically and aca-demically. Recent recruitmentsto the Section have becomewell established and even newerfaces have brought new skillsand interests. A dedicated pedi-atric neurosurgery program has

been successfully implemented under the direction ofTina Duhaime, MD, and the secure and fully integratednature of this program into our activities has allowed itorganizationally to become a key component of the newSection of Pediatric Surgery. Nathan Simmons, MDjoined us from the Unive rsity of V i r ginia and theUniversity of Texas at San Antonio, bringing specialexpertise in both complex spine and in neuro-endocrino-logical surgery. Most recently, Jonathan Friedman, MD, aproduct of the Mayo Clinic Neurosurgery program,brought to the Section a special focus in cerebrovasculardisease, replacing Bob Harbaugh,MD, who left to lead theneurosurgery program at Penn State-Hershey. Clinicalproductivity over the past year exceeded expectations, theresidency program continued to earn national recogni-tion, and academic activity expanded and diversified. Oneof the cornerstones of the neurosciences at Dartmouth,Neurosurgery continues to provide comprehensive, state-of-the-art clinical care, advance knowledge in both thebasic and clinical arena, and train tomorrow’s leaders.Highlighting a most productive past two years, there havebeen 11 births within the Section!

Clinical activity

Existing and new programmatic initiatives both enjoyed asuccessful year.The expertise in pituitary tumor broughtto the institution by Henry Schmidek, MD, and NathanSimmons, MD, has enabled the creation of a multi-disci-plinary neuro-endocrine clinic and tumor board. Sharingresponsibilities with co-director Timothy Lukovitz, MD,Dr. Friedman has spearheaded the development of ourStroke Center. A new initiative in Pediatric MovementDisorders has brought together expertise from multipledepartments and will be at the forefront of the fieldnationally. This joins existing programs in spinal dys-

raphism and craniofacial deformity. Drs. Simmons, Ball,and Schmidek continue their surgical roles within theDHMC Spine Center. Dr. Ball remains an AssociateMedical Director of the Intensive Care Unit. Activity inbrain tumor and the NCCC Neuro-oncology programcontinues to build. The Surgical Epilepsy Program, withthe participation of Ann Christine Duhaime, MD andDavid Roberts, MD, continues to attract an internationalpatient population, and the Stereotactic and Functionalp rogr a m , also in collaboration with the Section ofNeurology and the Department of Psychiatry, expandedindications for deep brain stimulation.

Residency Program

We have continued to be fortunate in successfully recruit-ing the top resident candidates from a highly competitivenational pool. This is in part reflected in fifty-percent ofour resident complement coming from PhD programs.Henry Pallatroni, MD, our current Chief Resident whobrought West Coast distinction to the program in winningthe Retzius Neuroanatomy Competition while rotatingat L.A. Childrens Hospital, will graduate to fulfill militaryobligations. Kendall Lee, MD, PhD, an earlier recipient ofthe Thomas P. Almy Prize for Best Housestaff Teacher,won national recognition as the recipient of the presti-gious Philip C. Gildenberg Award for his work in stereo-tactic and functional neurosurgery. Dr. Lee also won theBest Resident Paper at the most recent NeuroscienceDay. Drs. Dimitrios Nikas, Patricia Quebada, and MichaelWolak, in addition to Drs. Pallatroni and Lee, all had con-tributions to the neuroscience or neurosurgery literaturethis past year.

Research

Dr. Duhaime’s laboratory, investigating pediatric headinjury, continues to enlighten understanding of responseto injury as a function of age. Its functional MRI studiesin pigs are the first successful fMRI studies in an animalmodel and are shedding light on neural plasticity. Dr.Friedman won national recognition for his work inbiodegradable polymers as the recipient of the SynthesAward at the 2003 Congress of Neurological Surgeonsand a patent for this work is pending.The Section’s workin image-guided and computer-assisted surgery, the inter-est of Dr. Roberts, continued its productive collaborationwith the Thayer School of Engineering and its populatingof academia and industry with image-guided surgery and

NEUROSURGERY

David W. Roberts, MDSection Chief

2 0 0 3 F riedman JA , M c I ver JI, Collignon FP, Nichols DA , P i e p gras DG.D evelopment of a pontine cyst after endovascular coil occlusion of a basilara rt e ry trunk aneury s m : case re p o rt . N e u ro s u r g e ry 2003;52(3):694-9; d i s c u s-sion 8-9.

2 0 0 3 F riedman JA ,Wetjen NM,Atkinson JL. Utility of intraoperative ultra-sound for tumors of the cauda equina. Spine 2003;28(3):288-90; d i s c u s s i o n9 1 .

2 0 0 2 F riedman JA ,Wijdicks EF. 10 most commonly asked questions aboutsubarachnoid hemorr h a g e. N e u ro l og 2002;8(4):271-6.

2 0 0 2 M c I ver JI, F riedman JA ,Wijdicks EF, P i e p gras DG, Pichelmann MA,Toussaint LG, 3 rd , McClelland RL, Nichols DA ,Atkinson JL. P re o p e r a t iveve n t ri c u l o s t o my and re bleeding after aneurysmal subarachnoid hemorr h a g e. JN e u rosurg 2002;97(5):1042-4.

2 0 0 2 Cohen-Gadol A A ,B ritton JW, Jack CR, J r. , F riedman JA , M a rsh W R .Transient postictal magnetic resonance imaging abnormality of the corp u scallosum in a patient with epilepsy. Case re p o rt and rev i ew of the literature. JN e u rosurg 2002;97(3):714-7.

2 0 0 2 F riedman JA ,Windebank A J, M o o re MJ, Spinner RJ, C u rrier BL,Yaszemski MJ. B i o d e gr a d a ble polymer grafts for surgical repair of the injure dspinal cord . N e u ro s u r g e ry 2002;51(3):742-51; discussion 51-2.

2 0 0 2 F riedman JA , P i e p gras DG. Remote cerebellar hemorr h a g e. JN e u rosurg 2002;97(2):498-9; author reply 9.

2 0 0 2 Wetjen NM, F riedman JA , M eyer FB. Epidural hematoma and mu s c l ecalcification after encephalomyo s y n a n gi o s i s . Case illustration. J Neuro s u r g2 0 0 2 ; 9 7 ( 2 ) : 4 9 4 .

2 0 0 2 F riedman JA , Rabinstein A A , M eyer FB. Pe risylvian fro n t o t e m p o r a lhematoma due to ru p t u re of an anterior communicating art e ry aneury s m .Case illustration. J Neurosurg 2002;97(2):493.

2 0 0 2 F riedman JA , G o e rss SJ, M eyer FB, P i e p gras DG, Pichelmann MA,M c I ver JI,Toussaint LG, 3 rd , McClelland RL, Nichols DA ,Atkinson JL,Wijdicks EF.Vo l u m e t ric quantification of Fisher Grade 3 aneurysmal sub-arachnoid hemorr h a g e : a novel method to predict symptomatic vasospasm onadmission computerized tomogr a p hy scans. J Neurosurg 2002;97(2):401-7.

2 0 0 2 Maher CO, F riedman JA , M eyer FB, Lynch JJ, Unni K,Raffel C.S u r gical treatment of fibrous dysplasia of the skull in childre n . Pe d i a t rN e u rosurg 2002;37(2):87-92.

2 0 0 2 Maher CO,Wetjen NM, F riedman JA , M eyer FB. I n t r a o p e r a t ive lido-caine injection into the carotid sinus during endart e re c t o my. J Neuro s u r g2 0 0 2 ; 9 7 ( 1 ) : 8 0 - 3 .

2 0 0 2 F riedman JA , Manno E, Fulgham JR. P ro p o f o l . J Neuro s u r g2 0 0 2 ; 9 6 ( 6 ) : 1 1 6 1 - 2 ; author reply 2.

2 0 0 2 Dixon GR, F riedman JA , Luetmer PH, Quast LM, McClelland RL,Pe t e rsen RC, Maher CO, E b e rsold MJ. Use of cere b rospinal fluid flow ratesm e a s u red by phase-contrast MR to predict outcome of ve n t ri c u l o p e ri t o n e a lshunting for idiopathic norm a l - p re s s u re hy d ro c e p h a l u s . M ayo Clin Pro c2 0 0 2 ; 7 7 ( 6 ) : 5 0 9 - 1 4 .

2 0 0 2 F riedman JA , E c ker RD, P i e p gras DG, D u ke DA . C e rebellar hemor-rhage after spinal surgery : re p o rt of two cases and literature rev i ew.N e u ro s u r g e ry 2002;50(6):1361-3; discussion 3-4.

2 0 0 2 F riedman JA , Maher CO, Quast LM, McClelland RL, E b e rsold MJ.Spontaneous disc space infections in adults. Surg Neurol 2002;57(2):81-6.

2 0 0 2 K a d y rov NA, F riedman JA , Nichols DA , Cohen-Gadol A A , Link MJ,P i e p gras DG. E n d ovascular treatment of an internal carotid art e ry pseudoa-

n e u rysm following transsphenoidal surgery. Case re p o rt . J Neuro s u r g2 0 0 2 ; 9 6 ( 3 ) : 6 2 4 - 7 .

2 0 0 2 Luetmer PH, Huston J, F riedman JA , Dixon GR,Pe t e rsen RC, Ja c kC R , McClelland RL, E b e rsold MJ. M e a s u rement of cere b rospinal fluid flowat the cerebral aqueduct by use of phase-contrast magnetic resonance imag-i n g : technique validation and utility in diagnosing idiopathic normal pre s s u rehy d ro c e p h a l u s . N e u ro s u r g e ry 2002;50(3):534-43;discussion 43-4.

2 0 0 2 Collignon FP, F riedman JA ,Atkinson JL. R e c u rrent intrave n t ri c u l a rand subarachnoid hemorrhage due to an intracranial schwa n n o m a . C a s ei l l u s t r a t i o n . J Neurosurg 2002;96(2):377.

A b s t r a c t s

2 0 0 3 F riedman JA , L ewellyn EB, M o o re MJ, S c h e rm e r h o rn T C, K n i g h tA M , C u rrier BL,Yaszemski MJ,A m e e nuddin S,Windebank A J. R o bust axonregeneration following surgical repair of the injured spinal cord with a nove lb i o d e gr a d a ble implant (abstract). N e u ro s u r g e ry 53(2): 4 8 0 - 4 8 1 . A u g u s t ,2 0 0 3

2 0 0 2 F riedman JA ,Windebank A J,Yaszemski MJ, M o o re MJ, L ewellyn EB.A Schwann cell seeded, b i o d e gr a d a ble polymer implant for promoting axonregeneration following spinal cord injury (abstract). Annals of Neuro l og y5 2 ( 3 S ) : S 8 7 . S e p t e m b e r, 2 0 0 2 .

2 0 0 2 F riedman JA , Nichols DA , M eyer FB, Pichelmann MA, M c I ver JI,Toussaint LG III,A x l ey PL, B rown RD Jr. E n d ovascular coil occlusion ofru p t u red saccular cerebral aneurysms using Guglielmi detachable coils: I n i t i a l1 0 - year experience (abstract). Jo u rnal of Neuro r a d i o l ogy 29(1): 1 S 7 1 .A u g u s t , 2 0 0 2 .

2 0 0 2 F riedman JA , G o e rss SJ, M eyer FB, P i e p gras DG, Pichelmann MA,M c I ver JI,Toussaint LG III, McClelland RL, Nichols DA ,Atkinson JLD,Wijdicks EFM.Vo l u m e t ric quantification of Fisher Grade 3 aneurysmal sub-arachnoid hemorr h a g e :A novel method to predict symptomatic va s o s p a s mon admission CT scan (abstract). N e u ro s u r g e ry 51(2): 5 7 4 . A u g u s t , 2 0 0 2 .

2 0 0 2 Toussaint LG III, F riedman JA ,Wijdicks EFM, P i e p gras DG,Pichelmann MA,M c I ver JI, McClelland RL, Nichols DA , M eyer FB,Atkinson JLD. P rior aspirin use does not wo rsen outcome in aneury s m a lsubarachnoid hemorrhage (abstract). Jo u rnal of Neuro s u r g e ry 96(2): 4 3 0 -4 3 1 . Fe b ru a ry, 2 0 0 2 .

2 0 0 2 Maher CO, M eyer FB, F riedman JA ,Wetjen NM. P ro s p e c t ive analysisof intraoperative carotid sinus lidocaine injection during endart e re c t o my( a b s t r a c t ) . Jo u rnal of Neuro s u r g e ry 96(1): 1 7 9 A . Ja nu a ry, 2 0 0 2 .

2 0 0 2 Toussaint LG III, F riedman JA ,Wijdicks EFM, P i e p gras DG,Pichelmann MA,M c I ver JI, McClelland RL, Nichols DA , M eyer FB,Atkinson JLD. P rognosis in surv ivo rs of cardiac arrest following aneury s m a lsubarachnoid hemorrhage (abstract). Jo u rnal of Neuro s u r g e ry 96(1): 1 8 0 A .Ja nu a ry, 2 0 0 2 .

2 0 0 2 F riedman JA , Pichelmann MA,Wijdicks EFM, P i e p gras DG, M c I ve rJ I ,Toussiant LG III, McClelland RL, Nichols DA , M eyer FB,Atkinson JLD.P u l m o n a ry complications of aneurysmal subarachnoid hemorrhage (abstract).Jo u rnal of Neuro s u r g e ry 96(1): 1 8 0 A . Ja nu a ry, 2 0 0 2 .

D avid W. R o b e rt s , M D

B o o k s

2 0 0 2 B ro p hy BP, Gildenberg PL, R o b e rts DW, Franklin PO (eds):P roceedings of the 13th Meeting of the World Society for Stereotactic andFunctional Neuro s u r g e ry, Pa rt 2 (published as Vo l . 7 7 , Nos 1-4 ofS t e reotactic and Functional Neuro s u r g e ry ) . B a s e l : Karger Medical andScientific Publ i s h e rs , 2 0 0 2 .

J o u r n a l s

4314

brain modeling biomedical engineers. Funding for theSection’s research activities included support from elevendifferent funding sources, six of which were from theNIH.

Other academic activity

A major project within the Section has been the prepara-tion of the upcoming fifth edition of Dr. Schmidek’s land-mark text, Operative Neurosurgical Techniques: Indications,Methods, and Results. All faculty and residents are majorcontributors to what has become the most widely adopt-ed neurosurgery textbook. Dr. Ball added to his neuro-surgical and Critical Care responsibilities by serving onthe Admissions Committee of the Medical School. Dr.Duhaime again ran her popular summer neurosciencecourse at Brown University. Dr. Simmons became a diplo-mate of the American Board of Neurological Surgeons.

All of the faculty presented at national or internationalmeetings and contri buted to the literature (seeBibliography). Faculty are currently serving on nine edi-torial and eleven advisory or commentary boards. TheEditorial Offices of Stereotactic and Functional Neurosurgerymoved to Dartmouth in 2002, with Dr. Roberts becom-ing the journal’s third editor in its sixty-four year historyand Melissa Robb becoming Assistant Editor.The facultycurrently hold positions on the executive boards of theAANS Joint Section for Spine and the Joint Section forPediatric Neurosurgery, the AANS Membership andMember Benefits committees, the AANS Jo i n tSponsorship and Continuing Education committees, theYoung Neurosurgeons Committee, the Society ofNeurological Surgeons Undergraduate Committee andthe Exe c u t ive Council of the World Society forStereotactic and Functional Neurosurgery.

hy p o a l buminemia correlations with post-transplant complications. N ewEngland Surgical Society. Dixville Notch 2002

William S, L ay c o c k , I I I , M D

J o u r n a l s

2 0 0 3 M c G re evy JM, G o o d n ey PP, B i r k m eyer CM, F i n l ayson SR, L ay c o c kW S, B i r k m eyer JD.A pro s p e c t ive study comparing the complication ratesb e t ween laparoscopic and open ventral hernia re p a i rs . Surg Endosc 2003.

2 0 0 3 F i n l ayson SR, L aycock W S, B i r k m eyer JD. National trends in utiliza-tion and outcomes of antireflux surgery. Surg Endosc 2003;17(6):864-7.

2 0 0 3 F i n l ayson SR, B i r k m eyer JD, L aycock W S.Trends in surgery for gas-t roesophageal reflux disease: the effect of laparoscopic surgery on utilization.S u r g e ry 2003;133(2):147-53.

2 0 0 3 Liu JY, F i n l ayson SR,L aycock W S, Rothstein RI,Trus T L , Pohl H,B i r k m eyer JD. D e t e rmining an appro p riate threshold for re f e rral to surgeryfor gastroesophageal reflux disease. S u r g e ry 2003;133(1):5-12.

2 0 0 2 M c G re evy JM, F i n l ayson SR,A l varado R, L aycock W S, B i r k m eye rC M , B i r k m eyer JD. L a p a ro s c o py may be lowe ring the threshold to operateon patients with suspected appendicitis. Surg Endosc 2002;16(7):1046-9.

2 0 0 2 Liu JY,Woloshin S, L aycock W S, S c h wa rtz LM. Late outcomes afterl a p a roscopic surgery for gastroesophageal re f l u x .A rch Surg 2002;137(4):397-4 0 1 .

Pamela A . R ow l a n d - M o ri n , P h D

J o u r n a l s

2 0 0 3 R ow l a n d - M o rin PA . E valuating Technical Skill Competency: W h a t ’sOut T h e re. Focus on Surgical Education 2003;20(1)16,24.

2 0 0 2 R ow l a n d - M o rin PA . F rom the Top Dow n . Focus on Surgi c a lEducation 2002;19(4) 30-31.

2 0 0 2 R ow l a n d - M o rin PA , Coe NP, G re e n burg AG, Spence RK, Reed W P,Lang NP, Sadighi PJ, B u rc h a rd KW.The effect of improving commu n i c a t i o ncompetency on the certifying examination of the A m e rican Board ofS u r g e ry.Am J Surg 2002;183(6):655-8.

Thadeus L.Tru s , M D

J o u r n a l s

2 0 0 3 Liu JY, F i n l ayson SR,L aycock W S, Rothstein RI,Trus T L , Pohl H,B i r k m eyer JD. D e t e rmining an appro p riate threshold for re f e rral to surgeryfor gastroesophageal reflux disease. S u r g e ry 2003;133(1):5-12.

L o ri A .A l vo rd , M D

Book Chapters

2 0 0 3 A l vo rd , L A .“Full Circ l e ” , I n :When We We re Young In The We s t :Tru eS t o ries of Childhood, M e l z e r, R i c h a rd , e d i t o r, Sunstone Pre s s , 2 0 0 3

2 0 0 2 A l vo rd , L A ,The Scalpel and The Silver Bear, I n :A Life In Medicine:AL i t e r a ry A n t h o l og y, C o l e s , R . , and Te s t a , R . e d i t o rs ,The New Pre s s , N ewYo r k , N Y, 2 0 0 2 .

N e u ro s u r ge ry

Pe rry A . B a l l , M D

Book Chapters

2 0 0 3 Pa p avasiliou A K , Ball PA : C ritical Care of the Cere b rovascular Pa t i e n t .In Batjer H and Loftus CM (eds):Textbook of Neuro l ogical Surgery.P h i l a d e l p h i a : Lippincott Williams and Wi l k i n s , 2 0 0 3 .

2 0 0 3 N i k a s , D C, Ball PA : Fluids and Electro l y t e s . In Batjer H and LoftusCM (eds): Textbook of Neuro l ogical Surgery. P h i l a d e l p h i a : L i p p i n c o t tWilliams and Wi l k i n s , 2 0 0 3 .

2 0 0 3 B a l l , PA : Lumbar Micro Discectomy. In Batjer H and Loftus CM( e d s ) : Textbook of Neuro l ogical Surgery. P h i l a d e l p h i a : Lippincott Wi l l i a m sand Wi l k i n s , 2 0 0 3 .

2 0 0 3 B a l l , PA : Spinal Cord Compre s s i o n . In Kruse J, F i n k , MP andC a r l s o n ,R (eds): S a u n d e rs Manual of Critical Care. P h i l d e l p h i a : S a u n d e rs ,2 0 0 3 .

J o u r n a l s

2 0 0 2 Fanciullo GJ, Ball PA , Girault G, Rose RJ, Hanscom B,Weinstein JN.An observational study on the prevalence and pattern of opioid use in25,479 patients with spine and radicular pain. Spine 2002;27(2):201-5.

Jonathan A . F ri e d m a n , M D

Book Chapters

2 0 0 3 Khurana VG, F riedman JA , M eyer FB. B i o l ogy of cerebral blood ve s-sels and blood flow. In Management of Cerebral A n e u ry s m s . LeRoux PD,Winn HR, e d s .WB Saunders , P h i l a d e l p h i a , 2 0 0 3 . 1 3 9 - 1 6 7 .

2 0 0 2 Maher CO, F riedman JA , Raffel C. Po s t e rior fossa tumors in childre n .In Textbook of Neuro l ogical Surgery : P rinciples and Practice. Batjer HH,Loftus CM, e d s . L i p p i n c o t t - R ave n , P h i l a d e l p h i a , 2 0 0 2 . 9 8 5 - 9 9 7 .

2 0 0 2 Link MJ, Pollock BE, Nichols DA , F riedman JA , Foote RL, S t a f f o rdS L . Dural art e ri ovenous fistula radiosurgery. In Contemporary Stere o t a c t i cR a d i o s u r g e ry : Technique and Eva l u a t i o n . Pollock BE, e d . F u t u r a ,A rm o n kN Y, 2 0 0 2 . 1 0 9 - 1 3 8 .

J o u r n a l s

2 0 0 3 F riedman JA , P i e p gras DG. C u rrent neuro s u r gical indications forsaphenous vein bypass gr a f t i n g . N e u ro s u r gical Focus 2003;14(3): A rticle 1.

2 0 0 3 M a g t i b ay PM, F riedman JA , Rao RD, Buckner JC, C l i by WA .U nusual presentation of adult metastatic peritoneal medulloblastoma associat-ed with a ve n t ri c u l o p e ritoneal shunt: a case study and rev i ew of the litera-t u re. N e u ro-oncol 2003;5(3):217-20.

2 0 0 3 Collignon FP, F riedman JA , P i e p gras DG, Nichols DA , Cloft H.Transcutaneous coil, s t e n t , and balloon migration following endova s c u l a rt reatment of a cervical carotid art e ry aneury s m . Case illustration. J Neuro s u r g2 0 0 3 ; 9 8 ( 5 ) : 1 1 3 5 .

2 0 0 3 F riedman JA , Pichelmann MA, P i e p gras DG, M c I ver JI,Toussaint LG,3 rd , McClelland RL, Nichols DA , M eyer FB,Atkinson JL,Wijdicks EF.P u l m o n a ry complications of aneurysmal subarachnoid hemorr h a g e.N e u ro s u r g e ry 2003;52(5):1025-31; discussion 31-2.

2 0 0 3 F riedman JA , Nichols DA , M eyer FB, Pichelmann MA, M c I ver JI,Toussaint LG, 3 rd ,A x l ey PL, B rown RD, J r. Guglielmi detachable coil tre a t-ment of ru p t u red saccular cerebral aneury s m s : re t ro s p e c t ive rev i ew of a 10-year single-center experi e n c e.AJNR Am J Neuroradiol 2003;24(3):526-33.

2 0 0 3 Rabinstein A A , Pichelmann MA,F riedman JA , P i e p gras DG, N i c h o l sDA , M c I ver JI,Toussaint LG, 3 rd ,McClelland RL, Fulgham JR, M eyer FB,Atkinson JL,Wijdicks EF. Symptomatic vasospasm and outcomes follow i n ga n e u rysmal subarachnoid hemorr h a g e : a comparison between surgical re p a i rand endovascular coil occlusion. J Neurosurg 2003;98(2):319-25.