News

Dr. Webster Pilcher, Chairman, UR Medicine Neurosurgery

As soon as he received the case, Dr. Webster Pilcher knew this could be the surgery of a lifetime. For patient Dan Fabbio, it was.

As a musician who was working towards his master’s degree, Fabbio couldn’t imagine a life without music. And, yet, the possibility was very real.

In the spring of 2015, after weeks of seizures and hallucinations, Fabbio was diagnosed with a brain tumor. Fortunately, it was benign. Unfortunately, it was located in the right side of the brain — potentially near the region specialized in music.

That’s where Pilcher and his team came in.

Patient Dan Fabbio, Credit: Univ. of Rochester

At the University of Rochester Medical Center, Pilcher and his colleague, Brad Mahon, Ph.D., co-lead the Program for Translational Brain Mapping. This program combines functional MRI (fMRI) scanning with live electrical stimulation to create patient-personalized brain maps. By having patients engage in activities, such as reading or singing, during these procedures, the team can precisely pinpoint the activated structures of the brain. Utilizing these maps as a guide for surgery, Pilcher hopes to preserve the critical functions most important to a patient, while simultaneously advancing scientific knowledge of the brain.

Neurosurgery chair, Web Pilcher, M.D., BCS researcher, Brad Mahon, Ph.D., and Elizabeth Marvin, Ph.D., talked to NBC News (Aug. 29) about their work during a recent brain surgery that resulted in saving a New Hartford, New York resident's musical ability.

Dan Fabbio was 25 and working on a master's degree in music education when he stopped being able to hear music in stereo. Music no longer felt the same to him.

When he was diagnosed with a brain tumor, he immediately worried about cancer. Fortunately, his tumor was benign. Unfortunately, it was located in a part of the brain known to be active when people listen to and make music.

Fabbio told his surgeon that music was the most important thing is his life. It was his passion as well as his profession.

His surgeon understood. He's someone whose passion has been mapping the brain so he can help patients retain as much function as possible.

Dr. Web Pilcher, chair of the Department of Neurosurgery at the University of Rochester Medical Center, and his colleague Brad Mahon, a cognitive neuroscientist, had developed a brain mapping program. Since 2011, they've used the program to treat all kinds of patients with brain tumors: mathematicians, lawyers, a bus driver, a furniture maker. Fabbio was their first musician.

The idea behind the program is to learn as much as possible about the patient's life and the patient's brain before surgery to minimize damage to it during the procedure.

"Removing a tumor from the brain can have significant consequences depending upon its location," Pilcher says. "Both the tumor itself and the operation to remove it can damage tissue and disrupt communication between different parts of the brain."

Ahead of Fabbio's surgery, it was important to understand exactly what parts of his brain were responsible for his musical abilities. The team spent six months studying the functional and structural organization of Fabbio's brain, Mahon tells All Things Considered host Robert Siegel.

Strong Memorial Hospital’s Neurology and Neurosurgery specialty program has been ranked among the top 50 in the nation for 2017-2018 by U.S. News & World Report. The program ranked 39^th among the nation’s hospitals, and this is the seventh consecutive year it has been nationally ranked by U.S. News.

In June, UR Medicine’s Golisano Children’s Hospital was recognized as one of the nation’s best children’s hospitals in three specialty areas — Neonatology, Nephrology, and Neurology and Neurosurgery — in the U.S. News & World Report’s Best Children’s Hospital rankings.

For the 2017-18 adult rankings, U.S. News evaluated more than 4,500 U.S. hospitals; only 152 were ranked in at least one specialty.

Eight Strong Memorial Hospital specialty programs earned High Performing ratings: Cardiology and Heart Surgery, Diabetes and Endocrinology, Gastroenterology and GI Surgery, Geriatrics, Nephrology, Orthopaedics, Pulmonology, and Urology.

U.S. News recognized hospitals that were high-performing across multiple areas of care and ranked them within their states and by metropolitan areas. U.S. News rated Strong Memorial as the top hospital in the Rochester Metro area and fourth among New York state hospitals.

U.S. News evaluates nearly 5,000 hospitals nationwide for its Best Hospitals rankings; methodologies include objective measures such as patient survival, the number of times a given procedure is performed, infection rates, adequacy of nurse staffing and more.

Left to right: Brad Mahon, Frank Garcea, and Edward Vates

On a warm day in July 2005, Frank Garcea’s soccer playing days came to an abrupt end when he suffered what could have been a deadly stroke during a practice with his teammates. Instead, the events of that day and his subsequent treatment – which serve as the basis for a review published in the New England Journal of Medicine (NEJM) – set him on a career path that would ultimately lead to a Ph.D. studying how the brain recovers from injury.

Garcea, who was about to begin his senior year at the Aquinas Institute in Rochester, was in the middle of a training session when he started experiencing a pounding headache. He first suspected he might just be dehydrated on that hot summer day, but soon after his limbs began to tingle and grow numb, his eyes became sensitive to the bright sunlight, and he had difficulty walking. Very quickly it became obvious that something was wrong and someone called 911.

Garcea eventually ended up at Strong Memorial Hospital and was diagnosed with a subarachnoid hemorrhage. He would undergo surgery the next morning under the clinical care of UR Medicine neurosurgeon Edward Vates, M.D., Ph.D.

Subarachnoid hemorrhages account for approximately 5-10 percent of all strokes in the U.S. These occur when a blood vessel in the brain bursts causing bleeding. If not treated immediately, these strokes can cause major disability and, in many cases, death.

“When an aneurysm ruptures, it is an intracranial catastrophe,” said Vates, a co-author of the NEJM article. “In 25 to 50 percent of cases, these strokes result in death, and this estimate does not fully account for patients who die before receiving medical attention.”

Vates uses Garcea’s experience as jumping off point to describe the decision-making process required to diagnose and identify treatment options for subarachnoid hemorrhages.

UR Medicine’s Golisano Children’s Hospital has been recognized as one of the nation’s best children’s hospitals in three specialty areas — neonatology, nephrology, and neurology and neurosurgery — in the U.S. News & World Report’sBest Children’s Hospital rankings.

The 2017-2018 rankings, released online Tuesday, placed the children’s hospital’s neonatology program at No. 27 nationally; nephrology at No. 43; and neurology and neurosurgery at No. 44.

“As with everything we do and have achieved, this recognition reflects a partnership with contributions from the interdisciplinary workforces of pediatrics, surgery and surgical subspecialties, emergency medicine, neurology, and obstetrics and gynecology,” said Nina Schor, M.D., Ph.D., pediatrician-in-chief at Golisano Children’s Hospital. “It also wouldn’t be possible without our community, and the health care organizations outside the hospital.”

The Division of Neonatology, which provides care for premature and critically ill newborns, admits about 1200 infants per year. Approximately 1 in 12 babies born in the Finger Lakes Region spend their first days in the children’s hospital’s Gosnell Family Neonatal Intensive Care Unit (NICU), which is the region’s only Level IV NICU.

The American Heart Association/American Stroke Association (AHA/ASA) has once again honored the UR Medicine Strong Memorial Hospital as having met its highest standards of care for stroke.

Strong Memorial Hospital has received the AHA/ASA Get With The Guidelines program’s Stroke Gold Plus Quality Achievement Award. The hospital was also tapped for the Target: Stroke Honor Role Elite Plus, which recognizes hospitals that have consistently and successfully reduced door-to-needle time – the window of time between a stroke victim’s arrival at the hospital, the diagnosis of an acute ischemic stroke, and the administration of the clot-busting drug tPA. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.

“This recognition is a testament to the hard work of our outstanding team of nurses, physicians, and therapists and their dedication to provide the highest quality of care to stroke victims,” said neurologist Curtis Benesch, M.D., M.P.H., the medical director of the UR Medicine Comprehensive Stroke Center.

“This award reflects a singular focus on improving the care stroke victims receive from the first 911 call to when they arrive at the hospital through operating room, neurocritical care, and rehabilitation,” said Tarun Bhalla, M.D., Ph.D., the surgical director of the Comprehensive Stroke Center.

Strong Memorial Hospital is home to the region’s only Comprehensive Stroke Center, a designation by the Joint Commission that indicates that the hospital either meets or exceeds the highest standards of care required to provide timely and comprehensive care to patients with complex cerebrovascular disease.

The AHA/ASA Get With the Guidelines program recognizes hospitals that have reached aggressive goals of treating stroke patients and comply with core standard levels of care. For more information about the Get With The Guidelines program, visit the AHA/ASA website.

A new study shows that patients with low back pain who were depressed were more likely to be prescribed opioids and receive higher doses. Understanding these prescribing patterns sheds new light on the current opioid epidemic and may help determine whether efforts to control prescription opioid abuse are effective.

“Our findings show that these drugs are more often prescribed to low back pain patients who also have symptoms of depression and there is strong evidence that depressed patients are at greater risk for misuse and overdose of opioids,” said John Markman, M.D., director of the Department of Neurosurgery’s Translational Pain Research Program at the University of Rochester Medical Center (URMC) and senior author of the study which appears in PAIN Reports, a journal of the International Association for the Study of Pain.

Low back pain is a leading cause of disability in the U.S., the most common condition for which opioids are a prescribed treatment.

Using data from the Medical Expenditure Panel Survey, a federally-compiled set of large-scale surveys of families and individuals, their medical providers, and employers across the U.S., the researchers compiled opioid prescription data from 2004-2009.

A recent scientific study shows that insufficient amount of sleep leads to the development of Alzheimer's disease. Researchers gain more evidence and are beginning to believe that lack and poor quality of sleep results to the fusion of Amyloids, proteins that bond together to form Alzheimer's plaques.

Dr. Maiken Nedergaard, the lead researcher from the University of Rochester Medical Center, explains the glymphatic system that is present in humans. She says that this system is 10 times more active when in slumber than when awake. The process allows cerebrospinal fluid to flow through spaces around the neurons of people's brains. This a method of purging unwanted proteins (Amyloids) and other wastes into the circulatory system garbage collectors and eventually flushes it out of the body.

In simple terms, Nedergaard explains that the brain has its own sanitation and public works department. It is like a network of sewer facilities mostly done during the brain's nightlife. An example of a housekeeping staff descending to building offices for a cleanup duty to avoid the lumping compound that causes Alzheimer's.