VVolume 3olume 3 ,, Issue 1 - FIssue 1 - Fall 2007all 2007

(Continued on page 6)

Cervical Disc ReplacementLaura S. Paré, M.D.

http://neurosurgery.uci.eduhttp://neurosurgery.uci.edu

In This Issue:Cervical Disc Replacement.....Cover

A Note from the Chair.............2

New Radiosurgery Techniques...3

Essential Tremor..........................5

Management of Brain Tumors.........6

A major common symptom of pressure on a nerve in the neck or cervical spine is neck painthat spreads or radiates down the arm. Often, the pain may spread into the fingers. This typeof radiating pain is called a radiculopathy which is caused by compression of one of the nervesin the cervical spine. Other symptoms of radiculopathy can include numbness or tinglingspreading down the arm. Weakness of some arm or shoulder muscles may occur as well.Nerve root compression may be caused by bone spurs in the neck or osteophytes. At othertimes, the compression is caused by a herniated, or ruptured, cervical disc. When osteophytescause cervical radiculopathies, the onset can be gradual or sudden, sometimes brought on byan accident or fall. Cervical disc herniations often appear suddenly. For example, they mayoccur upon awakening in the morning without trauma or stress.

Most patients with cervical nerve root compression will have painful limitation of neck motion.Bending the neck backward, or cervical extension, usually aggravates the pain. Some patientsfind pain relief by raising the arm on the painful side and resting it on theirhead with the elbow bent.

Of greater concern than pressure on a single nerve is pressure onthe cervical spinal cord. When pressure on the cervi-cal spinal cord causes symptoms, it iscalled cervical myelopathy.Symptoms of cervical myelopathyare similar to the symptoms of nerveroot compression. However, theymay be more widespread, perhapsin both arms or even in both legs.Loss of control of the bladder or bow-els may occur in cases of severespinal cord compression. The occur-rence of significant weakness in oneor more muscle groups may requiresurgery to remove pressure fromthe nerve roots and the spinal cord.Cervical myelopathy can be causedeither by a cervical disc herniation orby widespread cervical osteophytes, also known as cervical spondylosis. This results in nar-rowing of the spinal canal.

Good news for patients with pain derived from a herniated cervical disc is that over 90% ofthem improve without surgery. Surgery for patients with radiculopathies is reserved for thosewith significant weakness or numbness and for individuals with pain who fail to improve withnon-operative treatment.

One of the most common operations performed by neurosurgeons is for treatment of herniat-ed cervical disc or cervical osteophytes. The operation is called an anterior cervical discectomy

Prestige disc implanted in the cervical

Welcome to the fifth UCI Neurosurgery Newsletter. Our first fourissues have been extremely well received throughout the MedicalCenter, School of Medicine, and our community at large. We areextremely grateful for the generous donations that we havereceived, which are helping us establish the funds necessary to cre-ate a first class neurosurgery research effort. Much has happenedhere at UC Irvine since our Spring 2007 issue. Dr. Linskey has beennamed an Orange County Physician of Excellence in neurological sur-gery by the Orange County Medical Association in collaboration withthe Orange Coast Magazine for the second year in a row. Dr. Linskeywas also named Deputy Director of the medical advisory board of thenational Trigeminal Neuralgia Association and was recently electedCorresponding Secretary of the Council of State NeurosurgicalSocieties. Dr. Devin Binder has successfully competed for, and won,a KO8 grant award by the National Institute of Health for his basicscience research work in epilepsy. This represent’s ourdepartment’s first NIH funding award. Dr. Laura Parehas completed a training course making her one of thefirst neurosurgeons in Orange County to be trained inimplantation of the newly FDA-approved Prestige®artificial cervical disc (see article on the cover).

Our department submitted its application for return toa residency training program in August. The proposedprogram will be centered at UC Irvine Medical Center,but will also include Children’s Hospital of OrangeCounty (CHOC) and Kaiser Anaheim for inpatient train-ing. Outpatient radiosurgery training will occur at theHoag/UCI Gamma Knife Center in Newport Beach. Wesuccessfully completed our American Council ofGraduate Medical Education (ACGME) site visit this October andexpect our application to be considered at the January 2008 neuro-surgery residency review committee (RC) meeting.

We are extremely happy to announce the successful recruitment ofDaniela Bota, M.D., Ph.D. to our multidisciplinary neuro-oncologyprogram. Dr. Bota is a Board certified neurologist who did her resi-dency training at the University of Kansas. She went on to completea formal Neuro-Oncology fellowship with Dr. Henry Friedman at DukeUniversity. She had previously completed a Ph.D. in MolecularBiology at USC. Dr. Bota will serve as Medical Co-Director of ourmultidisciplinary neuro-oncology program, sharing duites with Dr.Linskey from the surgical side. Her research work will be performedin UC Irvine’s Chao Family Comprehensive Cancer Center. She willalso collaborate with Dr. Yi-Hong Zhou at our department’s braintumor research laboratory. Dr. Bota is the only fellowship trainedneuro-oncologist in Orange County, and UC Irvine now has the onlycomprehensive multidisciplinary neuro-oncology program in thecounty. Our brain tumor program is now one of the most advancedand capable in the county. This is exemplified by the presence ofthe only intra-operative MR scanner in the county along with newtherupeutic modalities including the Varian Trilogy Linear Accelerator,the Peacock radiation system, and the imminent use of the newradiosurgery Gamma Knife Perfexion® unit at Hoag/UCI GammaKnife Center. (see article on page 3).

We are also happy to announce the successful recruitment of ourthird stroke neurologist, Dr. Vivek Jain. He will work in our multidis-ciplinary stroke and cerebrovascular program. Dr. Jain completed his

neurology residency at UC Irvine and a stroke neurology fellowshipat the University of Western Ontario. UC Irvine Medical Center is thefirst JCAHO-certified stroke center in Orange County. There are nowthree stroke neurologists on staff as well as two interventional neu-roradiologists. Our cerebrovascular neurosurgery service collabo-rates with these physicians.

Development of our comprehensive multidisciplinary spine programcontinues. We have added a clinical nurse coordinator and are hir-ing a research nurse coordinator. The Vice Chancellor for the HealthSystem approved the organization and implementation of our newmultidisciplinary spinal cord injury clinical initiative which includesthe eventual formation of a new spinal cord injury clinical unit with-in UC Irvine Medical Center.

Our Comprehensive Epilepsy Program and newlydeveloping Movement Disorder Program are boththriving under the surgical leadership of Dr. DevinBinder. The number of deep brain stimulation cases atUC Irvine is rapidly rising, and recruitment has justbegun for a second movement disorder neurologist forthe program.

Last spring, at the request of the Trigeminal NeuralgiaAssociation, UC Irvine formalized institutional sponsor-ship of the Orange County Trigeminal NeuralgiaAssociation regional support group. This summer, weassumed institutional sponsorship of the OrangeCounty chapter of the Acoustic Neuroma Associationpatient and family support group. With Dr. Bota’s

arrival, plans are also in place to proceed with formation of aUniversity sponsored Brain Tumor Support Group. We are proud toprovide support resources and professional expertise for theseworthwhile organizations.

Continuing education is also one of our priorities. Our weekly 1-hourCME neurosurgery grand rounds, held every Wednesday from 10-11am, is open to all Orange County neuroscience clinicians. Thespring CME symposium centered around the 5th annual John AKusske lecture will be held on Saturday May 10, 2008 at the Arnoldand Mabel Beckman Institute. The topic of the seminar will be neu-rotrauma. We are pleased to announce that this year’s lecturer willbe Jack Wilberger, M.D., a national neurosurgery expert in neuro-trauma from Allegheny General Hospital in Pittsburgh.

We aim to be the primary Orange County site for advanced tertiaryand quaternary neurosurgery patient care, as well as the mainOrange County site for neurosurgery clinical outcomes studies, clin-ical trials, and translational neuroscience research. We intend toestablish a top-tier neurosurgery training program, and to be thepreferred regional site for neurosurgery CME. With the continuingsupport of our Medical Center and School of Medicine leadership, ourreferring physicians, private industry, and the community, along withthe enthusiastic efforts of our faculty members, we are well on ourway to achieving these goals.

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AA NNoottee FFrroomm TThhee CChhaaiirr

Mark E. Linskey, M.D.Chairman

Stereotactic radiosurgery (SR) has become a mainstay of neurosur-gical treatment for patients with benign and malignant brain tumors,trigeminal neuralgia, and arteriovenous malformations (AVMs).Among many new technologies for delivering SR, the Gamma Knife®(GK) manufactured by Elekta, Inc. has the longest proven trackrecord for efficacy and patient safety. Dr. Mark Linskey, Chairman ofthe Department of Neurological Surgery at UC Irvine School ofMedicine, has been performing GKSR for 20 years. He is an interna-tionally-recognized expert in GKSR for trigeminal neuralgia,metastatic brain tumors, as well as skull base tumorsincluding acoustic tumors, meningiomas and pituitarytumors. Over the last 20 years, he has published mul-tiple manuscripts and book chapters regarding SR. Inaddition to many SR scientific abstracts presented atmedical meetings, he has given 47 invited talks onclinical results and experimental models for SR. Heis Co-Director of the comprehensive multidiscipli-nary neuro-oncology program at UC Irvine’s ChaoFamily Comprehensive Cancer Center. Also, he isDeputy Director of the Medical Advisory Board ofthe national Trigeminal Neuralgia Association.

In 2003, Dr Linskey’s extensive experience and expert-ise in GKSR were recognized by the Gamma Knife parentcompany, Elekta. At the time, he was one of nine experts inthe fields of Neurosurgery, Radiation Physics, and RadiationOncology invited to join Elekta’s international scientific advisorypanel. Along with Elekta engineers and software programmers, heand other experts designed a completely new Gamma Knife unit forSR. During an intense three year period from 2003 to 2006, Dr.Linskey worked diligently with the other 8 members of the interna-tional expert panel, secretly code named “Robinson” Project. Theirgoal was to design a new state-of-the-art gamma unit that retainedall of the proven features and advantages of the Gamma Knife while

addressing many logistical and planning prob-lems identified in existing systems.

They were able to develop thenew unit with significantlyadvanced capabilities. Theresult was the new Gamma

Knife Perfexion® Unit(Figure A) which

became opera-tional with thefirst prototypeinstallation inM a r s e i l l e s ,

France in 2006.The second unit was installed in

London, England shortly thereafter.

The Gamma Knife Perfexion® is a quantum leap in SR efficiencyand capability. The device has 192 Cobalt-60 source units. It isdesigned so that changes in the alignment of the system can beeliminated during treatment. The radiation beams from this sys-tem are directed towards isocenters within the brain (Figure B).These isocenters are the points in the brain where the central rayof the radiation beams pass. The stereotactic coordinate frame isattached directly to the comfortable Perfexion unit couch and thepatient. The couch automatically moves in a smooth repeatingfashion to each new coordinate position. The process eliminatesthe need for manual setting of isocenter coordinates, decreasingthe time between each successive radiation focus point treat-

ment. The patient experiences a continuous smooth treatment fromstart to finish with no interruption. Early studies on the first two pro-totypes suggest a treatment time savings of an average of 2 hoursper SR case, compared with existing models of the Gamma Knife.

In addition, the new Perfexion® unit is designed with a much widertreatment space for the patient. With the new Perfexion® unit,

treatment can now be delivered to parts of the brain and spinalcord which previously could not be radiated with exist-

ing GK models. All now can be reached with thepatient in a standard position on their back

(Figure C). Unique features of thePerfexion® unit include advanced planningtreatment software for the physicians. Thisgives the ability to customize the alignmentof the system as well as the beam size andintensity of the radiation. “There is nothingin the SR market today that can remotelycompare with the power, accuracy, and

capability of the new Gamma KnifePerfexion® unit” (M Linskey Elekta Robinson

Project Panel International Scientific Expert).

The Gamma Knife Perfexion® unit is being installedat Hoag Memorial Presbyterian Hospital in Newport

Beach, CA. It will replace the previous Gamma Knife Model U Unitat the former Hoag/UCI Gamma Knife Center. It should be opera-tional for patient treatment by November 2007. This is the locationwhere Dr. Linskey and his multidisciplinary SR team from UC Irvineperform GKSR for UC Irvine Medical Center patients. The center issupervised by a UC Irvine voluntary private practice faculty member,Dr. Christopher Duma. The Gamma Knife Perfexion® unit inNewport Beach will be the first and only such unit in southernCalifornia.

The power and capabilities of this new neurosurgical SR tool are bestunderstood and appliedby those who designedthe new unit and soft-ware as part of theinternational expertdesign team. For a con-sultation appointmentto see Dr. Linskey forconsideration of treat-ment on the newGamma KnifePerfexion® unit at HoagMemorial PresbyterianHospital, please call714-456-6392.

New Radiosurgery Techniques at UC IrvineJohn A. Kusske, M.D.

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Gamma Knife Perfexion® unit

GK Perfexion® Unit with laser lights demonstratingtreatment isocenter

GK

Perfexion®Unit with a patient in treatm

ent posi

tion

MMeeeett OOuurr FFaaccuullttyyMark E. Linskey, M.D.

Associate Professor and Chairman of the Department of Neurological Surgery and Co-Director of the UCIrvine Chao Family Comprehensive Cancer Center Neuro-Oncology Program. Dr. Linskey attended ColumbiaUniversity College of Physicians and Surgeons, and completed his neurosurgery residency at the Universityof Pittsburgh in 1993, as well as a neuro-oncology fellowship at the Ludwig Institute for Cancer Research inLondon as an American Association of Neurological Surgeons (AANS) van Wagenen Fellow in 1994. He iscertified by the American Board of Neurological Surgery (ABNS). His clinical interests include skull basemicrosurgery, adult and pediatric malignant and benign brain tumors, trigeminal neuralgia, hemifacial spasm,Gamma Knife stereotactic radiosurgery, and microvascular decompression for cranial nerve disorders.

Research interests include molecular epidemiology and biomarkers for brain tumors, developmental glial biology, radiobiology,brain tumor clinical trials, and clinical outcome studies.

Laura S. Paré, M.D. Associate Clinical Professor of Neurological Surgery , Co-Director Multidisciplinary Spine Program, andMedical Director of the General Neurosurgery Ambulatory Care Clinic. Dr. Paré attended the University ofChicago Pritzker School of Medicine, completed her Neurosurgical Residency at the Montreal NeurologicalInstitute, McGill University, Canada in 1991, as well as a spine fellowship at UCLA in 1997. She is certifiedby the ABNS as well as being a fellow of the Royal College of Surgeons of Canada. Her clinical interestsinclude general neurosurgery, complex and minimally invasive spine surgery, syringomyelia and Chiari mal-formation, brain and spine tumors, and normal pressure hydrocephalus. Her research interests include cere-brospinal fluid physiology, and intracranial pressure wave form analysis.

Devin K. Binder, M.D., Ph.D.Assistant Professor of Neurological Surgery, Director of the Epilepsy and Functional Neurosurgery Service,and Surgical Director of the UC Irvine Comprehensive Epilepsy Program. Dr. Binder attended Duke UniversitySchool of Medicine where he also earned his Ph.D. in Neurobiology. He completed his neurosurgical resi-dency at the University of California, San Francisco in 2005 and a clinical and research fellowship in Epilepsyat the University of Bonn in Germany as an AANS van Wagenen Fellow in 2006. He is eligible for certifica-tion by the ABNS. His clinical interests include general neurosurgery, epilepsy surgery, and functional neu-rosurgery for movement disorders, tremor and pain. His research interests include studying the functionalrole of neurotrophins, aquaporin-4, glia, and the extracellular milieu in epilepsy, as well as the clinical out-

come of surgery for epilepsy and deep brain lesioning and stimulation for movement disorders and tremor.

Other Faculty MembersJohn A. Kusske, M.D.Yi-Hong Zhou, Ph.D.

Kim Anderson, Ph.D.Daniela Bota, M.D., Ph.D.

Volunteer Faculty MembersMichael Muhonen, M.D.William Loudon, M.D.Christopher Duma, M.D.Richard Kim, M.D.

Robert Jackson, M.D. Bradley Noblett, M.D.Sylvain Palmer, M.D.

RESEARCHRESEARCH SUBJECTSSUBJECTS NEEDED!NEEDED!UC Irvine Neurological Surgery is looking for sub-

jects for an ongoing clinical study of normal pressurehydrocephalus (NPH). This syndrome consists of

difficulty walking, urinary incontinence, and memorydifficulties, in any combination (see Vol. 1, Issue 1).

If you or someone you know might be interested inparticipating, please visit our website at

http://neurosurgery.uci.edu/nph for more details, or call the NPH study coordinator at (714) 456-6966.

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Essential tremor (ET) is the most commonmovement disorder. It affects approximately4 to 5 percent of the population 40 years ofage or older and both sexes with equal fre-quency. Although it was previously referredto as “benign essential tremor”, it is nowclear that ET is far from “benign.” The dis-ease usually progresses slowly and causes ETpatients to develop significant problems withtheir normal daily functions such as eating,writing, self-care, and driving. Severelyaffected patients are unable to feed or dressthemselves.

Certain characteristics of the tremor distin-guish ET from other conditions. First, the tremor usu-ally involves both arms, and may also affect the head,jaw, and voice. Second, the frequency of the tremor isbetween 4 and 12 times per second. Third, the tremoris a “kinetic” or “action” tremor, meaning that thetremor is greatly increased with movement. This ismost obvious during voluntary movements such as writ-ing, dressing, pouring, eating, and other daily activities.Occasionally, patients may develop tremor at rest, usu-ally in later stages of the condition. In contrast, thetremor in Parkinson’s disease is quite different. Itoccurs primarily at rest and is often associated withrigidity, difficulty initiating movements, and/or postural instability.

The cause of ET is unclear. The tremor itself is thought to occur byabnormal communication among three parts of the brain: cerebel-lum, thalamus, and cerebral cortex.

There are several risk factors for ET. First, advancing age is a riskfactor. Second, ethnicity may be a risk factor. Studies have showna trend toward higher prevalence in Caucasians. Third, a family his-tory of ET is a separate risk factor. However, specific genes for EThave not yet been identified, and many patients with ET have noaffected relatives.

First-line therapy for ET is medical treatment with drugs such asprimidone and propanolol. Both of these medications reduce tremor,but usually do not completely eliminate the tremor. Often patientsmust weigh the benefits of partial tremor reduction against the risksof having intolerable side effects caused by these drugs, such asexcessive fatigue. Interestingly, the tremor in ET is often reduced byalcohol, but of course this cannot be considered a treatment!

When medications fail, in 50 percent of patients with ET, surgery canbe quite effective. The most common type of modern surgery for ETis deep brain stimulation (DBS) surgery. This involves placing a thinmetal electrode into a specific target in the brain. The primary tar-

get in the brain for ET is the thalamus, which is a large, ovalcluster of nerve cells important for many functions includingthe control of movement (Figure 1).

During the operation, the electrode is connected to a stim-ulator. Electrical stimulation of a portion of the thalamuscalled the ventral intermediate nucleus (Vim) can complete-ly and reliably stop a tremor on the opposite side of thebody. During testing, the patient is awake and comfortable.The reduction of tremor can be demonstrated during sur-gery using various tests (Figure 2).

In a separate operation about one week later, the electrodeis then attached to an implantable pulse generator (IPG),

placed under the skin in the chest(Figure 3). All parts of the DBS sys-tem are internal without any wirespenetrating through the skin.Stimulator settings are adjusted dur-ing a routine office visit to reduce oreliminate tremor while minimizingside effects such as tingling or slurredspeech.

DBS surgery for ET is extremely effec-tive in reducing tremor and improvingquality of life. The success rate oftremor reduction or elimination is 75to 90 percent. As a result, dailyactivities such as writing, eating, anddressing are improved significantly.The benefits of surgery persist for atleast 5 years.

The primary risks of DBS surgery arebleeding and infection. The mostserious potential risk is bleeding inthe brain. This risk is approximately3 percent, with approximately 1 per-cent of patients having a permanentdisability. Infection occurs in about 4percent of patients and is usually notlife-threatening although removal ofthe DBS system is sometimesrequired.

In summary, DBS of the thalamus is considered the treatment ofchoice for patients living with ET and disabling tremor uncontrolledby medications. These patients and their physicians deserve to beaware of this surgical option which can markedly improve the quali-ty of life.

Essential TremorDevin K. Binder, M.D., Ph.D.

Figure 1. MRI scan of the braindemonstrating the thalamus (redarrow).

Figure 2. Archimedes spiral” drawn by a right-handed ET patient before (left) and after(right) placement of the DBS electrode in theleft thalamus.

Figure 3. DBS system for ET withthe electrode in the left thala-mus connected via an extensionlead to the IPG (battery) in leftupper chest.

Reeve-Irvine Research CenterFor more information contact Dr. Kim Anderson

at 949-824-0056 or kanderso@uci.edu

Study 1 qualifications:- You have a spinal cord injury- Your injury was 1 year ago or more- You are 18 to 65 years old

Study 2 qualifications:- You have a cervical SCI or a lower thoracic SCI- You are 5 or more years post-injury

Study of Blood Sugar ControlThe Reeve-Irvine Research Center is conducting two research studies to determine more

details about how spinal cord injury damages the ability to control sugar levels in blood. Theinformation gained from this study will be used to help scientists and medical doctors developexperiments addressing these issues, with the aim of developing therapeutic treatments for

people living with SCI. All information will be kept stricly confidential.

5

6

and fusion (ACDF). This operation is performed from the front of theneck. The entire cervical disc at the affected level is removed (dis-cectomy). This takes the pressure off the nerves and spinal cord. Abone graft is then inserted into the empty space, or disc space, for-merly occupied by the disc. Placing the bone graft into the discspace reduces the chance that the cervical spine will develop anabnormal curvature. It will also prevent the bones of the cervicalspine from abnormally healing in a collapsed position, which couldalso compress the nerves. When the bone graft grows into the cer-vical vertebra on either side this is called a fusion. Often, at the timeof surgery, a metal plate will be placed on top of the vertebrae andthe bone graft using screws, which accelerates the fusion processand holds the spine in normal position during the healing process.

The relief of symptoms from this operation is usually excellent, butfusing the cervical spine does result in restricted motion at the lev-els fused. In turn, this results in increased mechanical stress at thespinal levels above and below the fusion. The increased stress cancause accelerated degeneration, or adjacent segment disease, at thelevels above and below the fusion. Sometimes the degeneration thatdevelops at the other spinal levels will also require surgery if symp-toms occur.

Spine surgeons have been interested in developing artificial discs forthe spine in an effort to preserve normal spinal motion and hopeful-ly to reduce the incidence of adjacent segment degeneration. Thefirst cervical artificial disc to become generally available in the U.S.was recently approved by the FDA and is called the Prestige Cervical

Disc. This disc was originally designed in Bristol, England in 1991.The first trials of this artificial disc took place in Europe and Australia.The design of this artificial cervical disc has evolved three times sincethen. The Prestige Cervical Disc is a metal-on-metal ball and troughdesign which reproduces as closely as possible, the normal move-ment of the disc and joints.

The Prestige Cervical Disc was investigated in the U.S. in a multi-cen-ter trial that included 541 patients, in which the placement ofPrestige Disc was compared to ACDF. The results of this studyshowed that the Prestige Disc was equal to ACDF in relief of arm painand better than ACDF in overall improved function of the patient; lessneck pain and earlier return to work. The neurological status of thePrestige Disc patients was significantly better at 12 and 24 monthsafter surgery compared to the patients undergoing ACDF. ThePrestige Disc patients also needed less surgical revision proceduresthan the ACDF patients. X-rays of Prestige Disc patients show thatcervical spine motion is maintained at that level.

It is not yet known whether motion-preservation techniques in spinesurgery such as the Prestige Cervical Disc will reduce the incidenceof fusion-related consequences such as adjacent segment degener-ation. Not every patient who needs cervical spine surgery is a can-didate for the Prestige Cervical Disc. However, the improved neuro-logical and functional outcomes of patients who received the PrestigeCervical Disc suggest that this alternative to traditional cervical spinefusion is currently an excellent option for selected patients.

Neuro-Oncology and the Management of Brain TumorsDaniela A. Bota, M.D., Ph.D.

More than forty thousand Americans are diagnosed with braintumors annually. Frequently after the patient learns the diagnosisthere is a sense of loss, menacing one’s identity and feeling of wellbeing. However the diagnosis also ushers in a time of hope. Manybeneficial treatments are currently available for brain tumors. Theyoffer a chance of a long and productive survival.

Symptoms preceding thediagnosis of a brain tumormay be related to the loca-tion of the tumor in a specificarea of the brain. These mayinclude weakness or numb-ness in an arm or leg, or dif-ficulty with memory orspeech. Loss of balance anddifficulty with coordinationmay occur in some patients.Adults with brain tumorssometimes have seizures as afirst symptom. Severeheadaches may occur insome patients, and thepatients may complain of dif-

ficulty thinking or of episodes of nausea and vomiting. Following theonset of symptoms the patients will typically see their primary carephysician who may recommend a MRI brain scan. Once the tumoris identified, neurosurgeons may perform a biopsy or a procedure toremove the tumor if possible. At this time, the specific type of tumorwill be identified. Subsequently a therapeutic approach, tailored foreach patient, will be put together by a team including a neurosur-geon, medical neuro-oncologist, radiation oncologist and varioussupport personnel.

Brain tumors represent a mass of abnormal dividing cells in the brain.There are many types of brain tumors, some of them arising from thecells of brain which are called primary tumors. Others reach thebrain through the blood from other organs, and these are metastat-ic tumors. Tumors are classified at the time of diagnosis which isoften accomplished by a pathologist’s examination of the tissue.Some are high grade tumors which enlarge rapidly, and others arelow grade tumors which are slow growing. The majority of primarybrain tumors do not spread to other organs, but they can invade andreplace normal brain. This can lead to serious, and possibly lifethreatening complications in the absence of treatment.

The management of every patient is highly individualized and is bestseen as a collaborative process between the patient and the neuro-oncology team. Tumor type, size and location are all considered inthis process. Treatment after surgery usually consists of radiationand chemotherapy. Recent research has helped physicians under-stand the molecular mechanisms that control brain cancer cellgrowth and division in a variety of brain cancers. These new devel-opments are very encouraging and have led to the initiation of newchemotherapy drugs which are aimed at prolonging the survival andwell being of many patients. The role of the chemotherapy is to killthe dividing cells. These drugs mostly target the abnormal cancercells while causing less damage to normal cells thereby reducing theeffects on blood cells and reducing the incidence of hair loss.

The last ten years have brought a time of major discoveries in neu-roscience and oncology. This has led to better ways to fight cancer.An increasing number of brain tumor patients are now long term sur-vivors of this devastating disease. An important component of careduring treatment is aimed at optimizing the patient’s quality of lifeand preparing them for healthy interaction with their families and thecommunity.

A MRI scan of an intracranial tumor inthe left parietal lobe

Cervical Disc Replacement (continued from cover)

Dear Friends:

We are writing to ask whether you would consider helping to makea real difference in the development of the faculty of neurologicalsurgery as well as the research and educational activities in theDepartment of Neurological Surgery at UC Irvine. The process of re-establishing a residency program in neurological surgery is wellunderway. This will enable us to acquaint young physicians with theskills they will need to master the goals of being competent and car-ing neurosurgeons. This is the realm of education. One of thecharges of our university residency program will be to encourage ourresidents, along with talented investigators, to explore, to question,to push beyond known boundaries, and in that process to developbetter, safer therapies for the neurosurgical diseases of mankind.This is the realm of research.

We are impressed by the immense potential for combining clinicalefforts at UC Irvine Medical Center with the work of world renownedbasic neuroscientists on the UC Irvine main campus. Research inbrain tumors, cerebrovascular disease, brain and spinal cord injuries,movement disorders, come quickly to mind. With the reestablish-ment of our residency program this will undoubtedly come tofruition, but this will develop much more quickly and at a higher levelof excellence with your help and participation. These activities willoccur in the laboratory, in the operating room, as well as at the bedside. In order to support these young people fullywith a first class educational and research experience, a UC Irvine Neurological Surgery Resident Education fund and a UCIrvine Neurological Surgery Research fund have been created. In addition, a fund to endow faculty chair in NeurologicalSurgery has also been established. A funded chair will enable us to recruit the best and brightest neurosurgeons into thishigh priced Southern California market.

We are seeking to raise a $2,000,000 fund to support resident education and a $2,000,000 fund to support neurosurgicalresearch. An endowment of $5,000,000 is needed to assure the establishment of a neurosurgical faculty chair. Funds forthe endowment will be reinvested until a minimum of $1,250,000 is attained. If the amount does not reach this numberby July 2010, the endowment fund, at that time, will revert to the research/education funds. These sums are very large,but we firmly believe it is an essential goal if we are to go beyond what we already know and what we are already doingin order to further improve the quality of the care we provide to our patients and our community. We would be honoredif you would consider a gift to this fund, which is fully tax deductible to the extent of the law. Your help would make agreat deal of difference to the quality of education that we can offer to our residents in the future. In turn, we aim torepay your thoughtfulness and generosity with new levels of skill, new therapies, and other research advances that willbenefit all who have need of us. Please join us in supporting this effort by considering a generous donation on either aone-time or annual basis.

Sincerely,

Mark E. Linskey, M.D.Chairman

young physicians with the

skills they will need to master

the goals of being competent

and caring neurosurgeons.

This is the realm of education.”

“...to acquaint

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Mr. & Mrs. Jerry AndersonMr. & Mrs. Jerry Bronaugh

Marie Chow ChuDavid Hartman

Lan HuynhBernadette Kramer

Mozelle LanierScott LarsonTong Van Lee

Susan Manrow Brenda Marshall

Mr. & Mrs. GeorgeMatsumoto

Mr. & Mrs. Robert Mattox

Jerry McCulloughDave McLaughlinHeather PappasJeffrey Pulver

Mr. & Mrs. Kurt ReinkeLouis E. Rodriguez

Nita ShyerMarion Sapiro

Sean B. SingletonMr. & Mrs. Jack Thornell

Mr & Mrs Aaron WestlakeMr. & Mrs. Jumbo Williams

Mr. & Mrs. John Ziemer

UNIVERSITY OF CALIFORNIA, IRVINE

DEPARTMENT OF NEUROLOGICAL SURGERY

Newsletter created by Stanley Lee

To schedule an appointment or to refer

a patient, please call (714)456�6392.

UC Irvine School of MedicineDepartment of Neurological Surgery101 The City Drive SouthBldg. 56, Ste. 400, ZOT 5397Orange, CA 92868-3298

WWe Appreciae Appreciate Yte Your Generous Donaour Generous Donations!tions!

If you do not wish to receive any UC Irvine Neurosurgery

fundraising communications,please call (714) 456-6966 or email stanley@uci.edu

PLEASE VISIT USONLINE AT:

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