Guest post written by multiple surgeons from the Department of Neurological Surgery at Cleveland Clinic.
Deborah L. Benzil, MD, FAANS (top left); Andre Guelman Machado, MD, PhD, IFAANS (top right); Thomas E. Mroz, MD (bottom left); and Michael P. Steinmetz, MD, FAANS (bottom right).
LeBron James have departed for the sunny west coast, but Cleveland still claims bragging rights as the home of the Rock and Roll Hall of Fame as well as being the birth and resting place of Harvey Cushing, MD, considered the father of neurosurgery. Nearly 100 years ago (1921), the Cleveland Clinic (CC) was founded here and has since grown to become internationally renowned. George Crile, MD, a founder, practiced significant neurosurgery and in 1924 appointed Charles E. Locke, Jr., MD, the first chair of neurosurgery. Today, the Department of Neurosurgery is part of the Neurological Institute and continues to lead the way with innovation in clinical care, education and research with distinguished programs in spine, stereotactic radiosurgery (cranial and spine), laser ablation, complex epilepsy and the frontiers of functional neurosurgery.
This article is part of a two-part blog series. Part one will focus on educational innovation, functional neurosurgical advances as well as relate the success of programs for diversity and inclusion.
Educational Innovation
As a core value of the institution since inception, education has been a high priority, and the Department of Neurosurgery has led the way demonstrating innovation in education over several decades, particularly during the leadership of Edward C. Benzel, MD, FAANS. Just a few notable accomplishments include:
- Early adoption of comprehensive written evaluations using ACGME core competencies;
- Full integration of “Ethics in Practice” curriculum;
- Utilization of resident/fellow portfolios;
- Comprehensive socioeconomic education;
- Formal coaching and mentoring programs;
- Unique spine research club involving two medical schools;
- “Teach the Teachers” program including surgical and clinical feedback tools; and
- Premier program of empathy as key to quality and outcomes.
Such programs have allowed the residency program to grow and thrive. In addition, there are very active and competitive surgical fellowships in spine, functional, epilepsy, skull-base, and neuro-oncology.
Cutting Edge Functional and Epilepsy Teams
DBS and Rehab for Stroke
Stroke is the leading cause of long-term disability in the United States and the industrialized world. To date, physical rehabilitation is a proven treatment to promote stroke rehabilitation and is effective. Unfortunately, almost half of stroke survivors suffer from significant levels of disability that require assistance with activities of daily living long-term. Therefore, new technologies are needed to promote stroke rehabilitation outcomes.
Our neurosurgical functional research group at the CC has proposed that facilitation of the dentato-thalamo-cortical pathway can reverse the negative effects of crossed-cerebellar diaschisis (shocked dysfunction) and promote plasticity in the cortex surrounding the stroke (perilesional), improving long-term outcomes. Based on years of preclinical experimentation, we have shown that deep brain stimulation at the origin of the dentato-thalamo-cortical pathway promotes perilesional excitability, plastic reorganization of the perilesional cortex and expression of markers of long-term potentiation. Encouraged by preclinical results, we have translated our novel approach to a first-in-man clinical trial targeting deep brain stimulation at the dentate nucleus in patients with chronic hemiparesis after stroke (lost use of one side of their body). Similar to the result in our preclinical work, we have shown significant modulation in excitability of the perilesional cortex and improvements in strength (motor outcomes). The intervention has so far proven safe, and the results are encouraging. We continue to enroll qualified patients who suffered a stroke within the last three years
Diversity and Inclusion
Under the direction of Andre Guelman Machado, MD, PhD, IFAANS, a neurosurgeon and chair of the Neurological Institute, diversity and inclusion have received strategic importance. Through these pioneering efforts, the cultural change has been realized with a positive ripple effect on caregiver morale, recruitment and retention, as well as patient quality and safety. In a subspecialty that still trains just 16 percent women and where women represent well less than five percent of practicing neurosurgeons, the Cleveland Clinic’s department boasts six women neurosurgeons with a seventh just recently retired representing tumor, vascular, spine and pediatrics. Even more impressive, six of our 21 residents (nearly 30 percent) are female. Clearly, the leadership has worked hard to create a welcoming, inclusive environment for all.
Part two of this blog will focus on several aspects of innovation in spine care through Cleveland Clinic’s Center for Spine Health. Stay tuned!
Editor’s Note: We encourage everyone to join the conversation online by using the hashtags #NeurosurgeryMonth and #NeurosurgeryAwarenessMonth.
