There are neurosurgeons who make a mark — and then there’s Dr. Donald F. Dohn. On August 16, Don turns 100 years old, and we’re not just lighting candles — we’re celebrating a legacy that shaped the very foundation of modern neurosurgery. 
From his early days in Buffalo, New York, to the hallowed halls of the Cleveland Clinic, Don’s story is the stuff of legend. After earning his medical degree from the University of Buffalo, he trained under giants like Dr. Walter Hamby and Dr. W. James Gardner, Jr., becoming a force of nature in his own right. He didn’t just train neurosurgeons — he built neurosurgical training. Over 45 neurosurgeons and fellows passed through his tutelage as he helped formalize the educational structure of neurosurgical residency, moving it beyond the traditional apprenticeship model.
Chris was born Dec 22, 1961, in Milton, MA. His family had a legacy of several generations attending the prominent Milton Academy, and Chris followed in those footsteps, as he was often proud to point out. He attended Princeton University, followed by medical school at Tufts. His career was shaped by his neurosurgical training at Thomas Jefferson University, where he developed a passion for cerebrovascular surgery under the guidance of Dr. William Buchheit. He then pursued a fellowship in Pittsburgh under Drs. Peter Janetta, Dade Lundsford, and Douglas Kondziolka, where he honed his microvascular and radiosurgery skills.
Chris joined the faculty at Northwestern in 1996 after finishing training. It was a unique time in the department, as Dr. Hunt Batjer had started as Chair only the year before, and the faculty was being completely revamped. Chris came to Dr. Batjers’ attention when, at an AANS/CNS Joint Officers meeting at the O’Hare Hilton, Dr. Buchheit and Dr. Ed Laws approached him and said, “We have the perfect faculty member for your new department; his name is Chris Getch”. Hunt called his cell immediately and had a 30-minute discussion, followed by an invitation for an interview in Chicago. His recruitment provided Chris with an opportunity to play a significant role in shaping the program’s future. Chris rose to the rank of Professor of Neurosurgery at Northwestern and trained a generation of neurosurgeons during his time there. He was a master surgeon who delighted in performing rigorous cerebrovascular procedures, especially microvascular decompressions for trigeminal neuralgia and hemifacial spasm. He would show off the anatomy of a procedure to the entire operating room, explaining everything on the screen while mentoring the residents. He was fascinated by facial pain and even barged into one of our offices one afternoon, demanding to see a Schaltenbrand-Wahren stereotactic atlas to better understand the procedure that a patient he had seen in the clinic that day had undergone elsewhere.
We were his trainees (BB) and junior partners (BB and JR). Chris always made time to go over case plans with us and to join us in the operating room during the early years of our practice to provide support and technical assistance with challenging anatomy. His steady presence gave us the confidence to stretch our skills and become better surgeons. His rounds were legendary as he was able to spot subtle clinical signs and symptoms that remained invisible to the rest of the team. No one could sense the onset of vasospasm sooner than Chris. Neuroradiologists were always on alert for his phone calls to notify them of subtle findings they may have missed, but Chris did not. He was intense but amiable in how he challenged everyone around him. His laugh could be heard down the hall as he engaged students, colleagues, nurses, and partners in a jovial and collegial way that was his signature. He expected excellence but was the first to admit his failures and defeats. He would let you know when you fell short, but also acknowledged when you performed well. He suffered deeply with complications and always put his patients first. He was in love with the aesthetic of clean microsurgery and insisted on high standards of surgical finesse with his trainees. He was a superior partner who would come in on off hours and weekends to handle cerebrovascular cases that came into the hospital while someone not specializing in those patients was on call. In fact, the last case he performed was an aneurysm clipping on a Sunday morning in one of these situations. He published over 75 peer-reviewed papers and numerous book chapters related to the surgical treatment of cerebrovascular disease and facial pain.
Importantly, Chris had significant influence outside the operating room. He served on the Board of Think First and worked with the Brain Aneurysm Foundation. He was the President of the Illinois State Neurosurgical Society and a driving presence during the state’s medical malpractice crisis. He was elected to the Executive Council of the AANS/CNS Joint Section on Cerebrovascular Surgery and the Executive Committee of the Society of Neurological Surgeons. He served as a guest examiner for the ABNS oral exams.
He served the Congress of Neurological Surgeons (CNS) in numerous roles, including a 10-year term on the Executive Committee. He was Chair of the Host Committee for the 1997 Annual Meeting, Scientific Program Chair for the 2005 Annual Meeting, and Chairperson of the 2006 Annual Meeting. He served as Vice President of the CNS from 2009 to 2010 and as President of the CNS from 2010 to 2011.
Chris had four sons from his two marriages. He delighted in adding the suffix “bear” to their names whenever he spoke of them (no matter how old they were!). He loved watching them play sports and doing outdoor activities with them. A special place for Chris was his family’s camp in the Canadian wilderness. Whenever possible, they made a family pilgrimage to that site. He was an avid model railroad enthusiast who maintained a large setup in his basement to which he was always adding new and often rare train cars or scenery.
Tributes to Chris’ influence have abounded in the wake of his untimely passing in January 2012. In 2015, the CNS and the National Institute of Neurological Disorders and Stroke (NINDS) established the NINDS/CNS K12 Getch Scholar Award. This 2-year award, funded by the CNS Foundation and NINDS, supports young surgeons early in their practice who wish to develop into productive surgeon-scientists. The Northwestern University Department of Neurosurgery has endowed the Getch Lecture, given each year during resident graduation. In recognition of the value Chris placed on multidisciplinary collaboration, the Department annually awards the Christopher Getch Clinical Excellence Award to a non-neurosurgeon or group that significantly contributes to the Department’s mission. In addition, the Brain Aneurysm Foundation Medical Advisory Board and Board of Directors established The Christopher C. Getch, MD, Chair of Research. The Illinois State Neurosurgical Society annually gives a Christopher Getch Distinguished Service Award to a member neurosurgeon along with the ingredients for Chris’s favorite drink, the Dark and Stormy.
Authors:
Joshua Rosenow, MD
Northwestern University Feinberg School of Medicine
Chicago, IL
Bernard Bendok, MD
Mayo Clinic
Phoenix, AZ
Hunt Batjer, MD
University of Texas at Tyler School of Medicine
Tyler, TX
The Medicare physician payment system is on an unsustainable path that has failed to keep up with inflation over the years, threatening patient access to care. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are actively engaged in preventing steep Medicare payment cuts and preserving patient access to care through the Surgical Care Coalition. The coalition is in year three of its campaign to stop these cuts and implement lasting changes to the physician payment and quality improvement systems.
On Jan. 1, 2023, neurosurgeons face a minimum 8.5% Medicare payment cut, including a nearly 4.5% cut for all Medicare Physician Fee Schedule services and a 4% Statutory Pay-As-You-Go Act cut, triggered due to new federal spending. After successfully protecting patients’ timely access to quality surgical care in 2020 and 2021 by securing Congressional action to mitigate proposed cuts to Medicare, the coalition is fighting against similar cuts proposed for 2023. The AANS and the CNS are also working with Congress on long-term solutions to fix these broken systems. To that end, we submitted detailed comments in response to a Congressional request for information.
The people who the proposed cuts will most impact are our patients. Every day, neurosurgeons take care of some of the sickest patients who face painful and life-threatening neurologic conditions. Alexander A. Khalessi, MD, FAANS, John K. Ratliff, MD, FAANS and Maya A. Babu, MD, FAANS, share their experiences as neurosurgeons and how the cuts will impact neurosurgical practices and their patients. The videos are available as follows:
Patients Deserve Timely, Quality Care
Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @SurgeonsCare.
In Episode 4 of Neurosurgery Blog’s Faces of Neurosurgery interview series, we spoke with Volker K. H. Sonntag, MD, FAANS (L) about his proudest achievements, his favorite surgery to perform and one surgical instrument he couldn’t live without. Dr. Sonntag is an emeritus professor of neurosurgery at Barrow Neurological Institute in Phoenix, Ariz.
Dr. Sonntag is most proud of the nearly 300 residents and fellows he has trained over the years, and the legacy they carry from him. One of his biggest accomplishments was “putting spine on the map” in neurosurgery, and seeing spinal neurosurgery grow over the course of his career. His autobiography, “Backbone: The Life and Game-Changing Career of a Spinal Neurosurgeon,” is available now.
The full interview is available here and on Neurosurgery Blog’s YouTube channel.
Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FacesOfNeurosurgery.
In Episode 3 of Neurosurgery Blog’s Faces of Neurosurgery interview series, we spoke with Kim J. Burchiel, MD, FAANS, FACS, about his passions, his early mentors and what has driven him throughout his career. Dr. Burchiel is currently John Raaf Professor and Chairman Emeritus of the Department of Neurological Surgery at Oregon Health & Science University (OHSU).
Dr. Burchiel is most proud of his contributions to trigeminal neuralgia and deep brain stimulation, as well as building the department at OHSU. His favorite neurosurgical instrument is the computer, something that has changed the field more than anything else.
To the neurosurgeon in need of a book recommendation, he suggests “Undaunted Courage” by Stephen Ambrose — a book about the Lewis and Clark expedition to the west.
When asked about advice for individuals starting a neurosurgery residency, Dr. Burchiel said, “It’s very much like Lewis and Clark. It is a voyage into the unknown — a lot of difficulties lay ahead, and you need to be able to persevere, be resilient and you have to take it one day at a time.”
The full interview is available here and on Neurosurgery Blog’s YouTube channel.
Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FacesOfNeurosurgery.
In Episode 2 of Neurosurgery Blog’s Faces of Neurosurgery interview series, we spoke with R. Michael Scott, MD, FAANS (L), about his early mentors, proudest achievements, and musical hobbies. Dr. Scott is currently Neurosurgeon-in-Chief-emeritus at Boston Children’s Hospital and Christopher K. Fellows Family Chair in Pediatric Neurosurgery.
Dr. Scott says that one of his proudest achievements is leaving behind an extensive legacy of patients throughout his career, as well as the residents he helped train. He is also proud of helping to better define Moyamoya disease and its surgical treatment.
He offers the following advice for neurosurgery residents, “Becom[e] an expert in something that interests you as you’re getting into residency.”
The full interview is available here and on Neurosurgery Blog’s YouTube channel.
Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FacesOfNeurosurgery.
From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they are relevant to our readership. Today’s post originally appeared on FOX 5 Atlanta on May 26, 2021. In the video segment, Franklin Lin, MD, FAANS, a neurosurgeon at Wellstar Kennestone Hospital in Atlanta, Ga., and his wife decided it would be safest for him to move out of his home and into a hotel at the beginning of the COVID-19 pandemic.
“A couple weeks turned into three weeks, three weeks turned into four weeks, and the pandemic just kept getting worse,” said Dr. Lin. He would spend time connecting with his family over Zoom and across the fence of their Marietta home. After getting vaccinated, Dr. Lin wanted to make sure that he couldn’t unknowingly transmit the virus to others. In February, as it became clear that likely wouldn’t happen, he came home after spending 11 months in a hotel.
The full interview is available below and at FOX 5 Atlanta here.
Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FacesOfNeurosurgery.
In Episode 1 of Neurosurgery Blog’s new Faces of Neurosurgery interview series, Kalmon D. Post, MD, FAANS (L) was interviewed about his proudest achievements, his advice to graduating residents and his favorite surgical instruments. Dr. Post is currently the Department of Neurosurgery chair emeritus at the Icahn School of Medicine at Mount Sinai Hospital.
“I’ve done about 10,000 operations over [the] years, and I think taking care of people and their families has always been number one to me,” Dr. Post reflected on his proudest accomplishment.
To residents graduating and starting their careers, he says to remember, “First you’re not a neurosurgeon; first you’re a doctor. Think about the fact that you have patients and families in front of you, and your first goal is to comfort them and make them better.”
The full interview is available here and on Neurosurgery Blog’s YouTube channel
Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FacesOfNeurosurgery.
On average, someone in the U.S. has a stroke every 40 seconds. Acute ischemic stroke remains one of the leading causes of death and disability in the U.S. and around the world. The American Heart Association (AHA) estimates that in 2016 there were 5.5 million deaths attributable to cerebrovascular disease worldwide — 2.7 million of those deaths were from ischemic stroke. May is National Stroke Awareness Month and provides the opportunity to remember patients who are survivors of this dreaded disease and highlight the physicians and researchers at the forefront of progress to improve care and outcomes in stroke.
Over the last five years, there have been significant advancements in the treatment of acute ischemic stroke secondary to large vessel occlusion (LVO). LVO is an especially disabling form of ischemic stroke because a large territory of brain tissue and function is typically affected. Five landmark clinical trials published in the New England Journal of Medicine in 2015 and 2016 (MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, and REVASCAT) all demonstrated overwhelming benefit for mechanical thrombectomy for LVO. In summary, the studies suggested that only three patients need to be treated with thrombectomy to improve the functional outcome of one patient (number needed to treat (NNT) of 3). This makes mechanical thrombectomy one of the most effective treatments not only in stroke but in all of medicine. The AHA quickly amended its guidelines to recommend thrombectomy for ischemic stroke patients. However, the recommendation was reserved for a select number of indications, including:
- occlusions of the internal carotid artery (ICA) and proximal middle cerebral artery (MCA) segments of the cerebrovascular tree;
- those who had received intravenous (IV) tissue plasminogen activator (TPA);
- those with good baseline functional status; and
- those being treated within 6 hours of symptom onset.
These were significant steps in the right direction; however, there are still many patients who fall outside these indications which might benefit from mechanical thrombectomy.
Since then, indications for thrombectomy have expanded. In 2019, two additional trials were published in the New England Journal of Medicine (DAWN and DEFUSE3) that demonstrated similar positive outcomes in select patients being treated up to 24 hours from symptom onset. Research to establish the role of thrombectomy in several other groups of patients is ongoing, including studies involving:
- pediatric patients;
- the elderly;
- more distal occlusions in the cerebrovascular tree;
- posterior circulation occlusions;
- patients with mild stroke symptoms despite evidence of large vessel occlusion; and
- other conditions.
There remains much to learn about this powerful treatment, and hopefully, the indications for mechanical thrombectomy will continue to expand.
Another active area of research is the improvement in stroke care delivery. Researchers are developing new systems to administer care for stroke patients as quickly and efficiently as possible. Emergency medical services (EMS) and stroke triage systems are being redesigned, often across hospital systems. In some cases, the stroke care team is coming to the patient rather than the patient to the team. In other cases, patients with a high likelihood of LVO bypass closer primary stroke centers and are brought to comprehensive stroke centers for thrombectomy. Artificial intelligence-based tools help identify and select patients earlier for these advanced therapies. New diagnostic tools are being developed that can be utilized by EMS providers in the field. Robotic mechanical thrombectomy and the potential of tele-mechanical thrombectomy are exciting advances on the horizon.
Finally, stroke, large vessel occlusions and mechanical thrombectomy have become an area of interest amid the COVID-19 pandemic. Evidence is emerging from epicenters of the crisis — like New York City — that patients, whether afflicted with COVID-19 or not, are seeking medical attention later in their stroke course due to fears regarding COVID-19. We expect many studies to be published in the ensuing months evaluating stroke and mechanical thrombectomy in COVID-19 patients. We are excited about what the future holds in cutting edge research to bring the best available care to stroke patients everywhere.
Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.
Justin R. Mascitelli, MD
University of Texas Health Science Center at San Antonio
St. Luke’s Baptist Hospital
San Antonio, Texas
Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, PA
The COVID-19 pandemic has caused sweeping systemic changes to the landscape of medicine and society as a whole in the few short months since the virus arose. The pandemic has impacted all medical specialties, and those still in training have experienced significant disruptions to their education. Medical schools were quick to respond to the spread of the virus to keep medical students safe. The first warnings from the University of Rochester School of Medicine and Dentistry (URSMD) administration came in early March — students were informed that those who intended to travel during spring break might be required to quarantine upon their return. At the time, the magnitude of the impending pandemic was unknown, and social distancing measures were still on the horizon.
Initially, physical classes were canceled until late March, by which time any students who had traveled to a COVID-19 hotspot would have completed a 14-day quarantine. The plan was to resume regular classes and clinical experiences following this disruption. However, it became clear within a matter of weeks that this would be impossible. For the safety of students, faculty and patients, it was eventually decided that all physical classes and clinical experiences would be canceled for the foreseeable future. Students at all levels were placed in an uncertain position as it became increasingly clear that in-person learning would not be possible for the remainder of the year. This uncertainty fostered fear and anxiety among students — many of whom were also dealing with the stress regarding their safety and that of friends and family.
For preclinical students like myself, we have been utilizing remote learning for the remainder of the year, which has been a significant disruption to our training. In particular, clinical learning has been impaired due to the difficulty of mastering medical history taking and physical exam techniques over Zoom instead of in-person practice with classmates and standardized patients. Another challenge has been coordinating exam proctoring for students who are in different time zones. Some students who have been planning summer research at other institutions or projects involving clinical or volunteer work have had their plans canceled.
Second-year students have been particularly concerned about the logistics of their upcoming United States Medical Licensing Exam (USMLE) Step 1 exams, given that social distancing measures preclude the use of physical test sites. Third-year students have been unable to complete their clinical rotations and have experienced considerable stress due to the ongoing uncertainty in scheduling away rotations for their fourth year. Fourth-year students have had their graduation and Match Day celebrations converted to online events. Graduation has also been moved up. Depending on their specialty of choice, some newly minted physicians have been called upon to begin their residency training early to respond to the COVID-19 pandemic.
Many student doctors have been frustrated because they are unable to contribute to patient care during this crisis. It has been challenging to find ways to help without potentially compromising patient safety. Despite these challenges, medical students at all levels and from all over the country have stepped up to do what they can to support the medical community during this crisis. During the initial stages of the pandemic, students volunteered their time to provide childcare for physicians called to the front lines and organized efforts to produce personal protective equipment (PPE) for health care workers. Additionally, students have made an effort to publicize clinical trials that need healthy volunteers, and the University of Rochester Medical Center (URMC) has initiated a program to recruit volunteer lab techs to help with COVID-19 research. The administration at URSMD has also sent out a request for medical student volunteers who might be called upon to assist in patient transport, ventilator preparation, and supply transport, as well as serving as respiratory care assistants if needed.
Medical education faces challenges moving forward. At this time, it is unclear when or if in-person education can resume. There have already been substantial efforts to promote methods of distance learning for medical students and residents, including Zoom-based lectures and an increased emphasis on online resources. However, this leaves something to be desired for hands-on clinical education, which does not lend itself well to remote learning. It is not clear when clinical rotations can be safely resumed, or when students will once again be able to schedule away rotations. The uncertainty surrounding away rotations is of particular concern for those students who are preparing to apply to residency in the coming year. It also remains to be seen how this crisis will affect the residency match process in the future. Many students have also had research or volunteering opportunities canceled due to the pandemic, and the future of USMLE board exams remains in doubt for the time being.
As a whole, medical educators and students have risen to the challenge of COVID-19. Medical educators have dedicated extra time and effort to minimize disruptions and to maximize students’ learning experience. Many medical students have helped their communities wherever possible and are responding admirably to the unprecedented disturbance in their education. Reactions like these foster hope that both students and educators will continue to work tirelessly to respond to crises as they arise.
Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.
Stephen Susa
First-year Medical Student
University of Rochester School of Medicine and Dentistry