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Brain Tumor Nonprofit StacheStrong Donates $110,000 for the Launch of the SNS Neurosurgeon-Scientist Training Program

By Brain Tumor, Career, TumorNo Comments

The Society of Neurological Surgeons (SNS) has established a Neurosurgeon-Scientist Training Program (NSTP) to increase the pool of neurosurgery residents conducting research and to enhance their success rate in becoming independent neurosurgeon-scientists. The NSTP will serve as a formal mentored research program for those neurosurgery residents who are beginning a protected research year or have already completed their protected research year.

The primary goal of this new program is to improve human health by providing participants with the skills, mentorship, education and experience needed to successfully compete for individual research funding (e.g., National Institutes of Health K awards and R01 research grants). Additional research by clinician-scientist neurosurgeons is critical to the fundamental discovery that advances new methods of care and new cures.

A donation of $110,000 by the non-profit StacheStrong provides crucial funding for brain tumor-related grants with the launch of the NSTP. StacheStrong is devoted to raising funds and awareness for brain cancer research. Defeating brain cancer and improving the quality of patients’ lives is the mission of StacheStrong.

Click here to read the press release.

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, @SNS_Neurosurg and @StacheStrong and using the hashtag #BrainCancerResearch.

January 13, 2023
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Increasing Patient Access to Stereotactic Radiosurgery through Innovation

By Brain Tumor, Tumor, Tumor SeriesNo Comments

Neurosurgery supports and welcomes transparent physician-industry interactions to foster healthy relations and spur innovative device development to benefit patients. Within the specialty of neurosurgery, there are numerous examples of just such benefits, including increased access to stereotactic radiosurgery (SRS). SRS is a treatment that delivers radiation to precise targets in the brain, such as tumors, while minimizing injury to adjacent areas.

As part of the ongoing Neurosurgery Blog Tumor Series, Deborah L. Benzil, MD, FAANS, FACS, interviewed Stefan Vilsmeier, the CEO and founder of Brainlab. Mr. Vilsmeier discusses why he founded the company and how his software and hardware have increased neurosurgical patient access to SRS. Mr. Vilsmeier observed that many institutions created homegrown radiosurgery systems, but there were no commercially available options.

Brainlab created an innovative software and hardware for performing SRS to provide greater treatment access through standardization. Taking it a step further, Brainlab offers the Novalis Circle, a user group to ensure quality, and Novalis Certified Accreditation Program to promote the delivery of radiosurgery at a level of efficacy and safety commensurate with the highest standards of clinical practice.

The interviews are available here and on Neurosurgery Blog’s YouTube channel.

Part I: What is stereotactic radiosurgery?

Part II: Dr. Benzil’s interview with Mr. Vilsmeier

Editor’s Note: Ethical interactions between industry and health care professionals are essential to strengthening patient trust in the health care system. The Open Payments system, also known as the Sunshine Act, is a federal program that collects information about the payments drug and device companies make to physicians and teaching hospitals. The data the Centers for Medicare & Medicaid Services collect is published annually.  

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 @NSTumorSection and using the hashtag #TumorSeries.

October 27, 2022
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Brain Tumors, Drug Development and Neurosurgeons: Ending the Losing Streak

By Brain Tumor, Tumor, Tumor SeriesNo Comments

For many neurosurgeons, years of training and technical refinement culminate in safely removing a patient’s brain tumor. We dedicate our careers to shepherding people past this inflection point, but the patient journey does not end there. For those with malignant tumors, our surgical heroics are quickly unraveled by tumor recurrence. Theoretically, adjuvant medical therapy should firewall patients against this reality; however, as we all know, no drug today provides much security to brain tumor patients. Our specialty is uniquely positioned to do something about this. Drug development is no longer the sole domain of oncologists, and some of the most impactful drug studies live in our operating rooms.

Conventional clinical trials are exercises in tremendous faith: an educated guess matches a patient to a new drug, followed by months of therapy (and side effects), ending with an MRI that provides, at best, an indirect measure of putative drug effect. For neurosurgical oncologists, Phase 0 and window-of-opportunity clinical trial paradigms offer a different take: brief, presurgical exposure to the experimental therapy, followed by a tumor resection that allows for direct measurement of drug penetration and target modulation in the patient’s own tissue. If the drug proves its worth in the patient’s tumor, the patient can remain on the drug long-term. In other words, safe and rapid quantification of drug effects in the end-user without sacrificing the one commodity all malignant brain tumor patients have in short supply — time.

It was nearly 20 years ago that the Food and Drug Administration last approved a new drug capable of extending high-grade brain tumor patients’ lives. Let that sink in for a moment, and allow yourself to question everything about it. This 20-year losing streak we are all living through is not happening for lack of effort or expertise. We are all aware of the unique challenges facing brain tumor drug development:

  • Poorly-predictive animal models;
  • Unclear tumor driver mutations;
  • Poorly brain-penetrant drugs;
  • Insufficient translational science funding;
  • Small market size; and
  • Patient risks from aggressive treatment.

These realities, and our accompanying track record, suggest that current systems governing oncology drug development should make way for a new paradigm — accelerated early-phase clinical trialing that quickly identifies and prioritizes drugs that deliver on their promise and, with equal analytical ruthlessness, eliminates those that do not.

Understanding the varied dimensions of drug development is a tall order for any specialty. But decades ago, ours made a concerted effort to expand the neurosurgeon-neuroscientist footprint. Today, an entire generation of us are as fluent in the laboratory as in the operating room. Drug development is our next frontier. For neurosurgeons like myself who are engaging in it, each patient’s operation has become a beginning instead of an end.

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 @NSTumorSection and using the hashtag #TumorSeries.

Nader Sanai, MD, FAANS
Barrow Neurological Institute
Phoenix, Ariz.

September 6, 2022
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University of Miami Increases Neuro-Oncology Collaboration and Mentorship Through Innovative New Fellowship Program

By Brain Tumor, Tumor, Tumor SeriesNo Comments

Neurosurgery has a long history of mentorship through a trainee’s dedicated time under a more experienced surgeon’s tutelage. Surgical training has long been considered a more advanced form of apprenticeship, mastering a skill under a more experienced practitioner’s guidance. In this tradition, the Sylvester Comprehensive Cancer Center — part of the University of Miami Miller School of Medicine — has launched an International Neuro-oncology Scholars Program (INOSP) that allows neurosurgery trainees to join internationally renowned brain tumor experts in other countries to increase their experience.

The goal is to enhance education and facilitate multi-institutional collaboration. The INOSP program is made possible by a generous gift from a grateful donor family. The plan is to support four traveling rotations each year.

Charles Teo, MD, IFAANS, left, with neurosurgery fellow Daniel Eichberg, MD.

“INOSP represents a unique resource offered to our fellows to visit and learn from world-renowned experts in neurosurgical oncology,” said neurosurgeon Ricardo J. Komotar, MD, FAANS, FACS. He continued, “The goal of the program is to enhance further their neurosurgical training so that they may be able to translate these techniques to our patients. With this international collaboration, we ultimately hope to improve clinical outcomes and enhance surgical education.”

The inaugural recipient of INOSP was neurosurgery fellow Daniel Eichberg, MD, who spent two weeks in Sydney, Australia, learning from highly accomplished neurosurgeons Charles Teo, MD, IFAANS and Michael Sughrue, MD, at Prince of Wales Hospital in Randwick, Australia.

“The opportunity to learn minimally invasive keyhole approaches for complex brain and skull base tumors in one-on-one training sessions from two of the most experienced neurosurgeons in these techniques was a powerful experience and augmented my skillset for cranial neurosurgery,” said Dr. Eichberg.

Dr. Sughrue and Dr. Teo have developed the world’s most advanced technology for mapping the brain’s functional and structural connectivity, which may be markedly abnormal in patients with brain tumors. Providing a better understanding of an individual’s connectome — a map of the brain’s overall connectivity — may critically impact brain tumor surgical outcomes by minimizing postoperative deficits, predicting recovery and maximizing the amount of tumor that can safely be removed during surgery.

Furthermore, this brain mapping technology uses machine learning and artificial intelligence techniques to guide non-invasive transcranial magnetic stimulation (TMS)-based neuro-interventional rehabilitation to improve postoperative brain tumor patients’ strength and speech deficits.

As a result of the international collaboration fostered by INOSP, Sylvester and the University of Miami Department of Neurosurgery will partner with the Sydney team in the Glioma Connectome Project. This endeavor seeks to learn how gliomas cause the brain to reorganize its connectome and initiate a TMS Neuro-interventional Rehabilitation prospective clinical trial.

“Not only are we now able to give our neurosurgical fellows access to additional world-renowned brain tumor experts and each of their unique skills, but we are also seeing that these new international relationships lead to groundbreaking global collaborative research and enhanced clinical trials that will continue to allow us at Sylvester to be able to provide the most advanced and world-class brain tumor treatments possible to our patients,” said program co-director Michael E. Ivan MD, MBS, assistant professor of neurosurgery.

Ashish Shah, MD; Alexis Morell, MD; Ricardo J. Komotar, MD, FAANS, FACS and Christopher A. Sarkiss, MD

Additionally, in 2019, the AANS/CNS Tumor Section, in conjunction with the CNS Foundation, created the International Observership Program, which will allow an Argentinean neurosurgeon to participate as an observer for three months at the University of Miami in the division of surgical neuro-oncology. The rotation focuses on all central nervous system tumors, with participation in clinic, conferences, surgery, and consultations.

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 @NSTumorSection and using the hashtag #TumorSeries.

Ricardo J. Komotar, MD, FAANS, FACS
University of Miami Miller School of Medicine
Miami, Fla.

May 10, 2022
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Socioeconomic Status and Short-term Glioblastoma Survival: Does it Make a Difference?

By Brain Tumor, Tumor, Tumor SeriesNo Comments

The recent COVID-19 pandemic highlighted socioeconomic differences in health care access detrimental to the outcome, including a per capita excess mortality highest among the Black and Latino population. The prognostic role of socioeconomic factors for patients diagnosed with glioblastoma multiforme (GBM) has been hotly debated. GBM is the most common malignant primary brain tumor in adults and affects 3.3 percent of pediatric brain tumor patients. The disease has made headlines in recent years with the diagnosis of high-profile political figures such as President Biden’s son Beau Biden and the late Sens. Ted Kennedy and John McCain. Significant advances in surgical and adjuvant treatments for this disease have had a positive impact on short-term survival. Yet, there is a still-very-low five-year survival rate in adults, around 5.5 percent. As new therapeutic approaches develop, prolonging short-term survival coupled with high quality of life remains a priority when caring for patients with GBM.

Our medical predecessors named the deadliest brain tumor “glioblastoma multiforme” long before the field of molecular biology was established. Yet, they already recognized the complexity of this disease and its heterogeneity by calling it multiforme. We now know that its molecular features are numerous. Different “clusters” of cells with different molecular signatures pose a significant challenge in developing patient-specific therapies even within the same tumor. In addition to differences in each tumor’s molecular signature, other environmental factors might contribute to the speed of disease progression.

 

A recent study collected data from 28,952 patients diagnosed with GBM from the publicly available National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer registry. The authors found that socioeconomic status affected overall short-term survival, and patients with higher median household incomes had significantly higher short-term survival. Additionally, patients owning a private insurance plan had lower short-term mortality than those who were Medicaid recipients. When considering the ethnic background, Asian/Pacific Islander patients had the highest short-term survival. Black patients with GBM had the highest mortality due to non-GBM related causes, such as cardiac and stroke events.

The above study also corroborated that Non-Hispanic White (NHW) represented 80 percent of the patients affected by GBM, while they only represent 60 percent of the U.S. population. The higher incidence of GBM in the NHW population corroborates previous studies. Multiple factors can contribute to this discrepancy, including the possibility that this increased percentage is biased by health care access disparities. Other factors that may contribute to such discrepancy could be related to differences in tumor genetics, highlighted by the glioma genome-wide association study (GWAS).

Providing the best care to all patients regardless of ethnic background and socioeconomic status remains a high priority in all medical and surgical disciplines, including neuro-oncology. Moving forward, additional studies are needed to deepen our understanding of the impact on the outcomes of such factors. Further clarifying and identifying differences in health care access, socioeconomic factors, and racial diversities will allow us to develop new and more focused strategies to fight GBM and co-morbid non-GBM related causes of death in our patients.

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 @NSTumorSection and using the hashtag #TumorSeries.

Isabelle M. Germano, MD, MBA, FAANS, FACS
The Mount Sinai Medical Center
New York, NY

March 11, 2022
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Neurosurgical Oncologists as Champions of Diversity, Equity and Inclusion

By DEI, Neuro-oncology, Tumor SeriesNo Comments

Recent events of systemic discrimination have led to national introspection on the importance of tolerance and diversity. The tragic killing of George Floyd in May 2020 was a sentinel event that raised awareness of the pervasive nature of systemic discrimination and served as a significant impetus for positive change. This was a clear reminder that we still face substantial challenges to tolerance and equal treatment for all as a society. It is also a unique opportunity to reflect on our common purpose as humanity.

In the immediate aftermath of Mr. Floyd’s death, many organizations issued statements reaffirming their commitments to promoting and advancing diversity through anti-discriminatory policies and initiatives. On their part, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released the following joint statement:

As a profession, we in neurosurgery aim to promote the highest quality of patient care and advance the specialty of neurosurgery and neurosurgical education while espousing the values of integrity, leadership, excellence, and professionalism. As organizations and as a profession, we are committed to inclusion and diversity within our neurosurgical community. As neurosurgeons, we are committed to providing the highest quality of care to all segments of our society. Indeed, our principles are only relevant to the extent they apply to the most disadvantaged in our society.

The Society of Surgical Oncologists (SSO) also released a similar statement:

The Society of Surgical Oncology condemns racism and violence in all forms. We recognize racism as an underpinning to health disparities, and recent events serve as a clarion call to all of us that there is a need to do more than what we do on a daily basis — provide the best cancer care to individual patients regardless of race, ethnicity, gender, sexual orientation, or socioeconomic status.

Diversity requires the core elements of equity and inclusion. Equity requires deliberate, fair and just treatment of our patients and colleagues irrespective of their background. Inclusion requires a conscious effort in thoroughly engaging diverse patients and colleagues in all aspects of the care we deliver and the decisions that govern our care through tolerance. Through equity and inclusion, our colleagues and patients feel respected and valued.

A firm commitment to the core elements of diversity is critical to the impactful delivery of neurosurgical care to society’s most vulnerable members. In treating life-threatening disorders of the nervous system, neurosurgeons can positively impact patients from all works of life. To render the best possible care, neurosurgeons should understand the diverse patient population they serve in the context of race, gender and ethnicity. When we deliver neurosurgical care in an atmosphere of tolerance and understanding, we serve as role models to those who look up to us.

Neurosurgical oncologists are integral to cancer care in the central nervous system, one of the most critical battle lines in the fight against systemic cancer-related morbidity and mortality. Despite advances in oncology, there is still a considerable disparity in cancer care. Racial and ethnic minorities and lower socioeconomic patients are disproportionately impacted by cancer. As part of the multidisciplinary management of diverse patients with central nervous system tumors, neurosurgical oncologists perform surgeries, stereotactic radiosurgery and clinical trials. Therefore, it is imperative for neurosurgical oncologists to incorporate diversity-informed clinical decision-making approaches to positively impact cancer patients who are affected by health disparities. Moreover, neurosurgical oncologists should be mindful of the barriers and challenges to recruiting underrepresented minorities into clinical trials, given historical precedence of mistrust. Identifying, acknowledging and addressing such barriers would undoubtedly enhance participation.

From a workforce perspective, organized neurosurgical oncology should strive to reflect the diverse cancer patient population they serve. Concerted efforts are needed to diversify the pool of neurosurgeons. We should strive to attract, train and mentor neurosurgeons from under-represented groups into the subspecialty of neurosurgical oncology. If we embrace diversity efforts, we should also establish benchmarks to assess progress in this journey. Beyond diversity in its members’ composition in general, neurosurgical oncology should strive to include diverse membership and leadership in committees. Such diversity efforts will strategically position us to address the neurosurgical oncologic needs of a multifaceted society uniformly.

As a profession, we should strive for the ideals of diversity and its associated tenets of equity and inclusion. Neurosurgical oncologists are in a unique position to understand and reduce health disparities. Our patients deserve that from us. We should never forget that our future is only as bright as the future of the patients whom we serve.

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, @AANSDiversity and @NSTumorSection and using the hashtag #TumorSeries.

Arnold B. Etame, MD, PhD, FAANS

Moffitt Cancer Center

Tampa, Fla.

February 2, 2022
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Introduction to Tumor Focus Series: Bringing “Better” to Our Patients in Multiple Ways

By Tumor, Tumor SeriesNo Comments

Neurosurgery has historically been a uniquely wide-ranging and varied specialty. Unlike other specialties that focus on a particular organ system or body region, neurosurgery is quite literally a “head-to-toe” specialty dealing with the brain, spinal cord, peripheral nerves and the other organs intimately related to the nervous system. Neurosurgeons classically had to be experts in a wide variety of surgical procedures and disease processes. As medical knowledge and technology have advanced, neurosurgeons have evolved with medicine to become experts in particular disease processes, leading to a reorganization of neurosurgery into sub-specialty disciplines.

Over the years, the Neurosurgery Blog has partnered with various neurosurgery subspecialty sections to provide an update on the state of the subspecialty, highlight current issues, add to the conversation and portray their concerns to a non-specialized audience. Today’s neurosurgeon must be facile in many different areas — both medical and non-medical. As medical care and health care delivery have grown increasingly complex, neurosurgeons must wear several hats: surgeon, team-member in multi-disciplinary care teams, teacher, scientist and advocate.

We partnered with the AANS/CNS Joint Section on Tumors for the following series of blogs. Under the guidance of Tumor Section chair, Jason P. Sheehan, MD, PhD, FAANS, and AANS/CNS Washington Committee representative, Michael A. Vogelbaum, MD, PhD, FAANS, members of the section came together and produced a sweeping overview of ongoing topics:

  • Arnold B. Etame, MD, FAANS, leads us off with a piece about diversity in neurosurgical oncology. Isabelle M. Germano, MD, FAANS, FACS, then tackles disparities in access to care and outcomes in brain tumor patients.
  • Ricardo J. Komotar, MD, FAANS, FACS, reports on efforts in education and collaboration on an international scale. Edjah E. Nduom, MD, FAANS, speaks to brain tumor advocacy, providing an overview of the outward-looking direction of some of our efforts.
  • Michael Lim, MD, FAANS, and Nader Sanai, MD, FAANS, bring us two pieces highlighting the ability of neurosurgeons to translate discoveries from the lab into patient care and back again and how neurosurgeons contribute to drug development in the increasingly complex fight against brain tumors. These pieces are complemented by an article by Manish K. Aghi, MD, PhD, FAANS, updating the role of neurosurgeons in clinical trials and research in neurosurgical oncology.

Academic publishing, the Journal of Neuro-Oncology, and the dissemination of scientific results, particularly in the era of the COVID-19 pandemic, are at the center of a piece by Dr. Sheehan and Christopher P. Cifarelli, MD, PhD, MMM, FAANS, FACS. Dr. Vogelbaum presents “A Neurosurgical Perspective on Multidisciplinary Care for Patients with Brain Tumors,” emphasizing the team-based nature of neuro-oncology care today.

In the era of a worldwide pandemic and an increasingly complex care delivery environment, neurosurgeons are playing more and more roles in delivering better care to our patients. This is especially true in the field of neurooncology. We hope that these blogs inspire you to join the efforts of this important field. The amount of work that the members of the section and the authors, in particular, put into these issues outside of patient care is astonishing and deserves credit!

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 @NSTumorSection and using the hashtag #TumorSeries.

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

January 20, 2022
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