Volume 6: Issue 6
February 28, 2005

NEUROSURGE

MONTHLY INFORMATION FROM THE CHAIRMAN'S OFFICE

UNIVERSITY OF TORONTO, DIVISION OF NEUROSURGERY

In This Issue:

From the Chairman's Office

Honours and Awards

Publications

Visiting Professorships

Residents' Corner

Question of the Month

PDF of the Month

Website of the Month

Upcoming Meetings

FROM THE CHAIRMAN'S OFFICE
This year's Annual Arthur and Sonia Labatt Brain Tumour Research Centre
Academic Lectureship took place on February 3rd, 2005. The invited keynote
speaker was Dr Darell Bigner from the Duke University Comprehensive Cancer
Center. Dr Bigner spoke on the latest trends in immunotherapy clinical
trials and research. Please see attached photo below.

A hands-on course in epilepsy surgery was held Saturday February 12th, 2005
for the neurosurgery residents in the Program at the Surgical Skills
Centre, Mt Sinai Hospital. Dr's Valiante and Rutka were the course
instructors. Residents learned advanced approaches to epilepsy surgery
including temporal lobectomy, corpus callosotomy, and peri-insular
hemispherotomy. Please see attached photo below.

This year's annual Keith Visiting Professor was Dr Richard G Fessler from
the University of Chicago, February 14-15, 2005. Dr Fessler helped to
adjudicate over the Morley Prize awards presentations, and delivered 4
separate lectures on topics in his field of interest, minimally invasive
spinal neurosurgery. The Scientific Symposia were organized by Dr's Eric
Massicotte and Michael Fehlings. This year's Morley First Prize Award
recipient was Sheila Singh, and runner-up award winner was Bradley Jacobs.
Special thanks are given to those residents who presented research work
outside the Morley Prize competition, and to those who presented
interesting spinal cases to Dr Fessler. Please see the attached photo
below of the residents with Dr Fessler.

IN MEMORIAM
Dwight Parkinson, Dr. F.R.C.S.(C) On Tuesday, February 1, 2005 Dwight
passed away peacefully, with family present, at the Grace Hospital. Dwight
was born in Boise, Idaho on May 14, 1916. He attended Dartmouth College
graduating in 1938. He attended McGill University in Montreal and obtained
his degree in Medicine in 1941, and a Master of Science in Neurosurgery at
the University of Minnesota in 1949. His training was interrupted by the
war where he served with distinction as a Battalion Surgeon with the 104th
Division in France, Belgium and Holland. He rose to the rank of Captain and
was awarded two bronze stars. Dwight completed his surgery residency at
Mary Hitchcock Hospital in Hanover New Hampshire in 1946 and his
neurosurgery residency at Mayo Clinic in Rochester, Minnesota from 1946 to
1949. He brought his young family to Winnipeg just before the great flood
of 1950 and filled a need in Manitoba as the only Neurosurgeon for many
years. He was certified F.R.C.S.(C) in 1951 and by the American Board of
Neurological Surgery in 1952. Dr. Parkinson was appointed Chief, Section of
Neurosurgery, Health Sciences Centre which encompassed the Winnipeg General
Hospital, Children's Hospital, Rehabilitation Hospital, Women's Centre, and
Psychiatric Hospital, and also held this position in the Faculty of
Medicine, University of Manitoba from 1957 until 1981. His contributions to
the Neurosurgery scene have been many over the years, most notably the
practical Simultaneous Stereo AP and Lateral Rapid Serial Cerebral
Angiography equipment, developed in conjunction with the Picker X-ray
Company and Dr.A.E. Childe; the Neurosurgical Headholder and Cassette
Changer providing Intraoperative Rapid Serial Angiography; his description
and naming of the anastomotic arteries between the two parasellar portions
of the internal carotid artery; and the description of the relationship of
the cranial nerves in the parasellar region, The Triangular Space. He is
perhaps best known for his approach to the Direct Repair of Carotid
Cavernous Fistula with Preservation of the Carotid, a method which paved
the way for further development. Dwight's teaching and research at the
Anatomy Department of the University of Manitoba continued after his
retirement from neurosurgery, right into the week of his death, during his
89th year. In addition to being the First President of the Canadian
Neurosurgical Society he has served as Past President for the Knowles
School for Boys, Police and Pal, Winnipeg Medical Society, Winnipeg Medical
Historical Society, Rehabilitation Hospital Staff, St. Charles Country
Club, Manitoba Golf Association, Canadian Society of Neurological Surgeons,
American College of Surgeons, Manitoba Chapter; and former Governor for the
Manitoba Chapter of the American College of Surgeons, as well as for the
Royal Canadian Golf Association.

HONOURS AND AWARDS
Peter Dirks received the 2005 Royal College Medal Award in Surgery

Jim Rutka received a 1 year grant from Brainchild for his work entitled
“Vascular Endothelial Growth Factor Genetic Polymorphisms in Paediatric
Brain Tumor Angiogenesis”.

Jim Rutka received a 5 year grant from the CIHR for his work entitled “Role
of cytoskeletal GTPases in astrocytoma motility”.

Ab Guha was on the CIHR grant review panel: Feb 20-22, 2005. Ottawa

Andres Lozano was appointed to the International Executive Scientific
Advisory Board, Michael J. Fox Foundation for Parkinson’s Research.
2005-2006

Andres Lozano has been appointed as Chair, Archives Committee, Movement
Disorder Society. 2005-2007 and to the Congress Scientific Program
Committee (CSPC), Movement Disorder Society. 2005-2006

Dr. Michael Fehlings has been appointed to the Board of Directors of ONE
Spine, a non-profit organization whose mission is to optimize and unify
education and research among neurological and orthopaedic spine surgeons in
order to improve patient care.

Dr. Michael Fehlings is cited in the Who’s Who Medical Sciences Education
(WWMSE).

Dr. Michael Fehlings and Dr. Alexander Velumian won the 1st place poster
award in the Basic Science category from the Heart and Stroke Foundation of
Ontario for their poster entitled "Unlocking the puzzle of ischemic spinal
cord injury: investigations of oligodendrocyte-myelin-axonal signalling"
which was presented at the Heart and Stroke Clinical Update conference in
December 2004. This award included prize money in the amount of $600.

Dr. Baylis Vivek Joseph, a Spine Fellow for 2005-06, is the Recipient of
the 2005 Sonntag International Fellowship Award of USD$5,000 from the
AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves,
which will be presented at the Annual meeting, March 11, 2005 in Phoenix,
Arizona.

Sheila Singh won first prize for the 2005 Thomas P. Morley Neurosurgical
Resident competition. February 15th, 2005

Brad Jacobs won second prize for the 2005 Thomas P. Morley Neurosurgical
Resident competition, February 15th, 2005.

PUBLICATIONS
Hamani C, Hodai M, Lozano AM: Present and future of deep brain stimulation
for refractory epilepsy. Acta Neurochir (Wien). Jan 31; 2005

Taylor M, Chambers A, Perry J, Bernstein M, and the Neuro-Oncology Disease
Site Group: Evidence-based review of the role of surgery for malignant
glioma. Current Oncology 11:53-62, 2004

Chang SM, Parney IF, Huang W, Anderson FA, Asher AL, Bernstein M, Lillehei
KO, Brem H, Berger MS, Laws ER, for the Glioma Outcomes Project
Investigators. Patterns of care for adults with newly diagnosed malignant
glioma. JAMA 293:557-564, 2005

Bernstein M: Muddy motives. When countries provide humanitarian aid, does
it matter why? University of Toronto Bulletin Number 11, pg. 8, January 24
2004.

Perrin RG, Bernstein M. Tension pneumoventricle after placement of a
ventriculoperitoneal shunt: A novel treatment strategy. Case Report. J
Neurosurg 102:386-388, 2005

Bernstein M: Immigrants - More is better for Canada. The Weekly Voice
January 28 - February 3, 2005

Wong AS, Massicotte EM, Fehlings MG. Surgical treatment of cervical
myeloradiculopathy associated with movement disorders: Indications,
technique, and clinical outcome. J Spinal Disord Tech. 18 Suppl:S107-14,
2005

Ghassan SS, Fehlings MG, Bouclauos CH. Medical and surgical management of
pyogenic and nonpyogenic spondylodiscitis: Part I. Contemporary
Neurosurgery 26(19):1-6, 2004

Ghassan SS, Fehlings MG, Bouclauos CH. Medical and surgical management of
pyogenic and nonpyogenic spondylodiscitis: Part II. Contemporary
Neurosurgery 26(20):1-6, 2004

Ghassan SS, Fehlings MG, Bouclauos CH. Medical and surgical management of
pyogenic and nonpyogenic spondylodiscitis: Part III. Contemporary
Neurosurgery 26(21):1-6, 2004

Ghassan SS, Fehlings MG, Bouclauos CH. Medical and surgical management of
pyogenic and nonpyogenic spondylodiscitis: Part IV. Contemporary
Neurosurgery 26(22):1-4, 2004

Hunter JP, Katz J, Davis KD: Dissociation of phantom limb phenomena from
stump tactile spatial acuity and sensory thresholds. Brain, 128:308-320,
2005.

Kwan CL, Diamant NE, Mikula K, Davis KD: Characteristics of Rectal
Perception are
Altered in Irritable Bowel Syndrome. Pain,113:160-171, 2005

Iida K, Otsubo H, Matsumoto Y, Ochi A, Oishi M, Holowka S, Pang E, Elliott
I, Weiss SK, Chuang SH, Snead OC, Rutka JT. Characterizing magnetic spike
sources by using magnetoencephalography-guided neuronavigation in pediatric
epilepsy surgery. J Neurosurg 102:187-196, 2005

VISITING PROFESSORSHIPS
David Houlden was an Invited Speaker at the American Society for Peripheral
Nerve Annual Meeting. "Neurophysiology in Nerve Surgery", Puerto Rico.
January 15-16, 2005.

Andres Lozano was an Invited International Speaker at the Pre-Olympic
International Neurosurgical Winter Meeting . “A re-evaluation of
neurosurgery for psychiatric disorders.” Sestriere, Italy. February 21,
2005

Peter Dirks was an Invited Speaker at the American Society of Pediatric
Neurosurgery, Annual Meeting, Wailea, Hawaii, "Brain Tumor Stem Cells:
Seeds of Brain Tumor Growth" January 31, 2005

Peter Dirks was an Invited Speaker at the Tandem Bone Marrow Transplant
Meetings, Keystone, Colorado, "Identification of Brain Cancer Stem Cells",
February 11, 2005.

Jim Drake attended the ASPN Meeting, Four Seasons Ballroom, Maui, Hawaii 1/
Moderator:Scientific Session III: Hydrocephalus. 2/Abstract Presentation
"Late Rapid Deterioration after Endoscopic Third Ventriculostomy".
3/Closing Remarks. February 2, 2005

Jim Drake attended the Canadian Pediatric Neurosurgery Group Meeting in
Whistler, BC. 1/ Endoscopic Third Ventriculostomy: The Canadian Experience
– Update. 2/ Bactiseal – a Mini-study. 3/ Telemedicine – Feedback from
January 20th Session. Feb.25-27, 2005

Michael Fehlings was Co-Chairman of the AO ASIF Advanced concepts in
Management of Spinal Disorders, Sun Valley Resort, Sun Valley, ID, Feb.
3-6, 2005:

Michael Fehlings was an Invited Speaker at Update on Studies re.
CervicalMyelopathy, AOSpine North America Scientific Committee meeting.
Pathophysiology and Pharmacology of Spinal Cord Injury February 14-15,
2005

Michael Fehlings was Co-Chairman Pittsburgh Neurotrauma Senior Residents
Forum, Pittsburgh, PA February 26-27, 2005

RESIDENTS’ CORNER
Faculty vs. residents hockey match Sunday, April 3rd, 2005, 5 to 6 p.m.,
Varsity Arena.

QUESTION OF THE MONTH (Prepared by Robin Humphreys)
With regard to experimental design, which of the following statements
is/are true?

A. The control group is the group chosen to receive no therapy.
B. A blinded procedure is one where neither the patient nor physician
knows what therapy is administered.
C. Randomization is a method to avoid observer bias.
D. Placebos are medications of different action than the test substance.

ANSWER TO THE LAST QUESTION (January NEUROSURGE Volume 6; Issue 5)
The answers are 1-E, 2-B, 3-C, 4-D, 5-A

A lesion situated in the caudal aspect of the right dorsomedial pons (E)
will affect the nucleus of the cranial nerve VI along with surrounding
tissue. This will invariably include the fibers of cranial nerve VII which
wrap around the nucleus of cranial nerve VI. As a result, there will be a
loss of facial expression on the right side because cranial nerve VII
innervates the muscles of facial expression, along with an inability to
move the right eye laterally because cranial nerve VI innervates the
lateral rectus muscle. When cranial nerve VI is involved in isolation there
is failure of abduction of the ipsilateral eye (A).

Cranial nerve III innervates all the rectus muscles except the lateral
rectus. Therefore a patient sustaining a lesion of this nerve will be able
to move the eye on the affected side medially (B).

The fourth cranial nerve (C) innervates the superior oblique muscle which
moves the eye downward from a medial position. This movement most often
occurs when one walks down a flight of stairs.

A lesion of the right medial longitudinal fasciculus (D) will disrupt axons
that arise from the nucleus of cranial nerve VI of the left side that cross
over and ascend to the oculomotor complex. Thus, this lesion would produce
a dissociation of horizontal eye movements in which gazing to the left
would result in a paresis of right ocular adduction together with monocular
horizontal nystagmus in the left (abducting) eye.

PDF OF THE MONTH
In this PDF, Mark Bernstein’s bold and pioneering work on outpatient
craniotomy is hi-lited in Oncology Exchange 3:20-23, 2004

WEBSITE OF THE MONTH
http://www.emedicine.com/med/topic3177.htm

At this web address, a review of current procedures used in the surgical
management of patients with epilepsy is described. As the residents in the
Program have just finished their block curriculum sessions on epilepsy,
and a recent hands-on course in surgical epilepsy procedures, this would be
timely review material for all.

UPCOMING NEUROSURGICAL MEETINGS AND EVENTS
Department of Surgery University Rounds, Palmer Lecture, Friday, March 4th,
2005 @ 7:30 a.m., Toronto Western Hospital, Auditorium. Dr. Steven A.
Curley, Professor, Surgical Oncology, MD Anderson Cancer Center, the
University of Texas.

Canadian Congress of Neurological Sciences, June 14-18, 2005, Ottawa,
Ontario.

Gallie Day, May 6, 2005. This year’s lecturer is Dr. David Herndon.

Congress of Neurological Surgeons, Boston, Massachusetts, October 8-13,
2005. Abstracts can now be submitted to
http://www.abstrak.com/core/cns2005

NEUROSURGERY RESIDENT SEMINARS, 9 a.m. to noon, Room 1527, The Hospital for
Sick Children

March 4, 2005

Dr. Jim Drake: Hydrocephalus I: Shunts
Dr. Sheila Singh: Split-cord malformation
Dr. Sami Khoshyomn: Intraventricular hemorrhage
Dr. Jay Riva-Cambrin: Scalp and skull tumours

March 11, 2005

Dr. James Rutka: Encephalocele
Dr. Jim Drake: Hydrocephalus II: Endoscopy
Dr. Robin Humphreys: Shunt complications

March 18, 2005

Dr. Peter Dirks: Myelomeningocele
Dr. Mandeep Tamber: Embryology of neural tube defects
Dr. Robin Humphreys: Lipomyelomeningocele, dermal sinus tracts and the
tethered cord

March 25, 2005

Cancelled, Good Friday

HEADS OF DIVISIONS MEETING
Thursday, March 31st, 2005, 0700 to 0800 hours, North Conference Room, The
Hospital for Sick Children

RESIDENCY PROGRAM COMMITTEE MEETING
Tuesday, March 22nd, 2005, 0700 to 0800 hours, North Conference Room, The
Hospital for Sick Children.