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Department of Surgery » Neurosurgery » Neurosurge » Volume 8.3

Volume 8: Issue 3 November 30, 2006



In This Issue:

From the Chairman's Office
Honors and Awards
Visiting Professorships
Residents' Corner
Question of the Month
PDF of the Month
Website of the Month
Upcoming meetings


This year's E Harry Botterell Lecturer in Neurosurgery at TWH was Professor Ziya Gokaslan from Johns Hopkins University Medical Center on October 30-31, 2006. Dr Gokaslan gave lectures on the surgical treatment of spinal cord ependymomas, the management of spinal column neoplasms, and sacral tumors. He also adjudicated over the case presentations by the residents, and the research presentations by the residents for the William J Horsey Prizes. This year's Horsey Prize Winners were: First Prize, Amro Al-Habib; and second prize, Scellig Stone. The social event for the lectureship was held at Hemispheres restaurant in Toronto. Special thanks are given to Michael Fehlings for organizing the Horsey Prize competition, and to Eric Massicotte for organizing the Scientific Program. I should also like to thank Chris Wallace and the neurosurgeons at TWH for hosting and sponsoring the 24th Annual E Harry Botterell Lectureship, one of our great annual educational offerings for residents, fellows, and faculty. Please see attached photos taken during the Botterell Lectureship.

City Wide Rounds this month were held on Friday November 24th, 2006, at SickKids Auditorium in honour of Mark Bernstein and his award winning lecture entitled: "The voices of neurosurgeons". Mark had received the Kurze Award from the American Association of Neurological Surgeons last April for his efforts in non-medical writing. At City Wide Rounds, Mark provided us with an inspired lecture and an update on his latest writings. Mark is the first U of T neurosurgeon who has been asked to give City Wide Rounds since 1999. Thank you Mark!

Ab Guha recently presided over the Society of Neuro-Oncology's (SNO) Annual Meeting in Orlando, November 16-18, 2006, as president. SNO has become the largest society for neuro-oncology in the world. It is a true testament to Ab's abilities that he has risen to the position of president of SNO. His term as president lasts two years, and he has now completed his first year. Congatulations to Ab on this wonderful achievement!

Gregory Hawryluk and Michael Fehlings were awarded a grant by the Craig H. Neilsen Foundation to support their research involving stem cell-based approaches to repair spinal cord injury.

Michael Taylor was appointed to the Awards Committee of the Society for Neuro-Oncology.

Karen Davis was appointed as Head of the new research division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute .

Mike Schwartz was Course Director for the Canadian Radiosurgery Society (CaRS) Meeting, Niagara-on-the-Lake, November 17-18, 2006

Andres Lozano was named the 2006 Inventor of the year, University Health Network.

Abhaya Kulkarni was awarded the Roscoe Reid Graham Scholarship from the Department of Surgery. This is a 3 year award offering research support for the recipient's research program. Congratulations Abhaya!

Peter Dirks and his research program on brain tumour stem cells were featured in the Globe and Mail, Saturday, November 25, 2006 with regard to stem-cell science.

Michael Fehlings received a Canada Foundation for Innovation (CFI) grant for his work on The Regenerative Medicine Project.

Greg Hawryluk received an AO North America Resident Trauma Research Grant


Akiyama T, Otsubo H, Ochi A, Galicia EZ, Weiss SK, Donner EJ, Rutka JT, Snead OC 3 rd . Topographic movie of ictal high-frequency oscillations on the brain surface using subdural EEG in neocortical epilepsy. Epilepsia 47:1953-7, 2006

Weyerbrock A, Mainprize T, Rutka JT. Endoscopic fenestration of a symptomatic cavum septum pellucidum: technical case report. Neurosurgery, 59:ONS-E491, 2006

Tamber MS, Bansal K, Liang ML, Mainprize TG, Salhia B, Northcott P, Taylor M, Rutka JT. Current concepts in the molecular genetics of pediatric brain tumors: implications for emerging therapies. Childs Nerv Syst 22:1379-1394, 2006

Bernstein M: The dog in me. Dogs in Canada, November 2006, page 41

Bethune A, Houlden D, Smith T, Yee A, Midha R, Singrakhia M. Generalized Peripheral Nerve Failure During Thoracic Spine Surgery: A Case Report. Journal of Clinical Monitoring and Computing (2006). Published Online at http://www.springerlink.com/content/9q62006p40610781/fulltext.pdf

Andrade-Souza YM, Ramani M, Scora D, Tsao MN, TerBrugge K, Schwartz ML. Radiosurgical treatment for rolandic arteriovenous malformations. J Neurosurg 105:689-697, 2006

Weinberger M, Mahant N, Hutchison WD, Lozano AM, Moro E, Hodaie M, Lang AE, Dostrovsky JO. Beta oscillatory activity in the subthalamic nucleus and its relation to dopaminergic response in Parkinson's disease. J Neurophysiology. Sep 27, 2006

Lozano AM. Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotactic Funct Neurosurg;84:248-251, 2006

Furlan JC, Krassioukov AV, Fehlings MG. Hematological abnormalities within the first week after acute isolated traumatic cervical spinal cord injury: A case control cohort study. SPINE:31(23):2674-2683, 2006


Jim Rutka as the Janes Visiting Professor gave the Chung Lectureship at the University of British Columbia, Department of Surgery, Vancouver, B.C. November 7 & 8 th , 2006.

1/ "Astrocytoma invasiveness: Molecular mechanisms from the leading edge". 2/ "Dangerous River". 3/ "Malignant brain tumors: Past present and future perspectives".

Jim Rutka was the Guest Speaker at the "20th Anniversary Symposium, A celebration of 20 years of clinical neuroscience" at Brown Medical School. "Malignant Brain Tumors: From a difficult past to a promising future" Providence, RI. November 11, 2006

Mark Bernstein was Guest Lecturer at the Division of Neurosurgery, University of Toronto City-Wide Rounds. "The Voices of Neurosurgeons". November 24, 2006:

Gregory Hawryluk was an invited speaker at The Second Annual Ontario Emergency Medicine Symposium hosted by McMaster University, "Traumatic Brain Injury: The Basics, Some Less Basics, and the Ultimate Importance of Cerebral Autoregulation". November 18, 2006.

Charles Tator gave the Keynote address at the Toronto Acquired Brain Injury Network Conference 2006. Brain Injury and Beyond: Looking Back, Thinking Forward. "Epidemiology and Prevention of Head Injuries in Sports and Recreation". Toronto, Ontario. November 24, 2006

Charles Tator was Guest Speaker at the Canadian Paraplegic Association Ontario Knowledge Mobilization Seminar Series. "Stem Cells for Repair of the Injured spinal Cord". Toronto, ON. November 29, 2006

Charles Tator gave the Keynote Presentation at the 2 nd National Spinal Cord Injury Conference, "What Regenerative Strategies Exist and are in Development that will be Applicable for Chronic Spinal Cord Injury Patients?" Toronto Rehabilitation Institute, Toronto, Ontario, October 27-28, 2006.

Charles Tator was an Invited Speaker at the British Cervical Spine Society. 1/ "Return to Play Guidelines for Athletes with Spinal Injuries or Other Spine Conditions". 2/ "Review of Experimental and Clinical Strategies to Enhance Recovery and Regeneration of the Injured Spinal Cord". Glasgow, Scotland, November 10-11, 2006.

Charles Tator was an Invited Speaker at the ThinkFirst Concussion Road Show. "Concussion Management in Sport: Diagnosis, Treatment and Return to Play". Toronto, Ontario, November 18, 2006.

Michael Taylor was an Invited Lecturer at the Head Start Prinicipal Investigators Meeting. 1/ "Molecular Predictors of Prognosis for Medulloblastoma". 2/ "Proposed Molecular Biological Studies on the Headstart IV Protocol". Los Angeles, California, October 2006

Michael Taylor was an Invited Speaker at the Pediatric Brain Tumour Foundation Annual Meeting. "Building a Blueprint for Brain Cancer".             Ashville, North Carolina, November 2006

Julian Spears sat on the International HHT Guidelines Expert Panel developing Guidelines for the Management of Brain Vascular Malformations in HHT. Toronto, November 15-16, 2006

Michael Cusimano was an Invited Speaker at the Ontario Public Health Association 2006 Conference. "Using Geomatics to Better Understand Patterns and Determinants of Traumatic Injuries". Cornwall Ontario, October 26, 2006

Karen Davis was an Invited Speaker at the Blaustein Pain Rounds at Johns Hopkins Hospital. "Imaging Pain Perception". Baltimore, Maryland, October 27, 2006

Jim Drake attended the Intracranial Neuroendoscopy Workshop at Weill Medical Cornell University, New York City, New York, November 17-19, 2006

Jim Drake attended the Hydrocephalus Board and Network meetings., Denver, Colorado Nov.28/06

David Houlden was an Invited Speaker at the Southern Society of Electroneurodiagnostic Technologists 47th Annual Meeting and Seminars. "Cranial Nerve Monitoring". Jacksonville, Florida, November 10, 2006

Andres Lozano was an Invited International Guest, European Society for Stereotactic and Functional Neurosurgery. 1/ "What have we learned from single cell recordings in the operating room?" 2/ "Clinical trials in Functional Neurosurgery". Montreux, Switzerland Oct 4-7, 2006

Andres Lozano was the Sutcliffe Kerr Lecturer, University of Liverpool, U.K.. "The Future of Neurosurgery". Oct 26, 2006

Ab Guha gave an Invited Talk at the Society of Neurooncology. "What is the best pre-clinical animal model of brain tumors". Lab talks presented 1/ "GATA-6 is an astrocytoma tumor suppressor gene identified by gene trapping of genetically engineered mouse glioma astrocytes"; 2/ "Molecular and transformation properties of genetically modified synthetic astrocytes differentiated from embryonic stem (ES) cells in-vitro"; 3/ "Differential expression of angiopoietin receptor complex and neuropilin-regulates heterogeneous vasculature within GBMs in a VEGF dependent manner"; 4/ Intratumoral Variations of Glycolytic Metabolism at the Molecular and MR Imaging Level in Glioblastoma Multiforme (GBM)"; 5/ "Identification of neurofibromin interacting proteins using mass spectrometric analysis"; 6/ "Genetic alterations in the initiation and progression of NF1 deficient Schwann Cells in Peripheral Nerve Sheath Tumors (PNST)". Orlando. Nov 15-19, 2006

Michael Fehlings was the Grass Visiting Lecturer in Neuroscience, University of Manitoba,. "Repair and Regeneration of the Injured Spinal Cord - Opportunities for Clinical Translation of Basic Research Discoveries". November 23/24, 2006

Michael Fehlings was an Invited Speaker at the Dutch Spine Society. 1/ "Current state-of-the-art in the diagnosis and treatment of traumatic spinal cord injury with focus on timing of Surgery"; 2/ "Cervical Bilateral Facet dislocation, Anterior Surgical Approach Posterior Approach". Netherlands, Nov. 2-4, 2006

Michael Fehlings was an Invited Speaker at the Management of the Neurotrauma Patient, San Francisco, CA. 1/ "Spinal Mechanisms, Cervical Classification, Case Dx, and Stabilization"; 2/ "STASCIS Update". November 11-12, 2006

Michael Fehlings was an Invited Speaker at Cedar Sinai, Los Angeles. 1/ "Repair and Regeneration of the Injured Spinal Cord: From Basic Science to Clinical Application". 2/ "Current Concepts and Future Directions in the Management of Clinical Myelopathy". November 28, 29, 2006

Hockey Match - Faculty versus Residents. Varsity Arena, Saturday, December 9th, 2006 @ 10 p.m. Please sign up with Stephanie. 416-813-8441 or stephanie.neilson@sickkids.ca

Gregory Hawryluk moderated November's online discussion forum for the Surgery in Africa series based on his chapter "Traumatic Brain Injury-Management in Africa" which was co-authored with Dr. M. Bernstein.


QUESTION OF THE MONTH (Prepared by Robin Humphreys)
An individual sustained a knife wound damaging a spinal nerve adjoining its entry to the spinal cord. If one could examine this peripheral nerve, which of the following would most likely be observed?

A. A displacement of the nucleus toward the periphery of the cell.
B. A mitotic division of the neuronal cell body.
C. A more intense staining of the cell body.
D. Degeneration of processes along the axon proximal but not distal to the lesion.
E. An initial loss of mitochondria in the axoplasm at Ranvier's node.


A high school student sustained a concussion while playing football. A few weeks later he was noted to be tilting his head to the right. It was thought that he had sustained a neck injury but on inquiry he stated that he had double vision and that the images were situated on top of each other vertically making it difficult to go down stairs. Upon testing by the team physician, it was determined that when his head was in the erect position, his left eye would not move downward when his eyes were turned to the right, and they tended to remain slightly deviated to the left. At this point he stated that he had doubled vision and felt better if his head was tilted to the right. The remainder of his eye movements as well as the remainder of his examination was normal.

1. Where did the damage occur?
2. Which muscle was weakened?
3. From which portion of the brainstem did the damaged nerve emerge?
4. What was the action of the weakened muscle?
5. How could the head trauma have caused the double vision?

Damage to the trochlear nerve causes weakness of the superior oblique muscle, resulting in inability of the eye to deviate downward when it is intorted. To compensate for the classic vertical diplopia, the patient tilted his head to the contralateral side, causing the contralateral eye to intort. The trochlear nerve originates in the periaqueductal grey matters and supplies the superior oblique muscle. It is also the only cranial nerve to emerge from the dorsal aspect of the brainstem; in this case it departed from the right dorsal midbrain. The action of the superior oblique muscle is to rotate the eye medially and downward. As the trochlear is not only the smallest cranial nerve (it has only one isolated function) but also runs the longest course of any cranial nerve, it is especially vulnerable to trauma, which is one of the most common causes of trochlear nerve weakness.  

JAMA 296: 2441-2450, 2006
JAMA 296: 2451-2459, 2006

These two PDFs provide the long-awaited results of the Spine Patient Outcomes Research Trial (SPORT) trial for lumbar disk disease. This was a large study which compared the results of observation versus standard open disk removal in the management of patients with lumbar herniated disk disease. I encourage you to read these two PDFs, and especially the Editorials which occurred in the same issue of JAMA. No doubt, this study will be discussed at the upcoming Spine Block Curriculum, or at a future journal club for the residents.


By going to this website, you will be linked to historical articles which review the progress of the neurosciences over the last several decades. These articles are found on the Nature Neuroscience Reviews site, and can be downloaded for free.


Department of Surgery, University of Toronto Surgical Rounds, Friday, December 1st @ 7:30 a.m. Sunnybrook Health Sciences Centre, Harrison Hall, EG 21. Dr. Clifford Ko, Associate Professor, UCLA Department of Surgery, Los Angeles, California. "What are we doing to improve the quality of care in surgery ... and is it working?"

Craniofacial surgery & Transfacial Approaches to the Skull Base. St. Louis, MO, December 2-3, 2006

19th Annual Contemporary Update on Disorders of the Spine, Whistler, BC, January 13-19, 2007

20th Annual Marshall Lectureship, Dr. Sean Grady, Charles Harrison Frazier Professor & Chairman of Neurosurgery, The Hospital of the University of Pennsylvania. Thursday, January 18 th , 2007 5 - 6 p.m., Main Auditorium, The Hospital for Sick Children.

2nd Annual International Spine Surgery Symposium, Kohala Coast, Big Island, Hawaii. January 21-25, 2007

2007 International Stroke Conference, San Francisco, California, February 7 - 9, 2007

Epilepsy, Mind & Brain, Prague, Czech Republic, March 2-4, 2007

7th Annual Meeting Canadian Spine Society, Mont-Tremblant, Quebec, March 21-24, 2007.

2007 AANS/CNS Section on Tumors Seventh Biennial Symposium, Washington, DC. April 13-14, 2007

2007 American Association of Neurological Surgeons Annual Meeting, Washington, DC, April 14-19, 2007

2007 NASBS Annual Meeting, Chicago, Illinois, May 24-27, 2007. Abstract Deadline February 1 st, 2007.


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

Friday, December 1, 2006
Topic: Asymptomatic Aneurysms
Incidence, Prevention, Natural History of Asymptomatic Aneurysms: Merdas Al-Otibi
Familial Aneurysms: David Cadotte
Aneurysms Associated with Other Diseases : Suneil Kalia
Imaging of Aneurysms: Ronit Agid

Friday, December 8, 2006
Topic: Subarachnoid Hemorrhage
Incidence, Diagnosis of SAH: Carlo Santaguida
Management of SAH: Cian O'Kelly
Surgical Management of Aneurysms: Julian Spears
Endovascular Management of Aneurysms: Seon Kyu Lee

Friday, December 15, 2006
Topic: Cerebral Vasospasm
Vasospasm: Definition and Incidence: Victor Yang
Prevention vs. Treatment: Todd Mainprize
Diagnosis and Imaging: Robert Willinsky
Treatment decision planning: Chris Wallace


Monday, December 18 th , 2006. Location TBA

Tuesday, December 12th, 2006, Room 7246, Black Wing, The Hospital for Sick Children 7 - 8 a.m.

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