For the first time in history at Tallahassee Memorial Hospital, 5 neurosurgeons were simultaneously operating in 5 separate operating rooms. I’m proud to be a part of this great practice!
I’m honored to present a lecture on July 12, 2017, at the TMH Neuroscience Grand Rounds. I will be speaking about current treatments for patients with brain metastases. This is a CME event for physicians.
Are you a physician? Interested? Call TMH at 850-431-5875 to reserve your spot!
I’m pleased to be one of the invited speakers to the Baptist Health Care Stroke Symposium in Pensacola, set for May 19, 2017. I’ll be speaking about Hemorrhagic Stroke as well as the role of the TMH Comprehensive Stroke Center in our community.
This conference is geared for all health care providers, including physicians, ARNPs/PAs, nurses, therapists, and EMTs/paramedics. CEUs are provided.
Although Dr. Lawson specializes in cerebrovascular surgery & endovascular neurosurgery, he also performs complex cervical and lumbar spine surgery. Roughly 45% of his practice is related to brain tumor surgery and cerebrovascular/endovascular neurosurgery (brain aneurysms, stroke, AVMs, and carotid disease). The other 55% is general neurosurgery, including complex cervical and lumbar spine surgery. In fact, Dr. Lawson performs much of the complex cervical spine surgery at TMH.
Recently, a young man presented as a trauma alert to the hospital with a suspected spinal cord injury. He was involved in an accident and was unable to use his arms or legs. His initial CT scan of the cervical spine demonstrated a C4 burst fracture with central canal compromise. This is a complex fracture that resulted in a spinal cord injury.
An MRI was performed, which confirmed the degree of spinal cord compression and injury. It was felt that surgery was his most reasonable treatment option. Surgery would involve two procedures: an anterior cervical corpectomy and a posterior cervical stabilization.
In the images to the left, we can see the axial CT scan, which shows the C4 burst fracture, a lamina fracture, and central canal compromise.
The MRI image seen to the left (below the axial CT scan), shows some central spinal stenosis with edema of the spinal cord. The spinal cord is the gray structure in the middle of the image, running from top to bottom. There is white, haziness noted in the cord, which is spinal cord edema (this is indicative of a spinal cord injury). One can also appreciate how the fractured bone pushes into the spinal cord.
Clinically, this patient had a severe spinal cord injury, with the inability to move his arms or legs upon arrival to the hospital.
After the MRI study, he was taken to the operating room for surgery. This consisted of two stages, anterior and posterior. In the anterior stage, a small incision made on the front of the neck and a C4 corpectomy was performed. In this procedure, the fractured vertebral body is removed, along with the disc above and below the fracture. This is done to take all of the pressure off of the front of the spinal cord and remove the fractured bone. Next, a bone strut (cadaver bone — fibula strut graft) is placed in the defect to reconstruct the spinal column and allow the neck to bear weight. A
cervical plate is then placed from C3 to C5 to hold the strut in place.
Next, the patient was flipped into the prone position (face down) so that the second phase of the procedure can be performed on the back of the neck. A posterior cervical stabilization with lateral mass screws and rods was performed from C3 to C6. In addition, a cervical laminectomy was performed at C3 to C5 to ensure decompression of the spinal cord.
The final result is the x-ray seen below. In this x-ray you can see that the C4 fracture has been removed, a bone strut is in its place, there is an anterior cervical plate (on the front of the spine) as well as posterior screws & rods (on the back of the spine).
This patient did very well after surgery, and regained partial use of the right arm and leg. He was transitioned to rehabilitation. Clearly, he has a long road of rehabilitation in front of him for his spinal cord injury, and we are excited to see how he is doing at the six month interval.
Dr. Lawson performs numerous cervical spine procedures, including:
- ACDF (Anterior Cervical Discectomy and Fusion) – a common procedure for treatment of herniated cervical discs, typically causing neck and arm pain.
- Posterior Cervical Laminectomy and Fusion – for treatment of cervical stenosis and cervical myelopathy.
- C1-2 Stabilization – for instability, fracture, or compression at C1 or C2. Most commonly, this is for treatment of C2 fractures or rheumatoid arthritis with compression of the spinal cord at C1-2.
- O-C Stabilization – for instability, fracture, or compression at the craniocervical junction.
- Complex cervical spine procedures (such as the C4 corpectomy and posterior stabilization described above) for the treatment of deformity or fracture.
Neck pain? Cervical spine fracture? Click here to contact Dr. Lawson and make an office appointment.
The most common brain tumors are actually metastatic brain tumors, or cancerous tumors from other parts of the body that have spread to the brain. Common cancers that cause brain metastases include breast cancer, lung cancer, renal cell cancer, and melanoma. In fact, brain metastases are nearly twice as common as primary brain tumors, which are tumors that start in the brain itself (have not spread from some other cancerous site).
Each year in the US there will be about 250,000 people diagnosed with a new brain metastasis, as opposed to about 80,000 primary brain tumors. Primary brain tumors include meningiomas, gliomas, pituitary tumors, and other rare tumors that I will discuss in a later post.
Since metastatic brain tumors are cancers that have spread to the brain from some other primary site (lung cancer, breast cancer, kidney cancer, melanoma, etc.), it is postulated that the number of brain metastases diagnosed each year will rise as patients live longer with their primary cancers.
Metastatic Brain Tumors may occur at any site within the brain, and symptoms are based on the location of the metastasis. Since the location of metastatic tumors is highly variable, symptoms experienced may be highly variable. Some common and nonspecific symptoms include headaches, nausea, and vomiting. Seizures may occur due to brain metastases, and these are usually treated with oral medications and removal of the tumor. Finally, neurologic impairment related to the tumor may occur. An example of neurologic symptoms related to a metastasis could be left arm weakness due to an enlarging tumor in the right frontal lobe (the area of the brain related to left arm movement).
Treatment Options for Metastatic Brain Tumors
In general, there are several treatment options for metastatic brain tumors: surgical resection of the tumor, brain biopsy for diagnosis, stereotactic radiosurgery (SRS), whole brain radiation therapy, and post treatment observation and surveillance. Often, patients with metastatic brain tumors undergo some combination of the above treatment options.
Surgical Resection – Large brain metastases may cause neurologic symptoms by compression of the brain or edema (swelling). Surgical resection, or removal of a tumor with surgery, is a common method of treating symptomatic brain metastases. This surgery involves an incision on the scalp, opening of the skull (a craniotomy), and then surgical removal of the tumor. Local tumor control is improved by adding radiation treatment to the tumor bed after surgery is performed and the incision has healed. Resection has the additional benefit of allowing a pathologist to examine the tumor after it is removed, which often allows them to determine the site of origin.
Stereotactic Radiosurgery (SRS) – SRS is a method of high precision radiation treatment for brain tumors, where a very high dose of focused radiation can be directed at one or more tumors. SRS allows high dose radiation to be delivered to a target (tumor) and a relatively small dose to the surrounding tissues. Dr. Lawson performs radiosurgery with local radiation oncologists, and you can learn more about SRS here. There is some evidence that radiosurgery has better cognitive outcomes and equal efficacy compared to whole brain radiation. Check out a recent article in JAMA on the issue here.
Whole Brain Radiation – Sometimes, there are numerous small brain metastases, too small or too numerous for surgical resection or radiosurgery. Whole brain radiation delivers a moderate dose of radiation to the entire brain. This treats both the tumors as well as brain tissues. It is effective, but may have long-term cognitive site effects (this is controversial).
Brain Biopsy – Occasionally, tissue diagnosis is needed for a brain tumor but the tumor is not in a location safe for surgical resection. Stereotactic Needle Biopsy may be a good option for obtaining tumor tissue for analysis and diagnosis. In this procedure, the patient is taken to the operating room and a small needle is passed through the skin, the skull, and into the tumor. This procedure uses computer navigation to accurately direct the needle into the tumor.
The Long Term Plan
In general, treatment of patients with brain metastases requires a team approach, with Neurosurgeons, Oncologists, and Radiation Oncologists. The individual prognosis depends on the patient’s primary cancer, their functional status, and how well they respond to the initial treatments. Dr. Lawson works closely with local TMH oncologists and radiation oncologists to give the most comprehensive brain tumor care in the region.
Tallahassee Neurological Clinic and Tallahassee Memorial Hospital have been selected as a site for the NEWTON2 trial, with Dr. Lawson as the local site primary investigator. This phase 3 trial is designed to study the efficacy of a novel substance compared to oral nimodipine for prevention of vasospasm in subarachnoid hemorrhage. This makes TNC and the TMH Comprehensive Stroke Center the only center in the region participating in phase 3 research in hemorrhagic stroke & subarachnoid hemorrhage treatments.
Institutional Review Board approval has not yet been granted, but we hope to finalize this in the next few months. The study is funded by Edge Therapeutics.
To learn more about the trial, click here.
June 7, 2016 – TMH announces their new designation as a Comprehensive Stroke Center by the Agency for Healthcare Administration, making TMH the only Comprehensive Stroke Center in the region. TMH has received the American Stroke Association “Get with the Guidelines” Gold Plus recognition for stroke care, and we are proud to be the only hospital within hundreds of miles with the Comprehensive Stroke Center designation.
Please see the full press release here: https://www.tmh.org/news/press-releases/2016/06/tallahassee-memorial-healthcare-designated-as-a-comprehensive-stroke-center
Dr. Lawson and his partner, Dr. Oliver, are the only board-certified neurosurgeons in the region with advanced certification in endovascular neurosurgery (CAST certification). They treat nearly 100 brain aneurysms per year, perform cutting edge thrombectomy procedures for the treatment of acute stroke, and countless other cerebrovascular procedures.
Together, TMH and Tallahassee Neurological Clinic are setting the standard for stroke and cerebrovascular care in Florida’s panhandle, south Alabama, and south Georgia.
Drs. Lawson and Oliver at Tallahassee Neurological Clinic (TNC) are enrolling patients in the Barrel Trial, a study to evaluate the safety and efficacy of a new intracranial stent. TNC/TMH is one of only 28 centers in the United States selected to participate in the trial.
Read the TMH press release here.
Read the article in the Tallahassee Democrat here.
Dr. Lawson presented at the annual systemic diseases and the eye seminar, for the 4th consecutive year. The 2016 presentation was on treatment of brain tumors.
The Florida Center for Brain Tumor Research (FCBTR) is a state funded organization, based in Gainesville, FL, for the study of brain tumors. The primary role is to establish a tissue bank for brain tumor research. Dr. Lawson is this only neurosurgeon in the region to participate in this organization and tissue bank.
Dr. Lawson presented a lecture on treatment of Acute Stroke and the MR CLEAN trial results at the TMH Cardiovascular Symposium. The second annual conference of its kind included over 100 medical attendees.
Dr. Lawson presented a lecture on Treatment of Cerebral Aneurysms at the 12th Annual Systemic Diseases and the Eye Seminar.
Dr. Lawson & Dr. Oliver have successfully treated over 100 cerebral aneurysms at Tallahassee Memorial Hospital. In just two years, TMH has become a major regional referral center for brain aneurysms and other cerebrovascular disorders.
Dr. Lawson presented a lecture on treatment of Acute Stroke at the TMH Cardiovascular Symposium. This conference, the first of its kind in Tallahassee, included over 70 medical attendees.
Dr. Lawson presented a lecture on Psuedotumor Cerebrii at the 11th Annual Systemic Diseases and the Eye Seminar.
Dr. Lawson and the newly opened cerebrovascular lab are detailed in the 2013 TMH Annual Report.
Dr. Lawson’s most recent article was published in the Journal of Neurointerventional Surgery in the July 2013 issue. The article, titled “Concomitant intracranial pressure monitoring during venous sinus stenting for intracranial hypertension secondary to venous sinus stenosis” describes a rare case of idiopathic intracranial hypertension (also known as psueodtumor cerebri) and treatment with a venous sinus stent. Dr. Lawson was the senior author on this paper.
The Tallahassee Democrat reports on the new, state-of-the-art neurovascular suite that has opened at Tallahassee Memorial Hospital. This new facility represents a dramatic advance in the level of care that can be provided regionally, including cutting edge treatment for brain aneurysms, arteriovenous malformations, and acute stroke intervention. It is the first facility of its kind in the region built for the purpose of treating vascular disorders of the brain and spinal cord. Please visit the Tallahassee Democrat to read more.
TMH is pleased to announce the addition of complex cerebrovascular services to their many great service areas. Additional facilities have been constructed to support the new service line, including a new neurovascular suite for endovascular procedures as well as a new neurological intermediate care unit. Please visit the TMH website to learn more.