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FirstHealth of the Carolinas
What is neurosurgery? By Dick Broom
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NeurosurgeryWhat is neurosurgery?

The nervous system, like most of the rest of the human body, is generally tough and resilient. But it can be threatened by many different diseases and disorders, as well as trauma.

Starting at the top, with the brain, the most common serious problems include aneurysms, blood clots and tumors. Some brain tumors are benign; others are malignant.

Carol Wadon, M.D., a neurosurgeon at FirstHealth Moore Regional Hospital, says benign tumors tend to be relatively easy to locate and remove.

“They are like a seed in an orange,” she says. “You can see what’s definitely tumor and what’s definitely not. But other tumors, the ones that are often malignant, are more like a drop of food coloring in a glass of water. You can see where most of it is, but there are tendrils that spread out.

“We try to take out as much of these tumors as possible without removing healthy brain tissue that the patient needs. Then we usually use chemotherapy and radiation to treat whatever remains of the cancer.”

Conditions that cause chronic pain in the neck and lower back are the most common nervous system disorders. The problem often occurs when the discs that separate and cushion the vertebrae become worn down.

“Just as most people’s hips and knees will wear out over time, so can parts of the spine,” says David Kee, M.D., another neurosurgeon at Moore Regional. “The cervical spine (neck) and lumbar (lower back) are particularly prone to this degeneration.”

The typical treatment, at least initially, is over-the-counter anti-inflammatory medication and, sometimes, physical therapy. Some patients receive steroid injections in the spine to relieve their pain. In most cases, surgery is considered as a last resort, after more conservative treatments have failed.

However, surgery may be the best first option if a disc has ruptured and is putting pressure on the spinal cord. Another condition that can painfully squeeze the spinal cord of individual nerves is stenosis, a narrowing of the spinal canal that is often caused by arthritis and often requires surgery.

Degenerative problems in the neck and back also can cause spinal instability.

“That means the bones don’t join together and move in concert like they did when you were 16,” Dr. Kee says. “If there is a slippage of one bone against another, that can be a painful condition that requires surgery.”

Sometimes patients have severe back or neck pain, but they don’t have any other problem that can be corrected surgically. In those cases, the pain may be relieved by electrically stimulating the spinal cord, a procedure called neuromodulation.

“Usually, an anesthesiologist or pain management physician will do a trial stimulation by putting in a temporary lead to see if it helps with the patient’s pain,” says Bruce Jaufmann, M.D., another member of the neurosurgical group at Moore Regional. “If it does help, then we can put in a permanent stimulator.”

Neuromodulation can also be used to prevent epileptic seizures in patients for whom anti-seizure medications don’t work very well. Neurosurgeons can implant stimulators to regulate the electrical impulses of the vagal nerve, a large nerve that connects the brain to organs in the neck, chest and abdomen.

All four of the neurosurgeons at Moore Regional are board certified in that specialty. Larry Carson, M.D., is one of only two neurosurgeons in the country who also is board certified in plastic and reconstructive surgery.

“Everything we do in neurosurgery requires some degree of tissue management, and the more complicated it is, the more the plastic and reconstructive training helps,” he says.

“That is especially true for people who have congenital deformities or deformities caused by trauma.

Dr. Carson says his areas of particular interest also include “complex and minimally invasive spine surgery.”

Problems with the peripheral nerves—those outside the brain and spinal column—are rarely as serious but can be painful and debilitating. The most common of these are carpal tunnel syndrome, in which a nerve in the wrist becomes pinched, and a similar condition involving the ulna nerve in the elbow. Neurosurgeons routinely perform operations to correct both of these problems.

Even though each of Moore Regional’s neurosurgeons tends to specialize to some extent in treating certain problems, all four perform virtually all types of procedures involving the brain, spinal cord and peripheral nerves.

“People can come to us for any sort of neurosurgical problem,” Dr. Jaufmann says.

“All four of us have many years of experience, and working together means that each of us can draw on that combined experience. It’s nice to have three other people we can go to for second opinions and consultations.”

GPSGPS

Neurosurgeons at FirstHealth Moore Regional Hospital use the newest and most advanced surgical navigation system to help them perform brain and spine surgery with maximum precision.

Called StealthStation, the system uses technology similar to that of a GPS (global positioning system) to provide surgeons with three-dimensional images of the interior of the brain or spinal column. By transmitting these images to a monitor, StealthStation enables the surgeon to pinpoint a tumor or other target of surgery and to make sure surgical instruments are in exactly the correct position.

“This system makes it much easier for the surgeon to get to a brain tumor, for example, especially deep inside the brain,” says Carol Wadon, M.D., a neurosurgeon at Moore Regional. “It allows us to be much more precise. It also means we can make smaller incisions, so patients have a smaller scar. Because we don’t have to stitch up huge incisions like we used to, patients can spend less time under anesthesia and less time in the operating room.”

The StealthStation system helps surgeons avoid damaging healthy tissue. It also minimizes pain, complications, recovery time and the need for repeat operations.

According to Tom Kane, administrative director of surgical services at Moore Regional, the StealthStation system is an important component of the hospital’s full-service neurosurgery program. “It enables us to provide treatment for more patients here, so they don’t have to go somewhere else to get the care they need,” he says.

Medtronic Inc. developed the first StealthStation in 1998, and neurosurgeons at Moore Regional began using the seventh and latest version of the system in March of this year. Dr. Wadon calls it “the newest and best.”

NeurosurgeryWith four board certified neurosurgeons on its medical staff, FirstHealth Moore Regional Hospital provides 24/7 neurosurgical coverage. For more information on how to make an appointment with either of these physicians, call (800) 213-3284
Larry Van Carson, M.D. Larry Van Carson, M.D. Undergraduate Education: B.S., University of Georgia, Athens Medical Education: M.D., Medical College of Georgia, Augusta Graduate School: MBA, University of Wisconsin, Madison Fellowship: William P. Van Wagenen Fellowship, Harvey Cushing Society, American Association of Neurological Surgeons (Craniofacial, Aesthetic and Skull Base), Paris, France Internship: Medical College of Georgia (General Surgery) Residency: Medical College of Georgia (Neurological Surgery, Plastic Surgery) Board Certified in Neurosurgery and Plastic and Reconstructive Surgery.
Bruce P. Jaufmann, M.D. Bruce P. Jaufmann, M.D. Undergraduate Education: B.S., State University of New York at Albany Medical Education: M.D., Albany Medical College of New York at Albany Internship: Albany Medical Center, New York (General Surgery) Residency: Albany Medical Center (Neurological Surgery) Board Certified in Neurology
David B. Kee Jr., M.D. David B. Kee Jr., M.D. Undergraduate Education: B.A., Amherst College, Amherst, Mass. Medical Education: M.D., Emory University School of Medicine, Atlanta Externship: Wilford Hall Medical Center, Yale University School of Medicine (Neurosurgical) Residency: Emory University/Affiliated Hospitals (Surgical, Neurosurgical) Board Certified in Neurosurgery
Carol M. Wadon, M.D. Carol M. Wadon, M.D. Undergraduate Education: B.A., State University of New York at Geneseo Medical Education: M.D., Albany Medical College of New York at Albany Internship: Albany Medical Center, New York (General Surgery) Residency: Albany Medical Center (Neurological Surgery) Board Certified in Neurosurgery

Quick to act

On April 20, 2009, I went to the Emergency Department at Moore Regional Hospital and that night was operated on by Dr. Bruce Jaufmann for bilateral subdural hematomas. Both Dr. Jaufmann and Dr. Matthew Reinhardt in the Emergency Department were quick to act, and I want to express my appreciation for their care and that of the nurses in the Emergency Department. I was in Waldrip MICU for four days and two days in 2 Neuro. Thanks to the nurses: Donna, David, Margaret, Alice and Carlena in Waldrip and Patty, Heather, Katie, Brandy, Kelly, Teco and Steph in 2 Neuro. This was my second experience with Moore Regional, having had quadruple bypass surgery 10 years ago. I’ll continue to consider Moore Regional Hospital as the best.

Simpson Brown
Pinehurst