Research Programs
As part of the development of the Neurological Institute the research efforts of the Department of Neurosurgery have come under the direction of Dr. Robert Miller who is the director of the Center for Translational Neuroscience. As the largest biomedical research enterprise in the state of Ohio, The breadth and depth of the research opportunities on the Case Medical Center campus are extensive. The following description highlights only the major focus of the members of the Department of Neurosurgery.
Cerebral Blood Flow and Metabolism
A nationally recognized research program in cerebral metabolism was established under the direction of Dr. David Lust. The laboratory is dedicated to elucidating pathophysiology following a variety of neurological insults and developing novel strategies to minimize brain dysfunction and injury. This entails work on various aspects of experimental cerebrovascular disease to determine how these insults cause neurologic deficits, whether from cellular paralysis or cell death. One major effort centered on the mechanisms of damage following permanent focal ischemia, reversible focal ischemia and single versus multiple reversible ischemic events. The focal ischemia study investigated the response of aged animals to focal ischemia. The laboratory examined the events involved in the delayed death of certain neurons in the hippocampus following a period of global ischemia that is compatible with survival as well as the relationship between prenatal metabolic stress and neonatal brain function which has been implicated in the evolution of cerebral palsy.
Experimental projects on the pathophysiology of spinal cord trauma are underway and chronic studies following head injury indicate a long-term effect on the metabolic processes in both ipsilateral and contralateral hemisphere to the insult. The cerebrovascular laboratory continues to add new techniques in order to broaden its approach to the study of stroke. Although Dr. Lust has recently retired, Dr. Akash Agarwal who is joining our department on August 1, 2006, plans to continue studies in the area of cerebrovascular disorders.
Neurosurgical Imaging
Dr. Robert Maciunas directs the Center for Image-Guided Neurosurgery. Research includes technology development in interactive image neurosurgery. Current studies include integration techniques for surgical navigation, non-rigid body approaches to tissue deformation, augmented reality displays, robotics instrumentation, intraoperative integration of real time imaging and electrophysiology data, and clinical outcomes analyses. The intra-operative MR OR provides an environment for many of these studies. A multidisciplinary development effort is underway to develop artificial intelligence-based automated analysis of intraoperative electrophysiology microelectrode recording during functional neurosurgical procedure.
David Dean, Ph.D., supervises the Neurological Surgery_Imaging_Laboratory. This group provides imaging support for clinical care, as well as performing ongoing research in neurosurgical imaging and the interface between imaging and surgery. The research lab provides assistance for open stereotactic procedures as well as for radiosurgical procedures. Research focuses on Computer Assisted Surgery. This includes the development of software which will provide intraoperative updating of 3-D images for use during surgery. The lab is also involved with development of custom fitting, tissue engineered cranial implants for use in neurosurgical procedures. The Imaging Laboratory supports the Gamma Knife radiosurgery unit, and has played a significant role in development imaging and operative tools and procedures for use in the intraoperative MR. Finally, the Imaging Laboratory conducts preclinical research in, and supports the Department’s clinical trials on, the photodynamic therapy of glioma (brain tumor).
Minimally Invasive Neurosurgery Laboratory
Dr. Alan Cohen directs the Minimally Invasive Neurosurgery Laboratory which focuses on developing new instrumentation and operative approaches for endoscopic neurosurgery and microneurosurgery. Residents use this laboratory to learn various microsurgical and endoscopic procedures in the Approach of the Month Club supervised by Dr. Cohen. For the past 15 years, Dr. Cohen has directed the American Association of Neurological Surgeons’ Practical Course in Minimally Invasive Neurosurgery, which trains neurosurgeons in the latest techniques of endoscopic surgery.
Virtual Reality Surgical Simulator
Dr. Cohen of the Department of Neurological Surgery and Dr. Cenk Cavusoglu of the Department of Computer Science and Engineering have developed a Virtual Reality Surgical Simulator to facilitate training in the field of Minimally Invasive Neurosurgery. This system is analogous to the airlines' use of flight simulators for pilot training. With the ability to use computer-generated MR images and to provide haptic (tactile) feedback, the system is realistic, reliable and repeatable. The Virtual Reality Simulator is an interactive training tool for medical students, residents and attendings and should be helpful in the planning of minimally invasive neurosurgical procedures as well as standard neurosurgical procedures. We believe the Virtual Reality Surgical Simulator may change the way surgery is taught, essentially serving as a "flight simulator" for the brain.
Neurodevelopment
Dr. Shenandoah Robinson heads a laboratory that studies how perinatal insults disrupt neurodevelopment and lead to chronic neurologic deficits in children including cerebral palsy, epilepsy and cognitive delay. The research focuses on understanding the underlying mechanism of injury, and developing an intervention for neonates that will ameliorate the neuronal and oligodendroglial loss that occurs after insults in the perinatal period. Her laboratory is located among other laboratories in the Department of Neurosciences. She has a long-standing productive collaboration with Dr. Robert Miller, Professor of Neurosciences and a world-renowned leader in glial development. Altered regulation of neurodevelopment plays a critical role in many of the most vexing neurological problems including trauma, stroke, multiple sclerosis, neurodegenerative processes and tumors.
Dr. Miller has a primary interest in CNS neural development with a focus on understanding the biology of neural diseases including Multiple Sclerosis, Brain tumors and Cerebral Palsy. Dr. Miller’s development research has focused on understanding the cellular and molecular mechanisms that regulate glial cell determination in the developing vertebrate CNS. Oligodendrocytes, the myelinating cells of the CNS, develop from precursors that arise in distinct locations within the embryonic neural tube. The origin of oligodendrocyte precursors is a result of local signaling including expression of sonic hedgehog. A number of other influences are required to develop the final pattern of oligodendrocyte in the mature tissue. These include dispersal signals to guide cell migration and stop signals such as the chemokine CXCL1 that position precursors to receive appropriate proliferative and differentiative cues. Dr. Miller’s lab is currently defining the interplay between these different signals in order to gain a complete understanding of oligodendrogenesis. For more information about Dr. Miller’s research, please visit: http://www.case.edu/med/CTN/.
Neuro-Oncology
Dr. Robinson studies normal processes of proliferation and differentiation in glial development and their transformation in glial tumors. Current investigations are focused on the role of a regulatory pathway involving growth-regulated oncogene and platelet-derived growth factor in the genesis of oligodendrogliomas. Combined efforts from the Departments of Neurosurgery and Neurosciences are directed towards developing translational research projects.
Dr. Maciunas is involved in several clinical trials through the Ireland Cancer Center directed towards multimodality therapy for both benign and malignant brain tumors.
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