Boulder Neurosurgical Associates

Justin Parker Neurological Institute

Phone: 303-938-5700Fax: 303-998-0007www.bnasurg.com Boulder Community Hospital1155 Alpine Avenue, Suite 320 Boulder, Colorado 80304

Longmont United Hospital2030 Mountain View, Suite 500Longmont, Colorado 80501

Exempla Good Samaritan Medical Center300 Exempla Circle, Suite 270Lafayette, Colorado 80026

Minimally Invasive Spine Institute300 Exempla Circle, Suite 130Lafayette, Colorado 80026

Platte Valley Medical Center1606 Prairie Center Parkway, Suite 250 Brighton, CO 80601

Rocky Mountain CyberKnife905 Alpine AvenueBoulder, Colorado 80304

The Most Advanced and Comprehensive

Cancer Treatment in the Region

BRAIN AND SPINE TUMOR PROGRAM

E x p e r t i s e

Boulder Neurosurgical Associates (BNA) brings a full range of the newest

technologies, clinical trials and remarkable surgical skills to Colorado.

By putting together a multidisciplinary team of expert physicians, BNA

has created the most advanced system of cancer care in the region from

initial diagnosis through the most aggressive treatment to rehabilitation.

Comprehensive treatment plans are individually selected striving to

achieve the best outcome for every patient. We use proven cancer

treatment strategies along with latest innovations to achieve optimal

results and at the same time assuring that risks will be minimized.

Our neurosurgeons have advanced training and experience in treating of all

types of brain and spinal tumors and are on the leading edge of minimally

invasive endoscopic surgical technologies. BNA neurosurgeons use the most

sophisticated tools available, potentially resulting in both improved survival

and a better quality of life. Sometimes even patients with previously

designated untreatable lesions can be helped tremendously. Some of these

latest technological enhancements include CyberKnife radiosurgery, a

fluorescence-guided surgical microscope, awake craniotomy, intraoperative

MRI and other real-time intraoperative navigation systems for tumor

resections and the latest minimally invasive surgical treatment options.

Our Neurosurgery program received the highest ratings

in the Denver metro area and is among the top 10% of

hospitals in the country for the services provided 1.

The Brain and Spine Tumor Program at Boulder Neurosurgical Associates utilizes a

multidisciplinary team approach to neurosurgery from pre-operative consultations through

surgical intervention and post-operative care. Individualized, patient-focused care is a

priority. BNA surgeons and other health care providers take an aggressive approach to

fighting the disease and use the most complex and innovative treatment methods available.

This includes surgery, radiosurgery, conventional radiotherapy, chemotherapy and the most

advanced tumor immunotherapy techniques.

Boulder Neurosurgical Associates and The Justin

Parker Neurological Institute (JPNI) are involved in

ongoing neurological research on several fronts.

Collaboration with the leading centers in the

nation, including Stanford and Duke University

Hospitals, enables patient access to the most

advanced clinical trials available.

BNA physicians have recently spearheaded clinical

trials that established radiosurgical treatment

parameters and treatment strategies for spine

tumors1 and Glioblastoma Multiforme2,3. Similarly,

we have previously set the standard for the

radiosurgical treatment of skull base meningiomas4

and evaluated the long-term outcomes for

thoracolumbar vertebral reconstruction after

surgery for metastatic spinal tumors5. BNA

surgeons have given dozens of presentations

at national and international meetings on the

treatment of brain and spinal tumors6,7,8.

Currently, BNA surgeons are testing vaccine

therapy for patients diagnosed with primary

and recurrent Glioblastoma Multiforme (GBM) in

conjunction with clinical trials at Duke University

School of Medicine. Patient immune cells are being

activated and multiplied in order to help the body

fight off tumor cells in the brain and prevent them

from growing.

BNA’s partnerships with leading medical device

manufacturers permit us to explore the latest

treatment technologies and use the most

advanced surgical techniques. We are currently

working with Zeiss, one of the world’s best

surgical microscopes manufacturers, on real-time

neuronavigation that allows neurosurgeons to

use fluorescence-guided surgery for brain tumor

resection. The OPMI® Pentero™ microscope assists

in the maximal removal of the tumor while safely

avoiding normal brain tissues. We plan to enroll

patients to test the safety and accuracy of this

revolutionary technology in the spring of 2010.

BNA is currently the only practice in the region

to offer the full functionality of this revolutionary

technology. As a national training center for

intraoperative image guidance systems, BNA has

first-hand experiences with the most advanced and

up-to-date technologies.

R e s e a r c h a n d C l i n i c a l T r i a l s

References:

1. Villavicencio AT, Burneikiene S, McNeely L, McIntyre M. CyberKnife Radiosurgery for Spine Tumors. Spinal Cord Radiation Dose and Volume Analysis. AANS/CNS Section on Disorders of the Spine and Peripheral Nerves, Orlando, Florida, February 27 – March 1, 2008.

2. Villavicencio AT, Burneikiene S, Romanelli P, McNeely L, Lipani JD, Fariselli L, McIntyre M, Chang SD, Nelson EL, Broggi G, Adler JR, Thramann JJ. Survival Following Stereotactic Radiosurgery for Newly Diagnosed and Recurrent Glioblastoma Multiforme: A Multicenter Experience. Neurosurgical Review, 2009 Oct;32(4):417-24.

3. Mason A, Toms S. Hormonal Modulation, Biological Response Modifiers, and Ab1 protein Toxins in the treatment of Malignant Gliomas. In: Barnett G (ed), High-Grade Gliomas: Treatment and Diagnosis. Totowa, NJ, Humana Press; 2006.

4. Villavicencio AT, Black PM, Shrieve DC, Fallon MP, Alexander E, Loeffler JS. Linac Radiosurgery for Skull Base Meningiomas. Acta Neurochir(Wien), 2001 Nov;143(11):1141-52.

5. Villavicencio AT, Oskouian RJ, Stokes J, Park J, Shaffrey CI, Johnson JP. Thoracolumbar Vertebral Reconstruction after Surgery for Metastatic Spinal Tumors: Long-term Outcomes. Neurosurg Focus, 2005 Sep 15;19(3).

6. Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ. Three-dimensional Fluoro-based CT Guidance for Complex Spinal Surgery. AANS/CNS Section on Disorders of the Spine and Peripheral Nerves 22nd Annual Meeting, Orlando, Florida. March 15-18, 2006

7. Villavicencio AT, Burneikiene S, Humphries S, McNeely L, McIntyre M, Thramann JJ. CyberKnife Radiosurgery for Spine Tumors. World Spine IV, Istanbul, Turkey. July 29 – August 1, 2007.

8. Villavicencio AT, Burneikiene S, Romanelli P, McNeely L, Lipani JD, Fariselli L, Chang SD, McIntyre M, Broggi G, Thramann JJ, Adler JR. Survival Following Stereotactic Radiosurgery for Newly diagnosed and Recurrent Glioblastoma Multiforme. 2008 American Association of Neurological Surgeons Annual Meeting, April 26 – May 1, 2008, McCormick Place, Chicago, IL. 1– CareChex Medical Quality Rating System.

S a f e r a n d L e s s I n v a s i v e P r o c e d u r e s - B e t t e r P a t i e n t O u t c o m e s

C y b e r K n i f e R a d i o s u r g e r y

A w a k e C r a n i o t o m y

The speech area is mapped intraoperatively. These figures demonstrate the before (A) and after (B) surgical resection. By mapping this patients speech intraoperatively with the patient awake, we were able to achieve a gross total resection of this patients tumor and preserve his speech function.

(A)

The CyberKnife technology allows patients to be treated on an outpatient basis, and they can return home immediately following the procedure.

For patients with tumors in highly functional

parts of the brain, BNA surgeons perform a

specialized type of surgery with the patient awake

and talking during the surgical resection of their

tumor. Depending on the region of the brain and

the lesion, different electrical or cognitive tests

are performed to allow the surgeon to carefully

‘map’ the selected region of the brain. This allows

the surgeon to identify the safest possible route

and region of resection. to certain craniotomies

if necessary. Because we utilize state-of-the-art,

short acting anesthetic agents for the initial

opening of the skull and the brain has no pain

receptors, this can be a relatively painless and

comfortable procedure that adds safety

I n t r a o p e r a t i v e M R I

The PoleStar N-20 intraoperative MRI system

is the only real-time visualization system of

its kind in the four state region of Colorado,

Wyoming, Montana and New Mexico. This

system allows BNA neurosurgeons to precisely

localize tumors during surgery and obtain real-

time MRIs while performing surgical resections.

Most surgeons’ technical skills are limited by

an obligatory conservative approach with the

goal of avoiding the risk of stroke, paralysis or

speech loss. Surgeons often leave a part of the

tumor unresected in an attempt to avoid these

complications because they cannot see the

tumor margin in surgery and thus have to rely on

postoperative images for radiographic evaluation.

Real-time MRI technology allows BNA surgeons

to confirm intraoperatively that the entire tumor

has been removed while still in surgery. This can

give new hope to patients by potentially reducing

the number of additional surgeries required and

can result in improved survival through a more

complete surgical resection of their tumor.

CyberKnife treatment planning for spinalmetastases.

(B)

CyberKnife is a revolutionary non-invasive treatment option for benign and

malignant lesions of the brain and spine. Developed with patient safety

and comfort as a primary consideration, CyberKnife delivers extremely high

doses of focused radiation to a specific area in the body with incredible

accuracy. This technological breakthrough allows another option for

patients with tumors previously considered as too dangerous or inoperable.

By limiting radiation to the normal surrounding tissues, BNA surgeons can

even treat recurrent tumors that have already failed treatment with other

types of radiation or surgery.

CyberKnife radiosurgery cannot always replace surgery, chemotherapy

or other traditional cancer treatment methods. Instead, it can be an

important alternative or adjunct to surgery for patients that have

exhausted or are not candidates for other treatment methods. The ability

to deliver high dose radiation in a single setting or over several days as

opposed to several weeks can be particularly useful in the treatment of

large tumors or lesions located near the brainstem, spinal cord, nerves and

other sensitive structures.

The extraordinary accuracy and capability to deliver a precisely focused

radiation dose around sensitive structures makes CyberKnife indispensable in

the treatment of spinal metastases. BNA surgeons often combine CyberKnife

with other minimally invasive techniques such as the percutaneous

kyphoplasty procedure for spinal tumors which provides stability for the

spinal column without the need for extensive reconstructive surgery.

O u r N e u r o s u r g e o n s - E x p e r t s P r o v i d i n g U n p a r a l l e l e d C a r e

Alan T. Villavicencio, M.D. E. Lee Nelson, M.D. Alexander Mason, M.D. Sharad Rajpal, M.D.

Dr. Villavicencio graduated

from Harvard Medical

School. He then completed

a neurosurgical residency

at Duke University and a

specialty fellowship at Cedars-

Sinai Medical Center. “Dr. V”

has extensive training in skull

base surgery, neurosurgical

oncology, peripheral nerve,

cerebrovascular, functional,

epilepsy surgery and both

minimally invasive and major

reconstructive spinal surgery.

“Dr. V” treats all types of brain

and spinal disorders, including

benign and malignant tumors,

performing upwards of 500

operative cases each year.

Dr. Nelson received his

Medical Degree from Baylor

College of Medicine in

Houston, TX where he also

completed his internship

and neurological surgery

residency program. Dr.

Nelson expanded his skill and

experience in complex spinal

instrumentation at the M.D.

Anderson Cancer Center, in

Houston. Dr. Nelson’s areas

of clinical interest continue

to include neurosurgical

oncology, including tumors

of the pituitary gland, and

complex spinal surgery with

an emphasis on minimally

invasive techniques.

Dr. Mason received his

Medical Degree from Ohio

State University College of

Medicine and Public Health.

He went on to complete his

neurosurgical residency at the

prestigious Cleveland Clinic in

Cleveland, Ohio with interests

in neuro-oncology, complex

and minimally invasive

spine, vascular surgery and

cerebrovascular disease,

and surgical epilepsy. After

completing his residency,

he underwent a formal

fellowship in cerebrovascular

and skull base surgery at

Emory University in Atlanta.

Dr. Rajpal received his

Medical Degree from the

University of Wisconsin,

where he continued his

training and residency in

neurological surgery. He

completed a combined

Orthopedic and Neurosurgical

Surgery Spine Fellowship at

the Cleveland Clinic where

he gained experience in the

latest techniques in spinal

oncology, minimal access

surgery and complex spinal

deformity. Dr. Rajpal’s clinical

interests include both spine

and general neurosurgical

conditions.

The mission of the tumor program is to advance scientific

discoveries and innovative medical technologies into clinical

practice and new therapeutic treatment options.

M i s s i o n

BNA neurosurgeons have advanced

training and experience in

the treatment of all types of

tumors and are on the leading

edge of minimally invasive

surgical technologies.

As experts in the field, BNA

offers some of the region’s best

results in the treatment of

brain and spine tumors. We are

dedicated to improving clinical

outcomes and patient safety

by promoting and implementing

evidence-based medicine into

clinical practice. We welcome

patient referrals and requests

for second opinion.