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.