Section of Neurosurgery

THE SECTION OF NEUROSURGERY at the University of Calgary and Alberta Health Services is fully integrated with its partner sections of Neurology, Physical Medicine and Rehabilitation (PM&R) and Translational Neurosciences within the Department of Clinical Neurosciences.

With a highly integrated and programmatic approach, sub-specialized care is provided to the patient population. This population includes the geographic region of Southern Alberta as well as Eastern British Columbia in the Kootenay Region and Western Saskatchewan, encompassing an approximate catchment population of 2.5 million. Care is provided by 18 neurosurgeons, (currently 16 Geographic Full Time (GFT) and two major clinical Participating Physicians), all of whom are sub-specialists and also provide general and emergency neurosurgical services. The Division of Neurosurgery provides five specialist call services: general neurosurgery, pediatric neurosurgery, spine surgery, vascular neurosurgery, and interventional neuro radiology. There are no fee-for-service physicians in the group; All members of the Division of Neurosurgery participate in the Neurosurgery AMHSP.

Specialized programs include cerebrovascular and endovascular neurosurgery, epilepsy neurosurgery, adult hydrocephalus, neuro-oncology, skull base surgery, pediatric neurosurgery, peripheral nerve surgery, functional neurosurgery, stereotactic radiosurgery and spine surgery. In partnership with neurology, rehabilitation medicine, orthopedic surgery, neuroradiology, and radiation oncology, section participating physicians provide the highest quality of sub-specialized care for this patient population.

RECRUITMENT

Recent additions to our group include Dr. Michael Yang (2022) who has an interest in spine surgery, post operative optimization of recovery and pain management, and Dr. Candice Poon (2023) who has an interest in hydrocephalus and neuro-oncology. 

Dr Yang has worked to develop a program in endoscopic spine surgery in Calgary as well as developing an ERAS protocol in spine surgery. 

Dr. Poon has established a neuro-oncology preclinical research laboratory with work also addressing aspects of CSF dynamics in neuro-oncology.

INNOVATIONS AND IMPROVEMENTS

Multidisciplinary Adult Hydrocephalus Program University of Calgary

The Adult Hydrocephalus Program encompasses neurosurgery, general surgery, anesthesiology, neurology, neuroradiology, neuro-ophthalmology and physiatry disciplines. Allied health involvement includes physiotherapy, occupational therapy and neuropsychology.

The clinic services a unique population that suffers from a chronic disease that can cause significant neurological disability (including but not limited to dementia), but that is also associated with a risk of acute clinical deterioration. These patients benefit from long-term care that is more substantial than many other neurosurgical patients and that is generally beyond the scope of family physicians and many Neurologists and Neurosurgeons. In addition, the clinic provides new and established patients with urgent clinical issues urgent assessment avoiding unnecessary Emergency Room utilization and fragmented care. Furthermore, many patients have other significant medical and not uncommonly, social co-morbidities that increase the complexity and challenges associated with patient care.   

Patient assessment is done according to defined process maps which include the use of clinic-based objective cognitive and gait testing, and selective neuroradiology investigations including some which are not available at other centers. At weekly Hydrocephalus rounds all patients undergoing assessment for a new diagnosis or potential candidates for surgery are reviewed and management strategies are developed. Certain complex patients are further reviewed with neurology, neuro-ophthalmology and neuroradiology. 

The surgical treatment of hydrocephalus by the Calgary Hydrocephalus program provides quantifiable positive patient outcomes and has resulted in a significant reduction of peri-operative complications. The surgical approach for surgical treatment has evolved past the basic levels offered in most other centers and now incorporates general surgery for ventriculo-peritoneal shunt insertion and anesthesiology for ventriculo-atrial shunt insertion. Endoscopic treatment of hydrocephalus is also very well developed in Calgary and provides successful treatment for a large number of patients without the need for shunt insertion. In addition, the endoscopic resection of colloid cysts causing hydrocephalus is not otherwise available in Western Canada. 

Robotic Surgical Assistant for Epilepsy and Functional Neurosurgery     

The Calgary Epilepsy Surgical Program is a multi-disciplinary comprehensive adult and pediatric group of clinicians and researchers tasked with treating and investigating patients with epilepsy refractory to medical management. One third of epilepsy patients are refractory and of these almost 50% may be candidates for seizure surgery capable of reducing early death from epilepsy, improving quality of life and reducing health care utilization.

Minimally invasive stereotactic techniques for intracranial depth electrode electroencephalogrphy (sEEG) have replaced traditional means performed through large craniotomies and the implantation of subdural electrodes. Robotic Assistants have become the preferred means of performing sEEG in both pediatric and adult epilepsy patients. The recently launched Laser interstitial thermal therapy (LITT) program for MRI-guided laser ablation is currently being used to treat epileptic foci but also has applications in other areas including movement disorders and neurooncology. It too is made possible by the precise stereotactic placement with robotic assistance.    

The adoption of more minimally invasive surgical techniques as with Robotic Assisted SEEG and LITT therapy reduce post-operative discomfort and complications, as well as shorten hospital stays and are expected to lead to lead to better health outcomes, improved patient and family experience of care, better clinician and staff satisfaction, and wiser allocation of resources. 

MR Guided Focused Ultrasound Program

The MR guided Focused Ultrasound (MRgFUS) platform, was launched in the spring of 2017. While the program started with philanthropic support for the acquisition of a human MRgFUS system for neurosurgery, a CFI infrastructure grant enabled a significant expansion of the program, which now has three major themes: neurosurgery, drug delivery, and neuromodulation.  Infrastructure spans the range from basic FUS technology development, to preclinical MRgFUS, to neuronavigated human FUS equipment, to human MRgFUS.  Experiments are ongoing in all three research themes and >30 human neurosurgical procedures for movement disorders have been completed.

Clinical outcomes have been comparable to prior published data, and new important methods to avoid complications, and to apply this therapy for completely different indications have been identified. For example, through collaboration with other centers as well as UofC psychiatry, to treat patients with severe Obsessive Compulsive Disorder with MRgFUS anterior capsulotomy. Four patients have been treated thus far with early significant improvements as measured by the Yale-Brown Obsessive Compulsive Scale.

Expected benefits of the program include more patients willing to undergo brain lesioning procedures using this less-invasive technology, cost savings for ongoing health care of patients with these chronic conditions, and development of new therapies (such as for specific kinds of pain, epilepsy, brain tumors and treatment for radiation necrosis).

The Pituitary Inter-Disciplinary Team-based Endocrine Treatment Program (PITNET) 

The Pituitary Inter-disciplinary Team-based Endocrine Treatment Program (PITNET) brings together neurosurgery, neuro-ophthalmology, otolaryngology and endocrinology to facilitate the care of patients with pituitary and sellar tumors.

The benefits of the PITNET program have included streamlining of patient care, fostering research initiatives, and enhanced teaching to both local and distant learners. Combined multidisciplinary clinics address the needs of both new and follow-up patients and have reduced clinic visits for many patients by providing up to three specialist assessments in one visit. Current research directions are focused on cost-effectiveness, the role of optical coherence tomography in patient management, comparisons of surgical approaches, and the utility of fMRI in optic compressive neuropathy. With a high concentration of surgical patients, the program has facilitated focused training on the diagnosis and management of these lesions to residents in the Section of Neurosurgery and to visiting neurosurgical fellows including international fellows from Australia and the Philippines.