Barnes Jewish Hospital/Washington University (St. Louis). Barnes-Jewish is the largest hospital in Missouri, with more than 1,250 beds, more than 1,800 employed physicians and nearly 18,300 surgeries performed in 2008. The hospital has four dedicated neurosurgery ORs and its 20-bed neuro-intensive care unit has computerized radiograph viewing and an in-unit positron emission tomography (PET) scanner. Its neurosurgeons also use a Gamma Knife to treat brain tumors and other abnormalities and the Cavitron, a surgical device that disintegrates and aspirates brain tumors. They perform stereotactic neurosurgery, a computer-assisted guidance in brain surgery that allows placement of biopsy tools or electrodes deep in the brain, and surgical navigation, which uses computers to plan precise approaches to areas of the brain during surgery. Other services include intraoperative angiography, which uses x-rays of blood vessels in surgery for aneurysms or arteriovenous malformations; movement disorder surgery, which is the surgical implantation of stimulators to treat Parkinson's isease and certain types of tremor; and cortical mapping EE, which helps surgeons stay away from essential brain functions.
Cedars-Sinai Medical Center (Los Angeles). Cedars-Sinai Medical Center, with 977 beds, near Beverly Hills, has had a long roster of movie stars as patients. The Cedars-Sinai Institute for Spinal Disorders, featuring eight neurosurgeons and two neuro-oncologists, performed more than 1,000 major neurosurgical procedures in 2008, ranging from craniotomies for tumor resections to surgical resection of vascular malformations. The Comprehensive Brain Tumor Program is involved in several innovative protocols for brain tumors, including the use of a dendritic cell vaccine for malignant glioma. Cedars-Sinai Medical Center has dedicated neurosurgical operating rooms equipped with intraoperative MRI, image-guided surgery, operating microscopes, lasers and intraoperative angiography. The institute also has the capability to perform stereotactic biopsy and radiotherapy of tumors.
Cleveland Clinic. Structured as a group practice, the Cleveland Clinic employs 1,800 staff physicians who work in multidisciplinary teams and use several hospitals totaling more than 1,000 beds. Neurosurgeons in the Cleveland Clinic Neurological Institute work with other physicians and providers. The center for brain tumors and neuro-oncology, for example, is a partnership with the clinic's cancer institute. Other centers in the Neurological Institute are involved in brain health, strokes and cerebrovascular health, brain aneurysms and related disorders, epilepsy, Multiple Sclerosis, pain, neuromuscular and neurological restoration. The institute benefits from extensive inter-specialty collaborations. Its fully integrated model allows the institute to measure quality and outcomes on a continual basis.
Duke University Medical Center (Durham, N.C.). The 924-bed Duke University Medical Center, commonly known as Duke University Hospital, is the flagship of Duke University Health System. Sen. Ted Kennedy, after consulting with medical experts around the country, decided in June to trust his treatment for a cancerous brain tumor to Dr. Allan Friedman, Duke's neurosurgeon-in-chief. Duke neurosurgery is one of the largest and busiest academic programs in the country. Neurosurgeons at Duke perform a wide array of disciplines, including primary and secondary brain and spinal tumors, one of the largest high-grade glioma patient populations in the world. More than two-thirds of adult brain tumor patients at Duke take part in clinical trials, compared to only 8 percent nationally. Duke neurosurgeons also remove skull base tumors, perform complex spinal resections and fusions, pain and functional neurosurgical procedures, peripheral nerve procedures and open vascular and endovascular procedures.
Emory University Hospital (Atlanta). Emory University Hospital, with 587 beds, is staffed exclusively by faculty at Emory University School of Medicine, treating 80,000 outpatients a year. The neurosurgery department includes Sanjay Gupta, MD, CNN's chief medical correspondent, and department chairman Daniel L. Barrow, who has authored The Practice of Neurosurgery, a major textbook of neurosurgery. The hospital's 20-room neuro-intensive care unit, which opened in 2007, includes a high-resolution CT machine and has a dedicated staff of neurointensivists. Neurosurgeons at Emory University are now removing benign tumors from deep within the brain though tiny incisions and openings in the skull no larger than a pea, which eliminates the need to fully open the skull to remove tumors.
Johns Hopkins Hospital (Baltimore). The 982-bed Johns Hopkins Hospital was an early teaching institution where the terms "rounds" and "residents" were coined. However, the hospital is by no means stuck in the past. For example, Johns Hopkins neurosurgeons are taking new therapies for treating brain and spinal tumors from the laboratory to the bedside. They have developed and refined many new techniques, including endoscopic, radiosurgical and other minimally invasive procedures that are saving lives or improving quality of life. Hopkins investigators are also using stem cells to answer fundamental questions about the brain's ability to regenerate or produce abnormal pathologies. Neurosurgery specialties include diagnosis and treatment of brain tumors, cerebral aneurysms and arteriovenous and cavernous malformations, carotid artery stenosis and spinal disorders. The hospital's neurological critical care unit provides the highest quality, most up-to-date, specialized care for neurosurgical patients after surgery and for patients with head and neck injuries, seizures and stroke.
Massachusetts General Hospital (Boston). The 905-bed Massachusetts General Hospital, teaching hospital of Harvard Medical School, conducts the largest hospital-based research program in the country, with an annual budget of more than $400 million. Neurosurgery at the Massachusetts General uses almost 10 percent of the hospital's beds and has an average daily census of 70-90 patients. The program has two interventional neuroradiologists and 32 neurosurgeons, of whom 15 are residents, performing about 2,600 neurosurgical operations annually. Four ORs are dedicated to neurosurgery and a 17-bed neuro-intensive care unit is staffed continuously. Neurosurgery researchers at Mass General are studying mutations that occur in glioblastomas, a form of brain tumor; neural growth and regeneration of damaged brain functions; intraoperative monitoring and imaging; cerebral blood vessels; and cellular neurobiology.
Mayo Clinic (Rochester, Minn.). Mayo Clinic, Rochester, has 1,700 physicians in more than 60 specialty and subspecialty areas, admitting patients to 1,265-bed Saint Mary's Hospital and 794-bed Rochester Methodist Hospital. Mayo's Department of Neurosurgery consists of 10 neurosurgeons working closely with colleagues throughout Mayo Clinic and performing more than 3,000 neurosurgical procedures each annually, among the highest procedural volumes for this specialty in the world. This year, neurosurgeons at Mayo found that posterior fossa exploration surgery provided significantly better pain relief than stereotactic radiosurgery for patients with trigeminal neuralgia. The Mayo Clinic's Brain Injury Program was recently named the State Lead Center of Excellence by the Sarah Jane Brain Foundation, which is developing a seamless, evidence-based brain-injury plan for children and young adults.
Methodist Hospital (Houston). The 899-bed Methodist Hospital is in the heart of the storied Texas Medical Center, but it also has small satellite hospitals throughout the Houston area. The Methodist Neurological Institute is built around four principles: physician-scientists, advanced technology, comprehensive patient services and innovative facilities. Specialists from multiple disciplines analyze a patient's condition from all perspectives to develop an all-encompassing treatment plan. More than 50 neurologists, neurosurgeons, neuroradiologist and neuro-rehabilitation physicians collaborate to make the institute a center for diagnosis, treatment, clinical trials and research. Clinicians and researchers at the institute provide comprehensive care for patients with neurological disorders including stroke, Parkinson's, Alzheimer's, multiple sclerosis, ALS, brain tumors, epilepsy, pituitary tumors and spinal disorders.
Mount Sinai Hospital (New York). The 1,171-bed Mount Sinai Hospital is located just east of Central Park and is affiliated with many hospitals throughout the city. Mount Sinai is a leader in functional neurosurgery, having pioneered the use of low frequency stimulation for the treatment of dystonia. Neurosurgeons at the hospital have performed the most deep brain stimulator (DBS) implants for Parkinson's disease, essential tremor, and dystonia in the New York region. Ongoing research includes clinical trials of gene therapy for Parkinson's and Alzheimer's disease and the use of DBS for the treatment of depression. Having pioneered stereotactic techniques since 1993, Mount Sinai has extended the scope of operable brain tumors by using frame-based or frameless stereotaxy, awake-and-asleep brain mapping, micro-neurosurgery and endoscopic surgery. The hospital now hosts an advanced multidisciplinary program for stereotactic neurosurgery, using computer-assisted image-guided neurosurgery to accomplish minimally invasive brain and spine procedures.
Neurologic and Orthopedic Institute of Chicago. The Neurologic and Orthopedic Institute of Chicago is dedicated exclusively to neuroscience and Orthopedic surgery. It has 10 operating rooms, 52 medical/surgical beds, 15 rehabilitation beds and 18 intensive care beds, a stereotactic radiosurgery suite, a neuroangiography suite and a comprehensive diagnostic imaging suite with a 1.5-tesla MRI and CT. The neurological practice is lead by the Chicago Institute of Neurosurgery and Neuroresearch. Physician expertise includes brain tumors, neck and back pain and neurovascular and stroke care.
Northwestern Memorial Hospital (Chicago). The 873-bed Northwestern Memorial Hospital claims to be the tallest hospital in the country, with one tower that is 22 stories high. The hospital boasts a cerebrovascular program for the surgical and endovascular treatment of stroke, brain aneurysms, brain or spinal vascular malformations, and other blood vessel-related problems. Its Acute Spinal Cord Injury Center, a partnership with the Rehabilitation Institute of Chicago, is one of 14 model systems of care for spinal cord injury in the nation. Northwestern has a state-of-the-art neuro-oncology program, minimally invasive surgical and non-invasive radiosurgical treatment for tumors and blood vessel malformations, treatment of functional disorders and a comprehensive program for the treatment of intractable and chronic pain.
Ronald Reagan UCLA Medical Center (Los Angeles). The 600-bed Ronald Reagan UCLA Medical Center opened in 2008 at a cost of $1 billion and is one of the first structures in the state that can withstand an 8.0-magnitude earthquake. UCLA Neurosurgery includes innovative clinical programs in epilepsy, neuroendoscopy, minimally invasive brain and spinal surgery, neuro-oncology for brain tumors, cerebrovascular surgery, stereotactic radiosurgery for brain and spinal disorders and surgery for movement disorders such as Parkinson's disease. The programs collaborate closely with other departments, including neurology, pharmacology, orthopedics and bioengineering. UCLA Neurosurgery has been using the RP-6 mobile robot system in its neurosurgery intensive care unit. The robot allows doctors to virtually consult with patients, family members and healthcare staff at a moment's notice, even if miles away from the hospital.
Rush University Medical Center (Chicago). Rush University Medical Center, with 613 beds, is undertaking a $900 million redevelopment that will include a new 14-level hospital and an orthopedic ambulatory building. Neurosurgeons at Rush collaborate with neurologists, neuroradiologists, critical care nurses and other specialists to address the full scope of problems affecting the brain, spine and nervous system. They use deep brain stimulation to eliminate tremors of Parkinson's disease and perform innovative surgeries to treat epilepsy. In a recent study, Rush researchers found that quantitative magnetic resonance angiography is a promising screening tool to detect in-stent stenosis with high sensitivity and specificity. Also, Rush has been testing the Penumbra Stroke System, a minimally-invasive investigational technique to remove blood clots in large brain vessels that cause acute ischemic stroke by using suction and catheterization techniques to rapidly restore blood flow in the brain and limit damage caused by stroke.
St. Joseph's Hospital and Medical Center (Phoenix, Ariz.). Located in the heart of Phoenix, 743-bed St. Joseph's Hospital and Medical Center has a medical staff of close to 1,500 physicians and 180 residents in 12 specialties. The Barrow Neurological Institute at St. Joseph's treats patients with conditions such as brain and spinal tumors, cerebrovascular conditions, and neuromuscular disorders. It is equipped with state of-the-art technology, including four biplane neuro-angio suites, three 3-tesla MRIs, five 1.5-tesla MRIs, one 3-tesla intra-operative MRI, one 7-tesla research scanner and multiple CTs. Researchers at Barrow have identified a novel receptor in the brain that is extremely sensitive to beta-amyloid peptide and may play a key role in early stages of Alzheimer's disease.
University of California, San Francisco Medical Center. The 560-bed UCSF Medical Center is affiliated with the University of California, San Francisco. The Department of Neurological Surgery at UCSF has services at all major hospitals in the area, providing a full range of neurosurgical subspecialty care. UCSF neurosurgeons use intraoperative MRI scanners and image-guided systems for precise surgical navigation. The hospital's research program is founded on a tradition of bench-to-bedside translational research, with the goal of bringing promising new treatments from the laboratory to our patients. One novel therapy at UCSF Medical Center involves using a miniature nerve stimulator instead of medication for the treatment of profoundly disabling headache disorders.
University of Chicago Medical Center. The 520-bed University of Chicago Medical Center recently began construction of a new 10-story building that will have 240 beds and 24 ORs when it opens in 2013. Research laboratories in the Section of Neurosurgery are well-equipped for channel studies, microfluorometry, blood flow measurement, cellular neurophysiology, molecular biology, pharmacology, microscopy, biochemistry, tissue culture, histology and animal pathology. The Section includes ancillary services in neurology, neuropathology, neurophysiology and a sleep laboratory. Three full-time neuroradiologists, trained and experienced in interventional neuroradiology, work closely with the neurosurgical service.
UPMC-University of Pittsburgh Medical Center. UPMC, encompassing 20 hospitals, also has operations in Italy, Ireland, the United Kingdom and Qatar and has heavily invested in information technology. UPMC neurosurgeons work closely with colleagues at the organization's Cancer Institute on brain, pituitary, spinal and peripheral nerve tumors. Advanced techniques allow for the removal of tumors that are of sizes and in locations of the brain that once would have been considered inoperable. UPMC neurosurgeons have performed more than 1,000 innovative surgeries in the past decade, removing brain tumors through the sinuses and nostrils. They have begun to perform brain surgery through a straw-like device to remove tumors deep in the brain. In addition to being one of the nation's premier users of Gamma Knife surgery, UPMC employs magnetoencephalography equipment for registration and localization of neural activity in brain research and in clinical practice.