HALIFAX NEUROSURGERY - Dalhousie University · HALIFAX NEUROSURGERY 2016 ANNUAL REPORT 3 Welcome to the Division of Neurosurgery’s 2016 Annual report. It is my pleasure to update

HALIFAX NEUROSURGERY 2016 ANNUAL REPORT | 1

HALIFAXNEUROSURGERY

ANNUAL REPORT

| HALIFAX NEUROSURGERY 2016 ANNUAL REPORT2


ContentsMessage from the Head of NeurosurgeryNeurosurgery FacultyNeurosurgery ResidentsClinical ActivitiesNeurosurgery Inpatient Unit 7.3Academic Neuroscience ProgramClinical/Research StaffAdministrative StaffNeurosurgery OR Nurses and AttendantsNeurosurgery Spine ProgramNeuromodulation ProgramSurgical Epilepsy ProgramNeurosurgery Simulation ProgramCerebrovascular ProgramBrain Tumour ProgramNeurotrauma and Injury Prevention ProgramsHalifax Neuropituitary ProgramMaritime Lateral Skull Base ProgramPediatric NeurosurgeryNeurosurgery Technology ProgramIntraoperative Neurophysiological Monitoring ProgramSpinal Cord Injury LaboratoryBrain Tumor LaboratoryNeuron Survival & Regeneration LaboratoryNeurosurgery FundingPublicationsPresentationsInvited LecturesNeurosurgery Residency Training ProgramNeurosurgery Rookie CampClinical Neuroscience Guest SpeakersAwards and RecognitionCross-Appointed FacultyAffiliated Faculty

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“This past year has been an eventful one, marked for each of us by various trials, successes and celebrations.”


Welcome to the Division of Neurosurgery’s 2016 Annual report. It is my pleasure to update you on the year’s events and accomplishments. This past year has been an eventful one, marked for each of us by various trials, successes and celebrations. For many of us, memories of 2016 will be saddened by the loss of our dear friend and colleague, Teresa Chapman. Teresa had recently retired as Charge Nurse after close to 35 years of dedicated service with Neurosurgery.

Our year has also been marked by many triumphs. I would personally like to welcome our newest neurosurgeon, Dr. Lutz Weise, to our neurosurgical team. He and his wife, Julie, and children, Jacob and Emilie, moved to Nova Scotia from Germany over the summer – it has been great having Dr. Weise and his family with us. We continue to attract the highest caliber of personnel to the neurosurgical team - welcome to all new members of the Neurosurgery family!

We are now seeing the tangible results of our multi-million dollar QEII Academic Neuroscience Program initiative. Our new IMCU (Intermediate Care Unit) was commissioned for patient care on December 5. It is a beautiful facility that will help us better serve our patients. I want to thank the QEII Foundation for its tremendous fundraising efforts and acknowledge the remarkable generosity of our donors – we are so encouraged by this incredible community support.

I also want to thank our administrative support within the Hospital and Nova Scotia Health Authority (NSHA), including our 7.3 Health Services Manager, Fran Kelloway, our Neurosciences Director, Randi Monroe, and NSHA Vice-Presidents, Paula Bond and Allan Horsburgh; and teams of people who worked hard on the detailed planning and who have been working hard on the many details involved in the transition process to a newly reconfigured neurosurgical unit.

Up next is demolition followed by construction of our brand new Epilepsy Monitoring Unit!

We are very fortunate to work with exceptional people at the IWK Health Centre, the QEII Health Sciences Centre and at Dalhousie University. A recent patient encounter reminded me of the strength of our team. I was in the OR and the patient was getting ready for surgery. As is now our routine, we reviewed the planned procedure with the patient and OR team. After finishing this, and as he was about to be put asleep, the patient looked up from the OR table, eyes bright, and said “Do what you have to do. I know I have the A Team”.

It is that type of encounter that reminds me of what we do, day in, day out: all of us, working as a team, look after patients who literally put their trust and their lives in our hands, knowing that we will provide the best care.

And that is what we celebrate in this annual report – a great neurosurgery team at the IWK, QEII and Dalhousie of whom I am immensely proud. We thrive in an exceptional environment where it is known by nursing students that neurosurgery is the best place to train and practice; where our OR team of dedicated neurosurgical nurses and neuroanesthetists is the envy of the country; where the best of the best neurosurgery residents come to be trained; and where our research and educational efforts are recognized on the national and international stages.

I hope that your review of this annual report will give you insight into the exceptional work of our “A Team”!

Message from theHead of NeurosurgeryDAVID B. CLARKE, MDCM, PhD, FRCSC, FACSHead, Division of Neurosurgery

Welcome to the Division of Neurosurgery’s 2016 Annual Report. It is my pleasure to update you on the year’s events and accomplishments.


Neurosurgery Facult y

SEAN CHRISTIE MD, FRCSC• Vice-Chair, Division of Neurosurgery• Director, Neurosurgery Spine Program• Director of Research, Division of Neurosurgery• Associate Professor, Department of Surgery

Areas of Interest:• Minimally Invasive Spinal Surgery• Complex Spinal Surgery• Neurotrauma• Sport-Related Neurological Injuries

DAVID B. CLARKE MDCM, PhD, FRCSC, FACS• Head, Division of Neurosurgery• Professor, Departments of Surgery, Medical Neuroscience, Medicine (Endocrinology) and Ophthalmology & Visual Sciences

Areas of Interest:• Transspheniodal Surgery, Neuro-oncology• Epilepsy Surgery• Neurotrauma and Injury Prevention• Neurosurgery Simulation/Education

DANIEL MCNEELY MD, FRCSC• Chief, Pediatric Neurosurgery, IWK Health Centre• Program Director, Neurosurgery Residency Program• Assistant Professor, Department of Surgery

Areas of Interest:• Pediatric Neurosurgery• Pediatric Epilepsy Surgery• Spinal Dysraphism• Hydrocephalus• Intraventricular Neuroendoscopy

SEAN BARRY MD, FRCSC• Treasurer, Division of Neurosurgery• Assistant Professor, Department of Surgery

Areas of Interest:• Minimally Invasive Spinal Surgery• Complex Spinal Surgery• Spinal Oncology• Neurotrauma


LUTZ WEISE MD, PhD • Associate Professor, Department of Surgery

Areas of Interest:• Functional Neurosurgery • Image Guidance • Movement Disorders • Neurophysiology• Complex Pain • Spinal Surgery• Stereotaxy

GWYNEDD PICKETT MD, FRCSC• Assistant Professor, Department of Surgery

Areas of Interest:• Cerebrovascular Surgery• Endovascular Treatment of Aneurysms

ADRIENNE WEEKS MD, PhD, FRCSC• Assistant Professor, Department of Surgery

Areas of Interest:• Cerebrovascular Diseases• Endovascular Treatment of Aneurysms• Neuro-Oncology

JACOB ALANT MBChB, MSc, MMed, FRCSC• Assistant Professor, Department of Surgery

Areas of Interest:• Minimally Invasive Spinal Surgery• Peripheral Nerve Surgery

SIMON WALLING MBCHB, FRCSC• Assistant Professor, Department of Surgery

Areas of Interest:• Neurotrauma• Injury Prevention• Neuro-Oncology• Pediatric Neurosurgery• Surgical Education


GREG JENKINS MD

Postgraduate Year 6MD Memorial UniversityNewfoundland, CanadaDr. Jenkins obtained his medical degree at Memorial University in 2011. He also earned an honors degree in biochemistry at Memorial University in 2007. Dr. Jenkins is expected to complete his residency training with Dalhousie University in 2017.

DAVID BRANDMAN MD

Postgraduate Year 4MD University of CalgaryAlberta, CanadaDr. David Brandman obtained his medical degree at the University of Calgary in 2010. Prior to studying medicine, he pursued a degree in biophysics at the University of British Columbia. Dr. Brandman is completing a PhD at Brown University studying brain-machine interface.

AARON ROBICHAUD MD

Postgraduate Year 4MD Dalhousie UniversityHalifax, CanadaDr. Robichaud obtained his medical degree from Dalhousie University in 2012. Prior to studying medicine, Dr. Robichaud obtained a Bachelor of Science degree in biology at Mount Allison University. He is pursuing a Master’s degree in Neuro-oncology in Dr. Weeks’ laboratory. Dr. Robichaud is expected to complete his residency training with Dalhousie University in 2019.

Neurosurgery Residents

AYOUB DAKSON MD

Postgraduate Year 5MD University of ManchesterManchester, EnglandDr. Ayoub Dakson obtained his MBChB from the University of Manchester, England in 2011 with a Masters in Medical Research (Merits). Prior to this, he completed a BSc (honors) in Medical Sciences in St. Andrews University. Dr. Dakson is expected to complete his training in 2018.


JOHN ADAMS MD

Postgraduate Year 4MD Memorial UniversityNewfoundland, CanadaDr. Adams obtained his medical degree at Memorial University in 2013. Prior to studying medicine, Dr. Adams obtained a Bachelor of Science Degree in Neuroscience. Dr. Adams is expected to complete his training with Dalhousie University in 2019.

HEIDI GODBOUT MD

Postgraduate Year 1Universitè de SherbrookeQuebec, CanadaDr. Godbout obtained her medical degree at the Université de Sherbrooke in 2015. Prior to studying medicine, Dr. Godbout obtained her undergraduate degree in Health Sciences.

OMAR ALSHARIF MD

Postgraduate Year 2MD King Saud University Riyadh, Saudi Arabia Dr. Alsharif obtained his medical degree at King Abdulaziz University in 2011. He joined the department of Neurosurgery at King Abdulaziz University as a teaching assistant in September 2012. In 2013 he began working as a research fellow at the University of Toronto on a scholarship. He is expected to complete his residency training with Dalhousie University in 2021.

ALWALAA ALTHAGAFI MD

Postgraduate Year 1MD King Abdulaziz University Jeddah, Saudi ArabiaDr. Althagafi obtained his medical degree at King Abdulaziz University in 2013. Prior to studying medicine, Dr. Althagafi pursued a bachelor of medical laboratory science in New Zealand. He is expected to complete his residency training with Dalhousie University in 2022.


NeurosurgicalProcedures

Clinical Activities

Ambulatory Care Visits

Cerebrovascular

6% Other

17%

Spine

39%

Functional

8%

Pediatric

9%

21%Cranial Procedures

Y2014 Y2015 Y2016 Y2014 Y2015 Y2016

Y2014 Y2015 Y2016

7000

1000

2000

3000

4000

5000

6000

1500

300

600

900

1200

1700

100

300

700

1100

1500

500

900

1300

Cerebrovascular

6% Other

17%

Spine

39%

Functional

8%

Pediatric

9%


Y2014 Y2015 Y2016 Y2014 Y2015 Y2016

Y2014 Y2015 Y2016

7000

1000

2000

3000

4000

5000

6000

1500

300

600

900

1200

1700

100

300

700

1100

1500

500

900

1300


Admissions

NeurosurgicalProcedures

Cerebrovascular

6% Other

17%

Spine

39%

Functional

8%

Pediatric

9%


Y2014 Y2015 Y2016 Y2014 Y2015 Y2016

Y2014 Y2015 Y2016

7000

1000

2000

3000

4000

5000

6000

1500

300

600

900

1200

1700

100

300

700

1100

1500

500

900

1300

Cerebrovascular

6% Other

17%

Spine

39%

Functional

8%

Pediatric

9%


Y2014 Y2015 Y2016 Y2014 Y2015 Y2016

Y2014 Y2015 Y2016

7000

1000

2000

3000

4000

5000

6000

1500

300

600

900

1200

1700

100

300

700

1100

1500

500

900

1300


Health Service Manager: Fran KellowayThe expansion to our Neurosciences Alliance with our Neurology partners has progressed throughout 2016 beginning with the Neurology inpatient unit physically relocating to the 7th floor of the Halifax Infirmary next to the Neurosurgery inpatient unit in January 2016. Renovations were completed on the Neurology unit to accommodate the team in their new environment, including creating a new team room, renovating a shower room, converting a single room to a double room and planning changes to the nursing station. Construction of the new IMCU between the two inpatients units began in late spring and was completed in December 2016, increasing our IMCU capacity from four beds to six beds. A Professional Practice review was completed for staffing and models of care for the new Neuroscience Alliance teams who will staff both Neurosurgery and Neurology. Part of this work involved introducing a new model of care in our expanded IMCU. This new model includes utilizing Care Team Assistants (CTAs) as part of our staffing mix in the IMCU. Education and orientation for the introduction of this new role occurred throughout the fall of 2016 and the new CTAs started in the IMCU in December.

The next phase of our progress towards our Neurosciences Alliance includes expanding our Epilepsy Monitoring Unit (EMU) from two beds to four beds and moving this service onto the Neurology inpatient unit.

Neuro-Ortho Spine (NOS) patients will be moved to the New Spine Unit located in the Neurosurgery inpatient unit with an increased capacity from twelve beds to seventeen beds.

All of these planned renovations have been made possible by funds generously donated through our QEII Foundation.

In 2016, the Neurosurgery Inpatient Unit continued to experience some changeover in nursing staff related to relocations, personal leaves and maternity leaves. In total we’ve hired fourteen new staff this year including nine new RNs, one LPN and four CTAs.

In addition to this turnover in staff, we have welcomed one of our staff nurses into the charge role, Samantha Warren (to replace Dayna ElHassan who went on maternity leave in January 2016) to join Shelley Nikolaev our second charge nurse.

Sadly, our colleague and friend Teresa Chapman passed away in May, one year after she retired from working more than 35 years with Neurosurgery as a staff nurse/ charge nurse.

The Neurosurgery Quality Management Committee, consisting of members from various disciplines, continues to meet on a monthly basis to identify successes as well as issues related to quality and efficiency of care, patient safety and accreditation standards. The purpose of the committee is to promote education and excellence in patient care and safety.

Neurosurgery Inpatient Unit 7.3

FRAN KELLOWAYHealth Service Manager


The Academic Neuroscience Program was established to provide timely access to advanced patient care, leading edge research, and training of health professionals. This program, involving Neurology, Neurosurgery, and Spine will create a new 6 bed state of the art Neurosurgical Intermediate Medical Care Unit (IMCU) and 4 bed Epilepsy Monitoring Unit (EMU), providing patients with the most comprehensive care in Atlantic Canada including prevention, intervention, long-term management, outreach and links to community providers.

Renovations and relocations occurred throughout the year. The Neurology unit was moved to its new location on 7.3 and many staff offices/rooms were relocated within the Halifax Infirmary. Construction of the new IMCU between the two inpatients units began in late spring. This construction created an increase in our IMCU capacity from four beds to six and opened in December 2016.

Continued work with professional practice involved introducing a new model of care in our newly expanded IMCU. This new model includes utilizing CTAs (Care Team Assistants) as part of our staffing mix in the IMCU.

Education and orientation for the introduction of this new role is complete and the new CTAs started with the opening of the IMCU in December.

The next phase of this project includes the expansion and relocation of the Epilepsy Monitoring Unit (EMU) as well as amalgamation our Neuro-Ortho Spine (NOS) patients onto our Spine unit in the Neurosurgery inpatient unit with an increased capacity from twelve beds to seventeen beds.

We would like to thank all our staff for their patience during this phase of the project.

We would like to thank the QE II Foundation and the NSHA leadership for their support in this endeavor.

Academic Neuroscience Program


LORELEI AUDASRN, BScN, CCRP

Program Coordinator: Neuro-Trauma/Simulation

CORALEA CAREYNeurosurgery Clinic Aide& Research Assistant

MISSY BRINSONRN

Brain Tumour Liaison Nurse

RON HILLTechnology Coordinator

NICKY AYLESRN

Neurosurgery ClinicProgram RN

Clinical / Research Staff

LYNNE FENERTYRN, BN, DO(MP)

Program Manager:Neuro-Trauma/Injury Prevention

ANDREA L.O. HEBBMSc., PhD, RN

Clinical/Research Coordinator:Brain Tumour Program/MaritimeLateral Skull Base Program/HalifaxNeuropituitary Program

JULIA BURKEClinic Aide


MURRAY HONGPhD

Imaging Specialist

JUDITH JARRETTRN, CCRP

Program Coordinator:Cerebrovascular

LISA JULIENRB, BScN, CCRP

Program Team Lead:Spine

SANDRA LANGILLEResearch Coordinator:Neurosimulation

ANGELA MEAGHERRN, NP

Neurosurgery Spine Program

ANITA MCPHEERN

Research Coordinator:Spine

NELOFAR KURESHIMD, MHI

Research Associate:Neurotrauma/Simulation/Spine

CAROL-ANN MILLERRN, NP

Cerebrovascular Program


Clinical / Research Staff (cont’d)

GINETTE THIBAULT-HALMANRN, CNN(c), MSc

Program Coordinator:Neuro-Trauma/Injury Prevention/Neurosurgery Spine

SUSAN RAHEYBSc, RET, RT(EMG)

Program Coordinator:Epilepsy

TIFFANY WEBBERSpine Referral TriageResidency ProgramCoordinator

JACKIE SEAGERSNeurosurgery Clinic Aide

KARINA RANKKAHealth Services Manager:Neurosurgery Clinic

MARIE PELLERINBooking Clerk

CHRISTINE POTVINRN

Program Coordinator/RN: Neuromodulation

SARANYAN PILLAIPhD

Research Associate:Neurosurgery Spine

LESLIE PERRINRN

Neurosurgery Clinic


DEBBIE AMIRAULTAssistant toDr. Sean Barry

Administrative Staff

MELISSA COOKAssistant toDr. Sean Christie

KATHARINE ANDERSONAssistant toDr. Gwynedd Pickett

CATHY CARONAssistant toDr. Daniel McNeely

DIANE JARDINEAssistant toDr. David Clarke

MAUREEN KAYAssistant toDr. Jacob Alant

EMMA GILLESPIE-FRASERAssistant toDr. Adrienne Weeks

PAM DOUCETTEAssistant toDr. Lutz Weise

SHIRLEY MACLEODAssistant toDr. Sean Christie

KELLY MARTINExecutive Assistantto Dr. David Clarke

CARLA ROBERTSAssistant toDr. Adrienne Weeks

TERRY SMITHAssistant toDr. Gwynedd Pickett

CHRISSY SHAYAssistant toDr. Simon Walling

LORRAINE SMITHAdministratorDivision of Neurosurgery

TIFFANY WEBBERResidency TrainingProgram CoordinatorSpine Referral Triage


Administrative Staff (cont’d)


Neurosurgery OR Nurses

Neurosurgery OR Attendants

J. GALLANT

S. GIBSON

D. HALL

L. MACISAAC

N. MURPHY

P. PARSONS

J. REDMOND

T. RUGGLES

G. SHERWOOD

D. SPLANE

T. THOMAS

J. TUFTS

R. WILLIAMS

M. WILSON

JENNY BARNES SMITH

SAM CAMERON

JENNIFER DERENGOSKI

SUE DOBBIN

AMANDA GEORGE

JEN HOYT

ANNE JURCINA

LAURA KNIGHT

DONNA MACQUEEN

AMANDA WOODS



Neurosurgery Spine Program

Director: Dr. Sean ChristieProgram Team Lead: Lisa JulienProgram Coordinator: GinetteThibault-HalmanResearch Coordinator: Anita McPheeResearch Associates: Nelofar Kureshiand Saranyan PillaiThe Neurosurgery Spine Program provides comprehensive care to patients with spinal disorders and spinal cord injuries.

Accomplishments• This year the Spine Program welcomes our first Dalhousie Spine Fellow, Mustafa Nadi. Dr. Nadi will be part of our Combined Spine Program between Neurosurgery and Orthopaedics and will participate in a breadth of procedures including adult and paediatric spine as well as neuromodulation procedures. Welcome Dr. Nadi!

• We would also like to welcome our new spine research coordinator, Lisa Julien to the team. Lisa brings over 22 years of clinical and research experience, in both critical care and transplant, to the program. She will be managing the research aspects of the program and overseeing the spinal cord injury studies.

• The Atlantic Canada Spine meeting was held for the eighth consecutive year as a regional CME spine-focused event. The topic of focus was Spine Surgery at the Extremes of Age. Dr. Michael Ford (Sunnybrook Health Science Centre) and Dr. Ken Rockwood (NSHA- Queen Elizabeth II HSC) were this year’s invited guest speakers. We thank Medtronic Canada for their continued support.

• The Skills Centre for Health Sciences continues to provide learning opportunities in spine procedures for residents and surgeons.

• OpNote is capturing spine operative data in a synoptic template for both Orthopedic Spine and Neurosurgery Spine Programs. Synoptic operative reports will standardize the clinical information captured by various surgeons and improve the quality of data captured compared to dictated reports.

BACK (LEFT TO RIGHT): D. Amirault, Dr. S. Christie, M. Cook, A. McPhee FRONT (LEFT TO RIGHT): Dr. S. Barry, M. Kay, L. Jarvie, G. Thibault-Halman, A. Meagher, S. Pillai, Dr. J. Alant


ResearchSpine program research projects include investigator-initiated studies, as well as multi-centre national and international studies.

• Improving Patient Access to Spine Care through Implementation of an Evidence-Based Spine Triage Clinic: objective of this project is to develop a comprehensive spine triage clinic with the goals of reducing wait times, improving patient outcomes, increasing patient and provider satisfaction levels, and decreasing healthcare costs.

• Trends and regional variations in surgical interventions for spinal degenerative disorders in Canada: This project will evaluate the changing epidemiology of spinal degenerative diseases and rates of elective spinal surgeries in Canada over a 20-year period in order to establish the trajectory of these entities and their economic impact on the Canadian healthcare system.

• Frailty Index in Spinal Cord Injury Patients: The assessment of frailty may be an important determinant in the appropriate management of older SCI patients. A series of standard laboratory values and clinical data have been previously used to determine a frailty index, which has been linked to clinical outcomes in the elderly. This project will investigate whether the frailty index is associated with in-hospital mortality in SCI patients.

• Attitudes of Canadian Spine Surgeons Towards Medical Assistance in Dying (MAID): A national survey was conducted to determine the level of support among Canadian spine surgeons for MAID. This project is in the data analysis phase.

• Modic changes in Chronic Lower Back Pain Patients: A retrospective chart and radiological review has been completed to determine whether patients with modic changes have poorer surgical outcomes than those without these imaging features. This project is in the manuscript writing phase.

• The Titanium study is a Research in Medicine (RIM) student project. This project is designed to investigate the level of titanium metal ions in a patient’s whole blood. Patient who are invited to participate have previously undergone, or are scheduled to undergo cervical arthroplasty surgery using the Medtronic Prestige LP prosthesis or are scheduled to undergo a single level anterior cervical disectomy and fusion with the Atlantis Vision Elite plate. Patients will be monitored for 10 years post-op; all serum samples are sent to a central facility for analysis. If patient titanium levels are reported to be > 100pbb there may be health concerns.

• Utility of the Spinal Instability Neoplastic Score (SINS) System in Surgical Practice: A retrospective chart review of patients with spinal metastatic cancer, to assess the Spinal Instability Neoplastic Score System (SINS) and its clinical utility in predicting surgical treatment decision is underway.

Several studies are conducted in partnership with the Rick Hansen Institute (RHI):

• The Canadian Multicenter Cerebrospinal Fluid Pressure Monitoring and Biomarker (CAMPER) study - a national multi-centre clinical trial examining spinal cord perfusion pressure (SCPP) in patients with acute SCI, as well as the effect of different vasopressor agents on SCPP. Cerebrospinal fluid samples collected as part of this study will be used to validate a series of biochemical markers correlating with injury severity and predicting neurologic outcome. We are pleased to be participants in the Biomarkers for Crossing the Translational Divide in Acute Spinal Cord Injury project, led by Dr. Brian Kwon’s team in Vancouver, which was awarded $3 million dollars through the Brain Canada MIRI competition.

• This year marks our 9th year of enrollment in the Rick Hansen Spinal Cord Injury Registry (RHSCIR), a national registry of patients with traumatic spinal cord injury (SCI). To date 188 patients have been included and we will be conducting our 10th year follow up visits starting in 2017.

• Using data collected nationally by RHSCIR and previously published inclusion/exclusion criteria for spinal cord injury (SCI) trials, we have examined the feasibility of recruiting subjects for acute spinal SCI clinical trials in Canada. The manuscript has been accepted for publication.

• The Canadian Spine Society (CSS) Registry is a national health data registry that tracks outcome measures of the surgical and non-surgical treatment of specific spinal conditions.. We are currently in our 3rd year of enrollment for this registry. The spine patient populations that are offered participation at our site are surgically managed for the following procedures/indications: 1.Cervical Arthroplasty, 2. Cervical Myleopathy/ Myleoradiculopathy and 3. Lumbar Spondylolisthesis.

Currently 121 patients have been included, 63 in 2016.


PublicationsAhn H, Bailey CS, Rivers CS, Noonan VK, Tsai EC, Fourney DR, Attabib N, Kwon BK, Christie SD, Fehlings MG, Finkelstein J, Hurlbert RJ, Townson A, Parent S, Drew B, Chen J, Dvorak MF; Rick Hansen Spinal Cord Injury Registry Network. Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury. CMAJ. 2015 Sep 8;187(12):873-80.

Evaniew N, Noonan VK, Fallah N, Kwon BK, Rivers CS, Ahn H, Bailey CS, Christie SD, Fourney DR, Hurlbert RJ, Linassi AG, Fehlings MG, Dvorak MF; RHSCIR Network. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry. J Neurotrauma. 2015 Nov 1;32(21):1674-83.

Haji FA, Clarke DB., Matte MC, Brandman DM, Brien S, de Ribaupierre S, O’Kelly C, Christie S, McDonald PJ, Kulkarni AV, Walling S and MacLeod A. Teaching for the Transition: the Canadian PGY-1 Neurosurgery ‘Rookie Camp’. Canadian Journal of Neurological Sciences. 42:25-33, 2015.

Book ChaptersFessler RG, Song JK, Christie SD. Lateral Parascapular Approach to the Upper Thoracic Spine

Case ReportBarry S, Dakson A. A case of rapidly progressing paraplegia. Spinal Columns. Volume 16, Number 1, Feb 2016.

AbstractsDakson A, Leck E, Butler M, Thibault-Halman G, and Christie S. The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spinal metastatic disease. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques / Volume 43 / Supplement S2 / June 2016, pp S49 - S49

Dakson A, Leck E, Butler M, Thibault-Halman G, and Christie S. Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumor histology. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques / Volume 43 / Supplement S2 / June 2016, pp S50 - S50

Dakson A, Bigder M, Elliott C, Guha D, Iorio-Morin C, Kameda-Smith M, Lavergne P, Makarenko S, Taccone MS, Tso M, Wang B, Winkler-Schwartz A, Sankar T and Christie S. The Canadian Neurosurgery Research Collaborative (CNRC): A novel, trainee-led, nationwide multicentre research network. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques / Volume 43 / Supplement S2 / June 2016, pp S23 - S24

Dakson A, Brandman DM, Thibault-Halman G and Christie S. The natural history of central cord syndrome and the role of surgical intervention: a retrospective review from 2005-2010. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques / Volume 43 / Supplement S2 / June 2016, pp S50 - S50.

Dakson A, Brandman D, Thibault-Halman G, Christie S. Optimization of the medical and surgical management of traumatic spinal cord injury. Trauma Association of Canada Annual Scientific Meeting, Halifax, May 5-7 2016.

Dakson A, Brandman D, Thibault-Halman G, Christie S. Investigating the Implementation of Acute Care Guidelines for Spinal Cord Injuries. Trauma Association of Canada Annual Scientific Meeting, Halifax, May 5-7 2016.

Dakson A, Brandman D, Thibault-Halman G, Christie S. The natural history of traumatic central cord syndrome as compared to other incomplete cervical cord injuries. Trauma Association of Canada Annual Scientific Meeting, Halifax, May 5-7 2016.


PresentationsChristie, S.”SCI in the Elderly, 8th Annual Atlantic Canada Spine Meeting, October 14-16, 2016.

Barry, S, “Medical Assistance in Dying (MAID) and the Spine Surgeon” Atlantic Canada Spine Meeting, October 14-16, 2016.

Alant J. “Management of C1-C2 Fractures in the Elderly” 8th Annual Atlantic Spine Canada Meeting, October 14-16, 2016.

Invited LecturesBarry, S. Medical Assistance in Dying: A neurosurgeons perspective. Canadian Neurological Society Meeting. Quebec City, Quebec. June 22, 2016.

Christie S. Surgical Management of Cervical Rheumatoid Arthritis, Division of Rhuematology Academic Rounds, January 21, 2016

Christie,S. You can do Nothing for me … My back is shot through – Lord Nelson, Canadian Association of NeuroScience Nursing, 3rd annual workshop, April 18, 2016

Funding/GrantsTranslating Research into Care (TRIC) Level 1 Grant. $3,000. 2016-17

Rick Hansen Institute. Canadian Multicentre Cerebrospinal Fluid Pressure Monitoring and Biomarker Study. $260,925.00. 2012-2016

Rick Hansen Institute. Rick Hansen Spinal Cord Injury Registry. $382,000. 2008-2017

Rick Hansen Institute. Minocycline in Acute Spinal Cord Injury study. $23,167. 2015-2016

Medtronic of Canada, Ltd. Unrestricted research grant. $40,000. 2016

Team Members:• Dr. Sean Christie, Neurosurgeon• Dr. Jacob Alant, Neurosurgeon• Dr. Sean Barry, Neurosurgeon• Dr. Dan McNeely, Neurosurgeon• Dr. Gwynedd Pickett, Neurosurgeon• Dr. Simon Walling, Neurosurgeon• Nelofar Kureshi, Research Associate • Dr. Saranyan Pillai, Research Associate• Lisa Julien, Program Team Lead• Anita McPhee, Research Coordinator• Ginette Thibault-Halman, Program Coordinator• Tiffany Webber, Spine Referral Triage• Debbie Amirault, Administrative Support • Melissa Cook, Administrative Support• Maureen Kay, Administrative Support

Team Collaborators:• Dr. William Oxner, Orthopedic surgery• Dr. Andrew Glennie, Orthopedic surgery• Dr. Cynthia Dunning Zwicker, Research Manager, Orthopedic Spine Service• Dr. Christine Short, NS Rehabilitation Centre• Dr. Sonja. McVeigh, NS Rehabilitation Centre• Dr. Mary Lynch, Pain Management Unit• Dr. Ian Beauprie, Pain Management Unit• Dr. Matthias Schmidt, Anesthesia• Dr. Susan Morris, Neurophysiology


Neuromodulation ProgramDirector: Dr. Lutz WeiseProgram Coordinator: Christine PotvinProgram RN: Nichola Ayles Our neuromodulation program provides neuromodulation care to the people of Atlantic Canada (population ~2.3M). The program focuses on improvements to quality of life primarily for people suffering from movement disorders, complex pain syndromes, and spasticity. The patient population includes patients with implantable neurostimulators for deep brain (DBS), cortical, spinal cord (SCS), and peripheral stimulation. We currently follow 205 people with stimulators for movement disorders, and 212 with stimulators for pain.

In addition to regular deep brain stimulation rounds in which patients are reviewed by the team and treatment options discussed, we run a complex pain clinic in which patients are seen and evaluated by both a neurosurgeon and a complex pain anaesthesiologist, and a treatment plan decided upon.

With their consent, patient information including quality of life surveys and intraoperative microelectrode recording data are kept on a database for analysis.

Various research activities are in progress, including electrophysiological and tractography studies in patients undergoing Deep Brain Stimulation. Ethics application was submitted on “Correlation of tractography and motor evoked potentials in deep brain stimulation”.

• Annual CANM Symposiums (Canadian Association of Neurophysiological Monitoring), Sept 2016, Halifax, NS, “Intraoperative Neurophysiologiy in DBS Surgery: From Microelectrode Recording to Evoked Potentials” Lutz Weise

In June 2016 the program welcomed a new functional neurosurgeon Dr Lutz Weise. In November 2016 the program welcomed Nichola Ayles, who will be the program RN starting in January 2017.

Team Members:• Dr. Lutz Weise, Neurosurgeon• Dr. Ian Beauprie, Anesthesiologist/Pain Specialist• Christine Potvin, Program Coordinator • Nichola Ayles, Program RN• Ron Hill, Neurosurgery Technology Coordinator • Murray Hong, Neurosurgery OR/Technical Specialist• Dr. John Fisk, Neurospsychologist • Dr. David King, Neurologist (movement disorders)• Dr. Kerry Schoffer, Neurologist (movement disorders)• Dr. Roger McKelvey, Neurologist (movement disorders)• Dr. Heather Rigby, Neurologist (movement disorders)

LEFT TO RIGHT: Dr. L. Weise, N. Ayles, P. Doucette, C. Potvin, R. Hill


Co-Chairs: Drs. David Clarke and Mark SadlerProgram Coordinator: Susan Rahey

The Epilepsy Program is a collaborative service supported by the Divisions of Neurology and Neurosurgery. Epilepsy patients referred from Nova Scotia, Prince Edward Island, New Brunswick and Newfoundland have access to:

• specialty outpatient clinics with support from Neuropsychology and Social Work• a two-bed inpatient Epilepsy Monitoring Unit (Phase I and Phase II studies)• access to state-of-the-art imaging techniques (3T MRI, fMRI, PET and MEG)• a variety of surgical options including cortical resection, lesionectomy, corpus callosotomy and vagus nerve stimulator implantation

Epilepsy Program Goals• To provide access to the latest medications and surgical techniques in the setting of a comprehensive epilepsy program to people in Nova Scotia, Prince Edward Island, New Brunswick and selected patients from Newfoundland • To continue to seek out innovative ways to continue to improve all aspects of service

Accomplishments• There were 47 admissions to the Epilepsy Monitoring Unit (EMU). Included in that total were 7 admissions for invasive recording with depth electrodes or a combination of depth and subdural strips/grids. Epilepsy surgical procedures were performed on 19 patients and more than 1400 patients were assessed in the various outpatient epilepsy clinics.

• All three EEG technology students successfully completed their Canadian Board of Registration of Electroencephalograph Technologists (C.B.R.E.T.), Inc. examinations. One of the three, Teona Bjork, was the recipient of the Dan Campbell Award, presented to the student with the highest marks in all sections of the examination in Canada.• We welcomed our first Epilepsy Fellow, Dr. Mazen Basheikh.• With the departure of Dr. Pohlmann-Eden in December, Dr. Stephanie Woodroffe joined the team, assuming responsibility for the First Seizure Clinic along with Karen Legg, NP.• Successful recruitment for an EEG/EMG technologist scheduled to join the team in January, 2017. • Susan Rahey was awarded the Albert and Ellen Grass Award for Outstanding Professional Contribution to the field of Electroneurophysiology Technology in Canada.• Planning for the expansion of the Epilepsy Monitoring Unit from 2 beds to 4 was completed, with construction scheduled to begin in January, 2017. The official opening is scheduled f or March 27, 2017, celebrating Purple Day in the new location.• Weekly epilepsy case conferences continue to be widely attended by team members along with colleagues from the IWK Health Centre and the MEG laboratory. Discussions of outpatient and EMU cases are augmented by a monthly journal club.• Educational opportunities were made available to community groups, nursing, technical and medical students and staff and to colleagues attending various local, national and international meetings. The results of research projects were presented at national and international professional meetings.• Celebration of Purple Day for Epilepsy Awareness on March 28 (the first Monday after the 26th) continued to be a high point of our year, with many staff and patients volunteering or attending our booth for purple cupcakes and education. This year we were once again privileged to host Cassidy Megan, the local young woman whose desire to bring epilepsy out of the shadows resulted in the global awareness day known as Purple Day.• We continue to benefit from the enthusiasm and commitment brought to the program by Residents assigned to the Epilepsy Program.

Surgical Epilepsy Program


ResearchTeam members are engaged in clinical and bench research, including drug trials, neuropsychological profile development, and brain stimulation and imaging techniques/modalities.

Future Directions:Program members continue their commitment to the betterment of epilepsy care in our region and beyond. Technical advances within the epilepsy surgery program continue.

Team Members:• Dr. Mark Sadler, Neurologist• Dr. David Clarke, Neurosurgeon• Dr. Dan McNeely, Neurosurgeon• Dr. Bernd Pohlmann-Eden, Neurologist• Dr. Stephanie Woodroffe, Neurologist• Dr. M. Basheikh, Epilepsy Fellow• Susan Rahey, Neurology, Program Coordinator • Dr. Antonina Omisade, Neuropsychologist• Dawnette Benedict-Thomas, Psychometrist• Karen Legg, Neurology, Nurse Practitioner EEG Technologists • Heather Smith, Social Worker• Dr. Alon Friedman, Basic Scientist

Team Collaborators:• Divisions of Neurology, NSHA, Central Zone and IWKHC • Neuroradiologists• Neuropathologists• Neuroscience and Perioperative Staff• Biomedical Translational Imaging Centre Staff• Maritime Medical Genetics Service• Health Services Managers • Biomedical Engineering• Sterile Processing

BACK (LEFT TO RIGHT): T. Bardouille, Dr. B. Pohlman-Eden, Dr. D. Clarke, Dr. D. McNeely, D. Gayala FRONT (LEFT TO RIGHT): A. Taylor, K. Legg, Dr. S. Al Hindi, Dr. A. Omisade, S. Rahey, Dr. N. Parks, Dr. M. Sadler


Director: Dr. David ClarkeProgram Manager: Lynne FenertyTechnology Coordinator: Ron HillResearch Associate: Nelofar KureshiSimulation provides an exceptional learning experience for clinical trainees by targeting skills and behaviors traditionally acquired in the clinical setting; improving patient safety, and delivering more cost-effective training. Simulation training allows healthcare professionals to experience scenarios that mirror real-life situations they may encounter with patients and families. Residency programs are recognizing the importance of simulation-based training of neurosurgical residents so that they can achieve required competencies of establishing a clinical knowledge base, diagnosing medical disorders, honing behavioral skills, and developing surgical technical skills. The Neurosurgery Simulation Program is led by Dr. David Clarke and promotes innovative simulation-based research relevant to the field of health professional education and practice.

VisionTo enhance education and skills across clinical disciplines and healthcare professions through simulation-based training and assessment.

Mission• To create a comprehensive surgical simulation program serving a variety of disciplines.

• To develop and expand the educational environment for healthcare trainees and interprofessional teams

• To foster research and commercialization of simulation- based education

Accomplishments • PeriopSim™, an iPad app for residents and nurses to learn surgical instruments and review surgical procedures is being developed by Conquer Mobile in collaboration with Dr. David Clarke, Dr. Ryan D’Arcy (Simon Fraser University), Dr. James Bond (Surrey Memorial Hospital), and Denise Lalanne (BIOTEC). PeriopSim™ is in use in more than 100 North American hospitals and is available as a free preview version on the Apple App Store.

• The Association of periOperative Registered Nurses (AORN) added PeriopSim™ to a six-month pilot program that will evaluate whether simulation learning is effective as an additional educational tool.

ResearchPeriopSim™ is currently under evaluation for its training utility in surgical teaching programs at Dalhousie University and the QEII HSC.

• Virtual Reality (VR) Training for Neurosurgery Residents: PeriopSim™ VR was tested on neurosurgery residents at the 2016 Canadian Neurosurgery Rookie Camp. The PeriopSim™ VR pilot simulation provides fully immersive medical simulation surgical instrument training.

• Simulation Training for Perioperative Nurses: The 100Nurses study, supported by a grant from the Brain Repair Centre to evaluate the PeriopSim™ platform, has been completed. This is the first study to assess the effect of tablet-based simulation training on instrument recognition for perioperative nurses. Our results show that the PeriopSim™ simulation platform can be used as an effective educational tool in teaching surgical instruments. Furthermore, we have shown that this learned knowledge is retained.

Neurosurgery Simulation Program


PresentationsKureshi N, Clarke DB, Hong M, Fenerty L, Thibault-Halman G, Fulmore C, Cromwell M, D’Arcy R. “Simulation-Based Training for Surgical Instrument Recognition – a Training Initiative for Perioperative Nurses”, Royal College Simulation Summit, St. John’s, NL, Abstract R7, October 14, 2016.

Clarke DB, Fenerty L, Hong M, Newton S, Thibault-Halman G, Fulmore C, Cromwell M, Hoyt J, Kureshi N, D’Arcy R. “Simulation-Based Training for Perioperative Nurses”, 27th Atlantic Operating Room Nurses Conference, Halifax, NS, September 24, 2016.

Team Members:• Dr. David Clarke, Neurosurgeon• Ron Hill, Neurosurgery Technology Coordinator• Murray Hong, Neurosurgery OR/Technical Specialist• Lynne Fenerty, Program Manager• Ginette Thibault-Halman, Program Coordinator• Nelofar Kureshi. Research Associate

Team Collaborators:• Dr. Ryan D’Arcy, Department of Computing Science, Simon Fraser University• Denise Lalanne, BIOTEC• Conquer Mobile

Director: Dr. Gwynedd PickettCoordinator: Judith Jarrett RN CCRP

Program SummaryThe Cerebrovascular Program is a multidisciplinary program involving neurosurgeons, neuroradiologists, stroke neurologists, nurses and trainees in each of these disciplines. Halifax is the referral centre for the treatment of cerebrovascular disorders in Atlantic Canada with extensive experience in surgical and endovascular management of aneurysms and arteriovenous malformations (AVM), and the only centre with a stereotactic radiosurgery program for the treatment of patients with AVMs. The cerebrovascular team meets weekly to review clinical cases from all of the Atlantic Provinces, and discuss recommendations for a multidisciplinary evidence-based approach to patient care.

Mission Our team is dedicated to providing world class, innovative care for patients with cerebrovascular disorders.

Program Goals• To treat patients with cerebrovascular disorders using the latest technology.

• To advance the knowledge and techniques for the treatment of cerebrovascular disorders through education and research.

• To translate research to evidence based practice.

Research We have had an active year in research, participating in several multi-center studies and local investigator driven studies as listed below. We maintain a number of databases that provide valuable information for local research endeavours.

Ongoing Multi-Centre Studies• CURES - The Canadian Unruptured Endovascular Coiling versus Surgical Clipping Trial, a randomized comparison of angiographic and clinical outcomes following treatment for Unruptured intracranial aneurysms. Currently enrolling, (Funding: $6,000.00).

Principal Investigator Dr. GE Pickett.

• STAT – Stenting in the Treatment of Large, Wide-necked or Recurring Intracranial Aneurysm Trial. Currently enrolling.


• HEAT – Multicenter randomized controlled trial of new generation Hydrogel coils versus bare platinum coils in the endovascular treatment of intracranial aneurysms. In Follow- up, 22 subjects enrolled, (Funding: $82,800.00).

• NAVIGATE ESUS – Secondary Prevention of Stroke in Patients with ESUS. Currently enrolling, 7 subjects enrolled, (Funding: $282,673.00).

• ECST-2 – The 2nd European Carotid Surgery Trial: A multicentre randomized controlled open prospective clinical trial with blinded outcome assessment. Currently Enrolling, (Funding: $282,673.00).


Ongoing Local StudiesEvaluation of the Unruptured Intracranial Aneurysm Treatment Score: how does it compare with treatment decisions made by a multidisciplinary team?


CT Perfusion Imaging to Predict Vasospasm in Subarachnoid Hemorrhage (Funding: $25,000.00).


Accomplishments• The Brain Aneurysm Support Group has been meeting regularly since October 2006. This invaluable resource serves as an opportunity for brain aneurysm patients and families to share information, give and receive emotional support, educate each other, identify needs and access further resources.

• We continue to treat patients from across the Maritime Provinces for a variety of complex cerebrovascular conditions.

Cerebrovascular Program



Future DirectionsProgram members continue to work together to improve the care of patients with cerebrovascular disorders in Nova Scotia and the Atlantic Provinces. We anticipate that 2017 will see expansion of local research endeavours, and improvements in our stereotactic radiosurgery program.

Invited PresentationsDr. Pickett. “Intracranial Aneurysms”, invited lecture at Canadian Federation of Neurological Sciences annual resident review course, June 21, 2016.

Dr. Pickett. “When to Refer to Neurosurgery”, invited lecture at the Atlantic Canada Stroke meeting, October 29, 2016.

Team Members & Collaborators:• Dr. Gwynedd Pickett, Director, Neurosurgeon• Judith Jarrett, Program Coordinator• Carole-Ann Miller, Specialty Nurse Practitioner• Dr. Adrienne Weeks, Neurosurgeon• Dr. Gordon Gubitz, Neurologist• Dr. Stephen Phillips, Neurologist• Dr. Laine Green, Neurologist• Dr. William Maloney, Neuroradiologist• Dr. Robert Vandorpe, Neuroradiologist• Dr. Matthias Schmidt, Neuroradiologist• Dr. Jai Shankar, Neuroradiologist• Dr. Jens Heidenreich, Neuroradiologist• Dr. Aiman Quateen, Neurointerventional Fellow• Dr. Mandeep Ghuman, Neurointerventional Fellow

BACK (LEFT TO RIGHT): A. Al-Habsi, Dr. G. Gubitz, Dr. R. Vandorpe, Dr. W. Maloney, Dr. S. Phillips, Dr. J. ShankarFRONT (LEFT TO RIGHT): C-A Miller, Dr. G. Pickett, Dr. A. Weeks, J. Jarrett


Program Co-Chairs: Drs. AdrienneWeeks and M. McNeillBrain Tumour Nurse Coordinator:Missy BrinsonResearch Coordinator: Andrea Hebb

The Brain Tumour Program is a multidisciplinary program involving neurosurgeons, medical oncologists, radiation oncologists, neuropathologists, neuroradiologists, nurses, and trainees of each of these disciplines. Weekly meetings of the Neuro-oncology Cancer Site Team provide evidence based recommendations for patient management. This team organizes visiting speakers and rounds, and is responsible for the development of provincial guidelines for the management of patients with brain tumours. This past fall our Brain Tumour Nurse was able to attend the first National Brain Tumour Conference held in Toronto with funding from the Neurosurgery division. She was able to network among other professionals and survivors passionate in brain tumours and wanting to find a cure. It was a great opportunity to see what others are doing around Canada to support our patients as well as hear about some of the research taking place to help find that cure.

The Brain Tumor Support Groups are located in Halifax and New Glasgow.

The Halifax Group hold meetings every 2nd Tuesday of each month at:

The Lodge That Gives, 5826 South StreetHalifax, NS

The New Glasgow Group hold meetings every 3rd Monday of the month at:

The East River Manor,695 East River RoadNew Glasgow, NS

Brain Tumour Support Groups help survivors, family and caregivers through their journey with a brain tumour in a number of ways:

• Providing connections with others who have faced life with a brain tumour thereby offering reassurance, reducing feelings of isolation and reinforcing a positive, hopeful attitude.

• Sharing practical information to:

– Help make informed decisions about brain tumour treatment options – Learn about relevant community resources – Enhance coping skills in order to reduce anxiety, feelings of loss of control and fear of the unknown, changes in family roles, and financial strain as a result of a brain tumour diagnosis. See more at: http://www.braintumour.ca/280/halifax-nova-scotia#sthash.TwDcHPLw.dpuf

Our prospective epidemiology Brain Tumour Database continues- with over 3500 patients currently entered.

ResearchDr. Simon Walling, Dr. Conrad Fernandez (IWK), Dr. Adrienne Weeks, Dr. Dan McNeely and Andrea L.O. Hebb, MSC, PhD, RN (Local Associate Investigators) are part of a collaborative research team lead by Dr. Nada Jabado at McGill University/McGill University Health Center (Principal Investigator Genome Canada). “Biomarkers for Pediatric and Adult High Grade Astrocytoma through Genomics and Epigenomics” is a Canada wide study for adult patients under the age of 50 and children, and their families surveying their thoughts surrounding receiving genetic research results.

A sub-study of this grant involves collecting tumour samples in patients with high grade astrocytoma, with the formation of human tumour cell lines in the basic science laboratory of Dr. Adrienne Weeks (PI) and Dr. Simon Walling (PI) and co-investigators Dr. David B. Clarke, Dr. Dan McNeely and Andrea L.O. Hebb, MSc, PhD, RN in collaboration with Dr. Sidney Croul, Pathology & Laboratory Medicine.

Brain Tumour Program


BACK (LEFT TO RIGHT): H. MacKenzie, Dr. M. Bance, Dr. R. VanDorpe, Dr. A. Weeks, Dr. S. Croul, Dr. S. Walling, Dr. D. ClarkeFRONT (LEFT TO RIGHT): Dr. Badahdah, Dr. M. MacNeill, M. Brinson, A. Hebb, Dr. D. McNeely

In collaboration with the Division of Pediatric Neurosurgery, British Columbia’s Children Hospital and Division of Neurosurgery, Department of Surgery, University of British Columbia and members of the Vancouver Pediatric Neurosurgery Study Group Dr. Simon Walling and Dr. Dan McNeely (Local Associate Investigators) are participating in a nationwide study “Mutism After Posterior Fossa Tumour Resection in Children: A Multicentered International Retrospective Study” to identify factors related to the overall management or surgical technique that correlate with a lower or higher incidence of Cerebellar mutism syndrome (CMS).

Basic Science Brain Tumour Research: see Brain Tumour Laboratory, Dr. Adrienne Weeks.

Abstracts/ConferencesConrad Fernandez, Andrea L.O. Hebb, Mandy Bouchard and Simon Walling (2016). Return of genomic results relevant to personalized decision-making in brain tumour patients: pilot questionnaire results. 48th Congress of the International Society of Paediatric Oncology, (October 19-22, 2016 in Dublin, Ireland), http://onlinelibrary.wiley.com.ezproxy.library.dal.ca/doi/10.1002/pbc.26233/full

FundingDr. Aaron Robichaud received both a Killam Scholarship and Beatrice Hunter Cancer Research Studentship to complete his Master of Science thesis on stress granules in glioblastoma multiforme (GBM).

PublicationsJai Shankar, Adil Bata, Krista Ritchie, Andrea L.O. Hebb and Simon Walling. Normalized ADC in the prognostication of patients with glioblastoma multiforme. The Canadian Journal of Neurological Sciences, 2016 Jan;43(1):127-33

Team Members:• Dr. Adrienne Weeks, Neurosurgeon, Co-Chair CNS CST • Dr. Mary McNeill, Medical Oncologist, Co-Chair CNS CST • Dr. Simon Walling, Neurosurgeon • Dr. Dan McNeely, Neurosurgeon• Dr. David Clarke, Neurosurgeon• Dr. Gwynedd Pickett, Neurosurgeon• Dr. Sean Christie, Neurosurgeon• Dr. Sean Barry, Neurosurgeon• Missy Brinson, Neurosurgery Brain Tumour Nurse Coordinator• Andrea Hebb, Neurosurgery Research Coordinator• Dr. Sid Croul, Neuropathologist• Dr. Alex Easton, Neuropathologist• Dr. Dorianne Rheaume, Radiation Oncologist• Dr. Liam Mulroy, Radiation Oncologyist• Dr. Lara Best, Radiation Oncologist• Dr. Jai Shankar, Neuroradiologist• Heather MacKenzie, Coordinator, Cancer Care Nova Scotia• Erin Little, Research Coordinator


Director: Dr. David ClarkeProgram Manager: Lynne FenertyProgram Coordinator: GinetteThibault-HalmanResearch Coordinator: Lorelei AudasResearch Associate: Nelofar Kureshi

Traumatic brain injury (TBI) is the leading cause of death and disability globally, and is implicated in nearly half of all trauma deaths. In Canada, there are approximately 23,000 TBI-related hospitalizations annually, with 8% resulting in death.

TBI represents 47.7% of all major traumas in Nova Scotia and the rate continues to rise annually. The majority of injuries are the result of blunt trauma (93%), with relatively few major TBIs resulting from penetrating trauma (7%). The most common mechanisms of injury are falls (44%) and motor vehicle crashes (27%).

It is estimated that the direct and indirect costs associated with TBI are $3 billion annually in Canada. Despite advances in the management of physical disabilities, disturbances of cognition, mood, and behavior constitute the most devastating aspects of brain injury for the patient, their significant others and society at large.

The Neurotrauma and Injury Prevention programs are dedicated to conducting research for preventative strategies and improved clinical management for TBI patients and families. Both programs collaborate across multiple sectors to deliver targeted, evidence-based injury prevention and clinical programming for TBI care.

Mission• Provide leadership in injury prevention and neurotrauma research, advocacy, education and knowledge translation

• Collaborate with multi-sectorial partners to design and deliver targeted injury prevention strategies and trauma system improvements

Goals• Develop evidence-based care pathways to accelerate access to neurosurgical care, reduce lengths of stay and optimize patient outcomes

• Provide excellence in injury prevention programming and education through an evidence-based approach

• Support advocacy efforts and enhancement of service provision throughout the spectrum of injury, across the continuum of care from prevention to the community

Accomplishments• In collaboration with the Neurosurgery Quality Committee, a TBI working group has been established to support clinical care pathways for TBI patients

• Systems to capture OR costs for neurotrauma cases continue to be explored with Case Costing (NSHA-Central Zone).

• The Government of Nova Scotia’s proposal for an acquired brain injury (ABI) Strategy has received input from multidisciplinary service providers, brain injury survivors, and members of the Neurotrauma program. The group has provided recommendations to the Minister of Health and Wellness on key strategic priorities to support the development of an acquired brain injury strategy in the province.

• In a partnership with the Division of Physical Medicine and Rehabilitation, Department of Family Medicine, and the Department of Emergency Medicine, we continue to work towards the development of a multi-disciplinary mTBI/ concussion clinic for NSHA.

• Neurosurgery continues to be a leader in the advocacy for improved clinical services for TBI. A successful conference was hosted; “Concussion Care in Nova Scotia: A Call to Action“. This conference brought together all specialties caring for patients on the TBI spectrum to discuss clinical solutions for the TBI service gap.

• The Concussion Nova Scotia resource website has been successfully launched: www.concussionns.com

• Along with community partners; Halifax Police, Cyclesmith and the Ecology Action Centre, we provided education and support for 185 helmets for persons of economic and situational need.

• Jake Blacklaws and Mike Smyth, first year Dalhousie Medical Students, are participants in the first TBI medical preceptorship with Dr. David Clarke. This program is intended to engage students early in their medical education in order to support capacity building for future TBI care in Nova Scotia.

Neurotrauma and Injury Prevention Programs


Research • All TBI admissions to Neurosurgery are reviewed weekly at TBI teaching and quality rounds, chaired by Dr. Clarke. Currently, over 2,170 cases have been reviewed for inclusion in the TBI database.

• A pilot study for all mild and moderate TBI patients discharged from Neurosurgery using the Rivermead Post-Concussion Questionnaire (RPCQ) has been completed by Paula Taylor, Nurse Practitioner, Nova Scotia Rehabilitation Centre. By using the RCPQ as a structured evaluative tool at relatively low-cost, we will provide additional support and guidance for patients, their families and care practitioners.

• A retrospective study has been completed comparing outcomes for different surgical approaches in the management of chronic subdural hematomas; this is in manuscript preparation.

• A multiple regression analysis has been completed examining the influence of multiple factors on expeditious access to tertiary care for TBI patients in NS. A manuscript has been submitted.

• Dr. Clarke is a member of the Canadian Traumatic Brain Injury Research Consortium (CTRC), a partnership of Canadian basic and clinician scientists focused on TBI research.

• “A National Biobank and Database for Patients with Traumatic Brain Injury “, the CanTBI study, is currently undergoing ethics review. We are anticipating screening and enrollment in the very near future.

• The Quantitative Analysis of Ski and Snowboard Helmet use in Nova Scotia study and the implementation of the first all-ages Snowsport helmet legislation in the world, has been published in Injury Prevention.

• The investigation of the incidence and economic burden of alcohol-related traumatic brain injury in Nova Scotia, a joint partnership with the Department of Health and Wellness and the Nova Scotia Trauma Program, has been completed with results presented nationally and internationally. Manuscript preparations are currently underway.

Published ManuscriptsHuybers S, Fenerty L, Kureshi N, Thibault-Halman G, LeBlanc JC, Clarke DB, Walling S. Long-Term Effects of Education and Legislation Enforcement on All-Age Bicycle Helmet Use: A Longitudinal Study. J Community Health. 2016 Aug 11. [Epub ahead of print]

Fenerty, L, Heatley J, Young J, Thibault-Halman G, Kureshi N, Bruce B, Walling S, Clarke DB. Achieving All-Age Helmet Use Compliance for Snow Sports: Strategic use of Education, Legislation, and Enforcement. Inj Prev. 2016 Jun;22(3):176-80.

National Conference Presentations Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green R, Clarke DB. “Characteristics and Patterns of Major Traumatic Brain Injury in Nova Scotia: A 12-Year Retrospective Analysis”, Trauma Association of Canada 2016 Annual Scientific Meeting Conference, Halifax, NS, May 6, 2016.

Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green R, Clarke DB. “The Effect of Blood Alcohol on Outcomes in Patients with Major Traumatic Brain Injury in Nova Scotia”, Trauma Association of Canada 2016 Annual Scientific Meeting Conference, Halifax, NS, May 6, 2016.

Green R, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Clarke DB. “P052: The effect of blood alcohol on outcomes in patients with major traumatic brain injury in Nova Scotia”, Canadian Association of Emergency Physicians Annual Meeting, Quebec City, Quebec, June 4-8, 2016; Canadian Journal of Emergency Medicine (CJEM), 18(S1), p. S96. doi: 10.1017/cem.2016.228.

Green R, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S and Clarke DB. (2016) “P053: Characteristics and patterns of major traumatic brain injury in Nova Scotia: a 12-year retrospective analysis”, Canadian Association of Emergency Physicians Annual Meeting, Quebec City, Quebec, June 4-8, 2016; CJEM, 18(S1), p. S96. doi: 10.1017/cem.2016.229.

Heatley J, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green R, Clarke DB, “An Investigation of Traumatic Brain Injuries and Alcohol-Related Motor Vehicle Crashes in Nova Scotia”, Canadian Association of Road Safety Professionals (CARSP) Conference, Halifax, NS, June 30, 2016.


BACK ROW: Dr. S. Walling, Dr. D. ClarkeFRONT ROW: M.Moores, N. Kureshi, G. Thibault-Halman, L. Fenerty

International Conference PresentationsKureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green RS, Clarke DB. “A458: Alcohol-Related Major Traumatic Brain Injury: A Province-Wide Retrospective Analysis”, European Society of Intensive Care Medicine (ESICM) 29th Annual Congress, Milan, Italy, October 1-5, 2016; Intensive Care Medicine Experimental, 4 (Suppl 1):30, 2016.

Funding and Grants$3 Million. A National biobank and database for patients with traumatic brain injury. Brain Canada Platform Support Grant. Matching contributions have been provided towards this Platform Support Grant by the Division of Neurosurgery, the Department of Surgery, and Capital Health. Primary Investigator: Jamie Hutchison (Univeristy of Toronto); Co-Investigators: Andrew Baker, Karen Barlow, David Clarke, Michael Esser, Robin Green, Anne-Marie Guerguerian, Jacques Lacroix, Alain Ptito, Keith Walley, Jamie Hutchison.

$20,000. An Investigation of the Health and Economic Outcomes of Alcohol-Related Traumatic Brain Injury in Nova Scotia. Department of Health Promotion and Protection. David Clarke, Simon Walling, Robert Green, Lynne Fenerty, Nelofar Kureshi, Mete Erdogan, Ginette Thibault-Halman

$36,000. Quantitative Analysis of Ski and Snowboard Helmet use in Nova Scotia Ski and Snowboard study. Department of Health Promotion and Protection. David Clarke, Simon Walling.

Team Members:• Dr. David Clarke, Neurosurgeon• Dr. Simon Walling, Neurosurgeon• Lynne Fenerty, Program Manager• Ginette Thibault-Halman, Program Coordinator• Lorelei Audas, Research Coordinator• Nelofar Kureshi, Research Associate• Annie Cudmore, Summer Student• Coralea Carey, Data Entry Clerk• Jake Blacklaws, Dalhousie Med 1 Student• Mike Smyth, Dalhousie Med 1 Student• Joe Lively, Injury survivor, Voice of Injury Prevention (VIP) - Speakers Bureau• Paula Dunn, IWK- Speakers Bureau

Team Collaborators:• Department of Physical Medicine and Rehabilitation• Finance Services, Case Costing (NSHA-Central Zone)• Department of Health Promotion and Protection• Atlantic Collaborative for Injury Prevention• Department of Emergency Medicine • Parachute (ThinkFirst) Canada• Department of Critical Care• Emergency Health Services• Concussion Nova Scotia• Trauma Nova Scotia


Program Co-Chairs: Drs. DavidB. Clarke and S. Ali ImranResearch Coordinator: Andrea Hebb

MissionOur team is dedicated to providing world class, innovative care for patients with pituitary/parasellar tumors.

Objectives• To provide a comprehensive, multi-disciplinary, patient- focused team.

• To be leaders in delivering accessible and innovative health care for patients with pituitary disorders.

• To create an environment that fosters education and research.

This program, unique to the Atlantic Provinces and much of Canada, provides comprehensive care to over 1700 patients with pituitary and sellar region tumours in a multidisciplinary clinic. Patients are seen by both Neurosurgery and Endocrinology. Collaboration with the Stereotactic Radiosurgery Group, Otolaryngology and Ophthalmology ensures coordinated assessment, treatment and follow-up. Monthly multidisciplinary teleconference rounds are held with external sites from Nova Scotia, New Brunswick and PEI.

Our program referrals continue with 52 new HNP surgical referrals, to include Newfoundland and 127 new HNP medical referrals, representing a consistent number of new patients from previous years.

There were 433 patient visits to the HNP medical clinic and 358 patient visits to the HNP surgical clinic in 2016.

Forty-one transsphenoidal surgeries were performed endoscopically in 2016 by Drs. Clarke (Neurosurgery) and Massoud (Otolaryngology).

Research/Program DevelopmentWe are continuing to collect sellar/parasellar tumor tissue intra-operatively under the protocol “Functional and Genetic Analysis and Banking of Neuro-Oncological Disease Tissues”. We hope to develop a better understanding of the genetic and functional pathways that confer an increased risk of developing and perpetuating neuro-oncological diseases (NODs), including neuropituitary tumors.

In addition, we have treated our 10th patient, as part of our Health Canada approved clinical trial on the stereotactic intracavitary instillation of 90yttrium for treatment of cystic sellar/parasellar lesions (PI: Dr. David Clarke). The clinical trial is being performed in collaboration with Dr. Steven Burrell and Dr. George Mawko in the Department of Diagnostic Imaging QEII Health Sciences Centre for treatment of HNP patients with cystic lesions.

Halifax Neuropituitary Program


BACK ROW: Dr. D. Clarke, A. Hebb, Dr. A Imran, R. Glasgow, Dr. D. ZwickerFRONT ROW: Dr. E. Massoud, D. Jardine, L. Tramble

Capital Health Research Fund “Non-functioning pituitary adenomas biomarkers” (PI: Andrea Hebb, PhD) was approved for funding in 2014 and we are starting the process of molecular analysis.

Publications 1. Munro V, Tugwell B, Doucette S, Clarke DB, Lacroix A, Imran SA. Recovery of adrenal function after chronic secondary adrenal insufficiency in patients with hypopituitarism. Clinical Endocrinology (Oxford). 2016;85(2):216-22.

2. Imran SA, Tiemensma J, Kaiser SM, Vallis M, Doucette S, Abidi E, Yip CE, De Tugwell B, Siddiqi F, Clarke DB. Morphometric changes correlate with poor psychological outcomes in patients with acromegaly. European Journal of Endocrinology 2016;174(1):41-50.

3: Al-Dahmani K, Mohammad S, Imran F, Theriault C, Doucette S, Zwicker D, Yip CE, Clarke DB, Imran SA. Sellar masses: An epidemiological study. The Canadian Journal of Neurological Sciences 2016;43(2):291-7.

4. Burrell S, Hebb AL, Imran SA, Mishra A, Mawko G, Clarke DB. Visualization of 90Yttrium colloid within a cystic craniopharyngioma using PET/CT/MRI Fusion. The Canadian Journal of Neurological Sciences 2017;44(2):192-193.

PresentationsMunro V, Tugwell B, Doucette S, Clarke DB, Lacroix A, Imran SA. “Recovery from Chronic Secondary Adrenal Insufficiency in Patients with Pituitary Disorders”, 51st Annual Congress of the Canadian Neurological Sciences Federation, Quebec City, QC, June 23, 2016; Canadian Journal of Neurological Sciences, Vol 43, Supplement S2, June 2016, ppS41-S41.

Team Members: • Dr. David Clarke, Neurosurgeon• Dr. Ali Imran, Endocrinologist• Dr. Emad Massoud, Otolaryngologist• Dr. Aditya Mishra, Ophthalmologist• Dr. Churn Yip, Endocrinologist• Dr. Deborah Zwicker, Endocrinologist- Sydney, NS• Dr. Angela McGibbon, Endocrinologist- Fredericton, NB• Lisa Tramble, Endocrinology Clinic Nurse• Andrea Hebb, Research Coordinator• Raven Glasgow, Program Clinic Coordinator • Dr. Sid Croul, Neuropathologist• Dr. Liam Mulroy, Radiation Oncology• Dr. Dorianne Rheaume, Radiation Oncology• Dr. Steven Burrell, Diagnostic Radiologist• Dr. George Mawko, Diagnostic Radiologist

Team Collaborators: • Diagnostic Imaging• Nova Scotia Eye Centre


Program Co-Directors: Drs. Simon Walling, Manohar Bance and David MorrisResearch Coordinator: Andrea HebbClinic Coordinator: Jackie SeagersThe Maritime Lateral Skull Base Clinic provides coordinated care through Otolaryngology, Neurosurgery and the Stereotactic Radiotherapy Group to patients with unilateral or bilateral vestibular schwannomas, acoustic neuromas and a range of other lateral skull base tumours.

The program provides coordinated care to over 650 patients with a range of lateral skull base tumours including vestibular schwannomas, other cerebellopontine angle tumours, lesions of the petrous apex and jugular foramen. Patients are carefully assessed and appropriate plans formulated. When treatment is required, the experts on our team provide a full range of treatment options including surgery, stereotactic radiation therapy (SRT), balance and hearing rehabilitation. This program is unique in Canada in allowing members from all disciplines to formulate management decisions in the same clinic.

NF2 Clinics continue to be held once every other month. This clinic is dedicated to patients with Neurofibromatosis Type 2 and includes collaboration with Medical Genetics, Radiology, Nova Scotia Hearing and Speech as well as Ophthalmology.

Our program referrals continue to increase, with 79 new Maritime Lateral SBC referrals, to include 16 from New Brunswick, 11 from PEI, 1 from Newfoundland and 1 from British Columbia representing a substantial increase in the number of patients seen in 2016 from previous years. Five hundred and fifty clinic visits occurred in 2016 almost a 200% increase from 2015.

Program Goals• To offer a single centre, multidisciplinary approach

• To be an internationally recognized centre for lateral skull base lesions

• To be at the forefront of clinical research in lateral skull base lesions

• To maintain a detailed database allowing critical appraisal of current treatment strategies

• To be sensitive to new developments in our specialty allowing us to be critical of our practice and outcomes

• To change our practice in light of evidence based research

Maritime Lateral Skull Base Program


Research in the Skull Base ProgramWe have developed several research fronts in this program. Some are listed below:

• What is useful hearing? Speech in noise comprehension with asymmetric hearing in acoustic neuroma subjects, when does the tumor ear stop contributing to binaural hearing?

• Database of tumor growth and outcomes. One of the largest series in the world with the “wait and scan” policy

• Patient expectations and attitudes to acoustic neuroma – questionnaire for all patients in our database

• Subjective hearing handicaps measured with standardized instruments

• Tinnitus and quality of life questionnaires added to each clinic visit

• Simon Walling, Dan McNeely, Andrea L.O. Hebb Mutism After Posterior Fossa Tumor Resection in Children: A Multicentre International Retrospective Study- collaboration with Vancouver Pediatric Neurosurgery Study Group (VPNSG)

Team Members:• Dr. Simon Walling, Neurosurgeon• Dr. Manohar Bance, Otolaryngologist• Dr. David P. Morris, Otolaryngologist• Andrea Hebb, Research Coordinator• Jackie Seagers, Clinic Coordinator

The Stereotactic Radiosurgery Team:• Dr. L. Mulroy, Radiation Oncology• Dr. D. Rheaume, Radiation Oncology• Mark Gulliver, Audiologist• Dr. Marie Earl, Dalhousie University School of Physiotherapy• Maritime Medical Genetics, IWK Health Centre

BACK ROW: Dr. M. Brace, Dr. D. Morris, Dr. B. WickensFRONT ROW: A. Hebb, Dr. M. Bance, J. Seagers, Dr. S. Walling


This was another busy year for Neurosurgery at the IWK Health Centre. Our goal is to offer the highest quality clinical service to pediatric patients of the region, in collaboration with our colleagues at referring sites. We also strive to offer high quality teaching, and to contribute to the advancement of knowledge through our participation in research.

On November 8, 2016, we held our first Eastern Canada Pediatric Video-Conference rounds with Montreal Children’s Hospital and l’Hôpital Sainte-Justine. We are hopeful that these rounds will continue on a regular basis.

The Neurosurgery Kids Fund continues to provide support to our patients and their families during their stay at the IWK Health Centre. We are grateful to the many benefactors who have donated their money, time, and energy towards sustaining this endeavor.

Team Members and Collaborators:• Dr. P. Daniel McNeely, Chief, Pediatric Neurosurgery• Dr. Simon A. Walling, Neurosurgery• Marie MacNeil, Neurosurgery Clinic Nurse• Kelly Boileau, Brain Tumour Clinic Nurse• Sheila Coutts, Spina Bifida Clinic Nurse• Katherine Wagner, Spina Bifida Clinic Nurse• Janet Woods, Neurosurgery OR Nursing Team Lead• Dr. Susan Morris, Neurophysiologist• Cathy Caron, Administrative Assistant• Chrissy Shay, Administrative Assistant• Steve Van-Iderstine, Research Associate

Pediatric Neurosurgery

Dr. D. McNeely

Dr. S. Walling


Neurosurgery Technology ProgramRon Hill – Technology Coordinator

Virtual Reality (VR) LabPeriopSim applications have been the main focus in the VR lab. This year we have been working on a transsphenoidal application with a detail zoom and inspection tool added to the application. In parallel to the IOS focused PeriopSim we are developing a 3D version using the HTC Vive headset and controllers for a full VR immersive environment. The first version was trialed at our annual Rookie Camp, held in Edmonton this year. The environment is comprised of three modules of instruments required for a trauma craniotomy. The project is being headed by Conquer Mobile and Halifax Neurosurgery.

The NeuroTouch is a virtual reality surgery simulator designed to train residents and hone the skills of experienced surgeons. As part of our Residency Training Program, we continue to develop and evaluate surgical scenarios.

Imaging and Image Guided SurgeryWe continue to investigate fMRI and have included MEG functional maps, merged with MR and PET on the OR Image Guided work stations. These maps allow better localization for intra-operative mapping and resection for both tumour and epilepsy surgeries.

To supplement our image guidance with MR, CT and PET; DTI scans are loaded into the StealthViz software application (Medtronic Navigation, Louisville, CO) for fiber tracking to better understand the connecting pathways. These tracks are overlaid on various merged image sequences that can –then be used for intra-operative navigation. Our work this year has been on mapping tracks to lesions, functional areas, optic tract and motor pathways for DBS surgery planning.


Intraoperative neurophysiological monitoring (IONM) uses electrophysiological techniques to provide ongoing feedback about brain and spinal cord function during higher risk neurosurgeries. IONM acts as an early warning signal, enabling timely intraoperative intervention and avoidance of post-operative deficits such as paralysis. Neurosurgeries that most benefit from IONM include brain and spinal cord tumour resections and complex spinal deformity corrections. In addition to providing critical warnings about nervous system status, IONM can be used as an intraoperative mapping and guidance tool to complement imaging studies such as MRI.

The IONM program in the Division of Neurosurgery is run by Dr. Susan Morris, an experienced neurophysiologist, working alongside Dr. Murray Hong.

In addition to clinical work, Dr. Morris is involved in research with a focus on understanding how different neurophysiological signals change in response to spinal cord compression. The goal is to improve existing intraoperative neuromonitoring methods and develop new techniques to optimize patient safety during spine surgery.

PublicationMorris SH, Howard JJ, El-Hawary R. Comparison of Motor Evoked Potentials versus Somatosensory Evoked Potentials as Early Indicators of Neural Compromise in Rat Model of Spinal Cord Compression. Spine 2016 Aug 5 (Epub ahead of print).

Team Members:• Susan Morris, PhD• Murray Hong, PhD

SUSAN MORRISPhD

Neurophysiologist,IntraoperativeNeurophysiologicalMonitoring

Intraoperative NeurophysiologicalMonitoring (IONM)


Spinal Cord Injury LaboratoryDr. Sean ChristieThe Spinal Cord Injury Laboratory has a number of basic research initiatives aimed at elaborating our understanding of CNS injury, from both cellular and genetic perspectives. This year again marks a continuation of exciting partnership projects with local private industry and the development of modernized protocols for whole tissue imaging of spine and brain tissue. Towards the end of the last year (2015) Dr. Saranyan Pillai, Ph.D. joined the lab as Research Associate to manage the lab and our multiple research goals. This summer we recruited Ms. MacKenzie Cook, from the Biomedical Sciences program as research assistant and Ms. Tanya Myers, an experienced animal surgeon and scientific technician, to work across the many projects we have. Our current research projects are as follows:

• Methodologies for identifying and analyzing spinal cells sensitive to secondary spinal cord injury progression. Following an initial mechanical trauma to the spinal cord, there is a progressive cascade of cell death that involves changes in the biochemical state of cells in proximity to the injury site. This “secondary spinal cord injury” mechanism is a central theme of our interest. To date, we have been characterizing a novel class of lipid peroxidation sensors for use in screening injured animal spinal tissue for early secondary injury events. The ability to isolate and enrich cells that exhibit sensitivity to secondary spinal cord injury allows us to screen for changes in gene regulation that may be central to the progression of this disease.

• Changes in microRNA expression in the context of spinal injury. MicroRNAs are small (~22 nucleotide) genetic regulators that exert widespread changes on the post- transcriptional activity of the genome.

The ability of a single species of microRNA to regulate a large number of target genes makes them an exciting therapeutic prospect. Using Next Generation Deep Sequencing services, we hope to identify key microRNA species that are critical for the initiation and propagation of secondary spinal cord injury across several species. We are also expanding our collaborations with other AMAP faculty, where our surgical spinal injury model may prove to be very useful.

• Adaptation of methodologies for whole tissue analysis in the context of neural injury – To circumvent the artefactual and labour-intensive nature of conventional histological approaches, we are working on adapting a recently developed method of tissue clearing, termed CUBIC, for use in spinal cord and brain analysis. By this method, which renders the normally opaque CNS tissue clear (by removing lipids while fixing the protein matrix) we are able to visualize neuronal injury and repair at the single cell level, using whole-tissue laser scanning confocal microscopy.

• A novel model of spinal cord injury and characterization of bloodflowautoregulationinpigs. Our collaboration with Dr. Michael Schmidt (Anesthesia) and Dr. Susan Morris continues to be productive. This project uses neurophysiological monitoring, total intravenous anesthesia and neurosurgical techniques in order to perform a precisely graded compression injury. Tissue procured from spinalized pigs is then analyzed (lipid peroxidation and microRNA screening) and serves as a proxy to the genetic and anatomical landscape seen in humans. We secured external funding and recently procured a new non invasive neurophysiology monitor, essential for this study. We also extended the grant awarded for this study to accommodate the characteristically greater logistical demands of large animal studies on research time and personnel.

• RNA stress granule formation in the spinal cord. In collaboration with Dr. Adrienne Weeks, we are examining the formation of RNA stress granules in the spinal cord. These granules, formed by an evolutionarily conserved response, renders the cell populations resistant to treatment methods in malignant conditions, but the implications in SCI require further understanding.

Neurosurgery Basic Science LabsLife Sciences Research Institute (LSRI)Brain Repair Centre (BRC)


Brain TumourLaboratoryDr. Adrienne WeeksThe Brain Tumour Laboratory, in collaboration with the Atlantic Canada Molecular Oncology Centre, is working to deliver precision and personalized therapeutic options for malignant brain cancer survivors in Atlantic Canada. A prospective tissue banking program for Neurooncology is in development with Dr. Croul and Dr. Weeks.

Dr. Aaron Robichaud won a Killam Research Scholarship and a Beatrice Hunter Research Scholarship for his MSc Thesis work on Targeting Stress Granules in Astrocytoma Cells in the laboratory of Dr. Adrienne Weeks.

Current projects include:

Dr. Adrienne Weeks received both a Meghans Walk ($25 000) and Department of Surgery Grant ($50 000) to continue to fund her research studies on targeting stress granules in brain cancer.

Dr. Adrienne Weeks is a Co-PI in a multimillion dollar Atlantic Canada Opportunities Agency grant with Dr. Jeremy Brown and Dr. Jim Fawcett studying a novel ultrasound based therapy for brain cancer.

Dr. Adrienne Weeks and Dr. Aaron Robichaud presented their work on Stress Granules and Astrocytoma Cells at two international conferences. The Society of Neurooncology meeting in Phoenix, Arizona and American Association of Cancer Research in San Francisco, California.

Neuron Survival& RegenerationLaboratoryDr. David ClarkeThe Neuron Survival and Regeneration Laboratory focuses on understanding the neuronal response to injury, and developing strategies aimed at enhancing the survival and regeneration of injured neurons. We are currently examining the role of specific cell surface molecules on survival of injured neurons and using genetic knockout models to examine functions of specific molecules. This year, PhD student, Margaret Po-Shan Luke, received the “Best Research Presentation” Award at the Dalhousie Clinical Neuroscience Research Day in Halifax for our work on the “Effect of NCAM on Aged-Related Deterioration in Vision”.

Laboratory Publications:

Po-Shan Luke M, LeVatte T, Rutishauser U, Tremblay F, Clarke DB. Polysialylated Neural Cell Adhesion Molecule Protects Against Light-Induced Retinal Degeneration. Investigative Ophthalmology and Visual Science, 57(11):5066-5075, 2016. Po-Shan Luke M, LeVatte T, O’Reilly A, Smith B, Tremblay F, Brown R, Clarke DB. Effect of NCAM on Aged-Related Deterioration in Vision. Neurobiology of Aging, 41:93-106, 2016.


(PI = Principal Investigator)

Dr. Sean Christie (Co-Investigator)2012-2016Rick Hansen InstituteCanadian Multicentre Cerebrospinal Fluid PressureMonitoring and Biomarker Study $260,925

Dr. Sean Christie (Co-Investigator)January 2015-December 2017Brain Canada MIRI CompetitionBiomarkers for Crossing the Translational Divide inAcute Spinal Cord Injury $3,000,000

Dr. Sean Christie (PI) 2016Medtronic of Canada Ltd.Investigating Outcomes in Spine Surgery$40,000

Dr. Sean Christie (PI) 2016-2017Nova Scotia Health AuthorityTranslating Research into Care (TRIC)Level 1 Grant$3000

Dr. David Clarke (Co-Investigatorand several others) PI: Alon Friedman2016-2021Canadian Institutes of Health ResearchMicrovascular Injury and Blood-Brain BarrierDysfunction as Novel Biomarkers and Targets forTreatment in Traumatic Brain Injury$950,000

Dr. David Clarke (Co-Investigatorand several others)PIs: Jamie Hutchison, Alexis Turgeon(co-leads) 2015-2019Canadian Institute of Health Research and Ontario Neurotrauma FoundationCanadian Traumatic Brain Injury ResearchConsortium (CTRC) Grant$1,824,513

Dr. David Clarke (Co-Investigatorand several others) PI: Jamie Hutchison2015-2018Brain Canada Platform Support Grant (Matchingcontributions provided by the Division of Neurosurgery,the Department of Surgery and Capital Health)A National Biobank and Database for Patients withTraumatic Brain Injury $3,000,000

Neurosurgery Funding


Dr. David Clarke (PI)Co-Investigators: Steven Beyea, Lauren Petley, Tim Bardouille, Denise Lalanne 2015-2018ACOA’s Business Development Program, Government of Canada, QEII Foundation and Conquer Mobile Biomedical Translational Imaging Centre (BIOTIC) R&D projects, supporting the development and commercialization of neuro-based technologies$370,000

Dr. David Clarke (PI)Co-Investigators: Nelofar Kureshi, Murray Hong, Conquer Mobile Inc.2015-2016Brain Repair Centre- Knowledge Translation Grant, Dalhousie UniversityVirtual Reality Neurosurgical Simulation Education and Training$30,000

Dr. Gwynedd Pickett (PI)Co-Investigator: Jai Shankar2016-2019Capital Health Research FundCT Perfusion in Subarachnoid Hemorrhage$15,000

Dr. Simon Walling (Co-Investigator)Co-Investigators: N. Jabad, C. Fernandez2016Genome CanadaBiomarkers for Pediatric and Adult High Grade Astrocytoma through Genomics and Epigenomics.$50,000

Drs. Simon Walling and David Clarke(Co-Investigators)2016Department of Health Promotion and ProtectionQuantitative Analysis of Ski and Snowboard Helmet usein Nova Scotia Ski and Snowboard study$36,000

Dr. Simon Walling (PI)Co-Investigators: David Clarke, Lynne Fenerty, Ginette Thibault-Halman, Nelofar Kureshi, Mete Erdogan, Rob Green2016Department of Health Promotion and ProtectionAn Investigation of the Health and Economic Outcomesof Alcohol-Related Traumatic Brain Injury in Nova Scotia$20,000

Dr. Adrienne Weeks (PI)2015-2016Beatrice Hunter Cancer Institute ResearchNew Investigator Renewal$25,000

Dr. Adrienne Weeks (PI)2016Department of Surgery Organotypic Brain Slice Model of GBM forUnderstanding Stress Granules$50,000

Dr. Adrienne Weeks (Co-Investigator)Co-Investigators: Jeremy Brownand Jim Fawcett2016ACOAMicroultrasound for Diagnostic and Ablationof Brain Tumours$2,000,000


Abidi SSR, Singh AK, Christie S. Transcription of case report forms from unstructured referral letters: A semantic text analytics approach. Studies in Health Technology and Informatics, 228:322-6, 2016. Al-Dahmani K, Mohammad S, Imran F, Theriault C, Doucette S, Zwicker D, Yip CE, Clarke DB, Imran SA. Sellar Masses: An Epidemiological Study. Canadian Journal of Neurological Sciences, 43(2):291-297, 2016.

Barry S, Dakson A. A case of rapidly progressing paraplegia. Spinal Columns. Volume 16, Number 1, Feb 2016.

Brawanski N, Atta J, Weise LM, Konczalla J, Quick-Weller J, Forster MT, Marquardt G, Seifert V, Senft C. Resection of central nervous system lymphoma (CNSL): a paradigm shift? Journal Neurosurgical Sciences, Sept 2016.

Burrell S, Hebb AL, Imran SA, Mishra A, Mawko G, Clarke DB. Visualization of 90Yttrium colloid within a cystic craniopharyngioma using PET/CT/MRI Fusion. The Canadian Journal of Neurological Sciences 2017;44(2):192-193.

Clarke DB, Kureshi N, Hong M, Sadeghi M, D’Arcy RCN. Simulation-Based Training for Burr Hole Surgery Instrument Recognition, BMC Medical Education, 16:153. 2016.

Fenerty L, Heatley J, Young J, Thibault-Halman G, Kureshi N, Bruce B, Walling S, Clarke DB. Achieving All-Age Helmet Use Compliance for Snow Sports: Strategic Use of Education, Legislation and Enforcement. Injury Prevention, 22: 176-180, 2016.

Ferguson C, Clarke DB, Sinha N, Shankar JJS. A Case Study of Symptomatic Retroclival Ecchordosis Physaliphora: CT and MR Imaging. Canadian Journal of Neurological Sciences, 43: 210-212, 2016.

Gessler F, Mutlak H, Tizi K, Senft C, Setzer M, Seifert V, Weise L. Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery. Journal Neurosurgery Spine, 24(6):965-70. Jun 2016.

Godbout H, Christie S. Cervical Radiculopathy: Diagnosis and Management. The Journal of Current Clinical Care 6(3), 23-33. 2016.

Haji FA, Clarke DB., Matte MC, Brandman DM, Brien S, de Ribaupierre S, O’Kelly C, Christie S, McDonald PJ, Kulkarni AV, Walling S and MacLeod A. Teaching for the Transition: the Canadian PGY-1 Neurosurgery ‘Rookie Camp’. Canadian Journal of Neurological Sciences. 42:25-33. 2016.

Huybers S, Fenerty L, Kureshi N, Thibault-Halman G, LeBlanc JC, Clarke DB, Walling S. Long-Term Effects of Education and Legislation Enforcement on All-Age Bicycle Helmet Use: A Longitudinal Study, Journal of Community Health, Aug 11, 2016. Imran SA, Tiemensma J, Kaiser SM, Vallis M, Doucette S, Abidi E, Yip CE, Tugwell BD, Siddiqi F, Clarke DB. Morphometric Changes Correlate with Poor Psychological Outcomes in Patients with Acromegaly. European Journal of Endocrinology, 174(1):41-50, 2016.

Imran SA, Yip CE, Papneja N, Aldahmani K, Mohammad S, Imran F, Zwicker DA, Theriault C, Thompson K, Clarke DB, Van Uum S. Analysis and Natural History of Pituitary Incidentalomas, European Journal of Endocrinology, 175: 1-9, 2016.

Jai Shankar, Adil Bata, Krista Ritchie, Andrea L.O. Hebb and Simon Walling. Normalized ADC in the prognostication of patients with glioblastoma multiforme. The Canadian Journal of Neurological Sciences, 2016 Jan;43(1):127-33

Publications


Larouche J, Yee AJM, Wadey V, Ahn H, Hedden DM, Hall H, Broad R, Bailey C, Nataraj A, Fisher C, Christie S, Fehlings M, Moroz PJ, Bouchard J, Carey T, Chapman M, Chow D, Lundine K, Dommisse I, Finkelstein J, Fox R, Goytan M, Hurlbert J, Massicotte E, Paquet J, Splawinski J, Tsai E, Wai E, Wheelock B, Paquette S. Development of a Completence-Based Spine Surgery Fellowship Curriculum Set of Learning Objectives in Canada. Spine 41 (6), 530-537, 2016.

Luke MP, LeVatte T, O’Reilly A, Smith B, Tremblay F, Brown R, Clarke DB. Effect of NCAM on Aged-Related Deterioration in Vision. Neurobiology of Aging, 41:93-106, 2016. SRI

Munro V, Tugwell B, Doucette S, Clarke DB, Lacroix A, Imran SA. Recovery of Adrenal Function after Chronic Secondary Adrenal Insufficiency in Patients with Hypopituitarism, Clinical Endocrinology (Oxf), 85(2):216-22. 2016.

Paterson GI, Christie S, Bonney W, Thibault-Halman G. Synoptic operative reports for spinal cord injury patients as a tool for data quality. Health Informatics Journal, 22(4), 984-991, 2016.

Po-shan Luke (PhD Student), M, LeVatte T, Rutishauser U, Tremblay F, Clarke DB. Polysialylated Neural Cell Adhesion Molecule Protects Against Light-Induced Retinal Degeneration. Investigative Ophthalmology and Visual Science, 57(11):5066-5075, 2016.

Quick-Weller J, Duetzmann S, Behmanesh B, Seifert V, Weise LM, Marquardt G. Oblique Positioning of the Stereotactic Frame for Biopsies of Cerebellar and Brainstem Lesions. World Neurosurgery. 86:466-9. Feb 2016.

Quick-Weller J, Kann G, Lescher S, Imöhl L, Seifert V, Weise LM, Brodt HR, Marquardt G. Impact of Stereotactic Biopsy in HIV Patients. World Neurosurgery.86:300-5. Feb 2016.

Quick-Weller J, Konczalla J, Duetzmann S, Franz-Jaeger C, Strouhal U, Brawanski N, Setzer M, Lescher S, Seifert V, Marquardt G, Weise LM. General anesthesia versus local anesthesia in stereotactic biopsies of brain lesions - a prospective randomized study. World Neurosurgery. 8750(16)30894-4. Sept 2016.

Quick-Weller J, Lescher S, Baumgarten P, Dinc N, Bruder M, Weise L, Seifert V, Marquardt G.Stereotactic biopsy of pineal lesions. World Neurosurgery. (16)30259-5. Jun 2016.

Quick-Weller J, Lescher S, Bruder M, Dinc N, Behmanesh B, Seifert V, Weise L, Marquardt G.Stereotactic biopsy of brainstem lesions: 21 years experiences of a single center. Journal Neurooncology. 129(2):243-50. Sept 2016.

Quick-Weller J, Lescher S, Kashefiolasl S, Weise LM, Seifert V, Marquardt G. Benefit of Stereotactic Procedures in a Series of 43 Children. Journal Child Neurology. 31(7):907-12. Jun 2016.

Steinbok P, Gopalakrishnan CV, Hengel AR, Vitali AM, Poskitt K, Hawkins C, Drake J, Lamberti-Pasculli M, Ajani O, Hader W, Mehta V, McNeely PD, McDonald PJ, Ranger A, Vassilyadi M, Atkinson J, Ryall S, Eisenstat DD, Hukin J. Pediatric thalamic tumors in the MRI era: a Canadian perspective. Childs Nervous System 32(20:269-80. 2016.

Stevens MTR, Clarke DB, Stroink G, Beyea SD, D’Arcy RC. Improving fMRI reliability in presurgical mapping for brain tumours. J Neurol Neurosurg Psychiatry, 87(3): 267-74, 2016.

Weeks A, Agnihotri S, Lymer J, Chalil A, Diaz R, Isik S, Smith C, Rutka JT. Epithelial Cell Transforming 2 and Aurora Kinase B Modulate Formation of Stress Granule-Containing Transcripts from Diverse Cellular Pathways in Astrocytoma Cells. American Journal of Pathology. 186(6):1674-87. Jun 2016.

Wu Y, Streijger F, Wang Y, Lin G, Christie S, Mac-Thiong J-M, Parent S, Bailey C, Paquette S, Boyd MC, Ailon T, Street J, Fisher CG, Dvorak MF, Kwon B, Li L. Cerebrospinal fluid and serum for identifying biomarkers of injury severity after acute human spinal cord injury. Sci Rep 2016.


PresentationsClarke DB, Hong M, Kureshi N, Fenerty L, Thibault-Halman G, Fulmore C, Cromwell M, D’Arcy R. “Simulation-Based Training for Surgical Instrument Recognition – a Training Initiative for Perioperative Nurses”, Royal College Simulation Summit, St. John’s, NL, Abstract R7, October 14, 2016.

Clarke DB, Fenerty L, Hong M, Newton S, Thibault-Halman G, Fulmore C, Cromwell M, Hoyt J, Kureshi N, D’Arcy R. “Simulation-Based Training for Perioperative Nurses”, 27th Atlantic Operating Room Nurses Conference, Halifax, NS, September 24, 2016.

Conrad Fernandez, Andrea L.O. Hebb, Mandy Bouchard and Simon Walling. Return of genomic results relevant to personalized decision-making in brain tumor patients: pilot questionnaire results. 48th Congress of the International Society of Paediatric Oncology. Dublin, Ireland. October 19-22, 2016

Bedjan Behmanesh, Stephan Dutzmann, Jurgen Konczalla, Volker Seifert, Matthias Setzer, Lutz Weise. “Quality of life in 182 patients after surgical and conservative therapy of spondylodiscitis: a study of long-term outcome”, 67TH Annual Meeting of the German Society of Neurosurgery (DGNC). Frankfurt, Germany. June 2016.

Dakson A, Bigder M, Elliott C, Guha D, Iorio-Morin C, Kameda-Smith M, Lavergne P, Makarenko S, Taccone MS, Tso M, Wang B, Winkler-Schwartz A, Sankar T, Christie S. The Canadian Neurosurgery Research Collaborative (CNRC): A novel, trainee-led, nationwide multicenter research network. 51st Annual Congress of the Canadian Neurological Sciences Federation. CJNS Vol 43 (S2), p23, 2016. (2)

Dakson A, Leck E, Christie S. The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spinal metastatic disease. 51st Annual Congress of the Canadian Neurological Sciences Federation. CJNS Vol 43 (S2), p49, 2016. (2)

Dakson A, Leck E, Butler M, Thibault-Halman G, Christie S. Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumour histology. 51st Annual Congress of the Canadian Neurological Sciences Federation. CJNS Vol 43 (S2), p50, 2016. (2)

Dakson A, Brandman D, Thibault-Halman G, Christie S. The natural history of central cord syndrome and the role of surgical intervention: a retrospective review from 2005-2010. 51st Annual Congress of the Canadian Neurological Sciences Federation. CJNS Vol 43 (S2), p50, 2016. (2)

Dakson A, Leck E, Christie S. The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spine metastatic disease. Canadian Spine Society 16th Annual Scientific Conference. Can J Surg Vol 59 (3 Suppl 2), 2016, S61.

Dakson A, Leck E, Christie S. Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumour histology. Canadian Spine Society 16th Annual Scientific Conference. Can J Surg Vol 59 (3 Suppl 2), 2016, S61.

Dakson A, Brandman D, Thibault-Halman G, Christie S. Optimization of the medical and surgical management of traumatic spinal cord injury. Trauma Association of Canada Annual Scientific Meeting, Halifax, NS. May 5-7 2016. Dakson A, Brandman D, Thibault-Halman G, Christie S. Investigating the Implementation of Acute Care Guidelines for Spinal Cord Injuries. Trauma Association of Canada Annual Scientific Meeting, Halifax, NS. May 5-7 2016. Dakson A, Brandman D, Thibault-Halman G, Christie S. The natural history of traumatic central cord syndrome as compared to other incomplete cervical cord injuries. Trauma Association of Canada Annual Scientific Meeting, Halifax,NS. May 5-7 2016.

Florian A. GeBler, Peter Baumgarten, Markus Bruder, Gerhard Marquardt, Volker Seifert, Lutz Weise. “Assessment of molecular markers reveals homogeneity between stereotactic and open surgical sample acquisition in anaplastic astrocytomas and gliobalastomas”, 67TH Annual Meeting of the German Society of Neurosurgery (DGNC). Frankfurt, Germany. June 2016.

Florian A. GeBler, Peter Baumgarten, Johanna Quick-Weller, Gerhard Marquardt, Volker Seifert, Lutz Weise. “Perioperative administration of corticosteroids in patients with primary CNS B-Cell-Lymphoma”, 67TH Annual Meeting of the German Society of Neurosurgery (DGNC). Frankfurt, Germany. June 2016.

Green R, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Clarke DB. “P052: The effect of blood alcohol on outcomes in patients with major traumatic brain injury in Nova Scotia”, Canadian Association of Emergency Physicians Annual Meeting, Quebec City, Quebec, June 4-8, 2016; Canadian Journal of Emergency Medicine (CJEM), 18(S1), p. S96.


Green R, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S and Clarke DB. (2016) “P053: Characteristics and patterns of major traumatic brain injury in Nova Scotia: a 12-year retrospective analysis”, Canadian Association of Emergency Physicians Annual Meeting, Quebec City, Quebec, June 4-8, 2016; CJEM, 18(S1), p. S96.

Heatley J, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green R, Clarke DB, “An Investigation of Traumatic Brain Injuries and Alcohol-Related Motor Vehicle Crashes in Nova Scotia”, Canadian Association of Road Safety Professionals (CARSP) Conference, Halifax, NS, June 30, 2016.

Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green R, Clarke DB. “Characteristics and Patterns of Major Traumatic Brain Injury in Nova Scotia: A 12-Year Retrospective Analysis”, Trauma Association of Canada 2016 Annual Scientific Meeting Conference, Halifax, NS, May 6, 2016.

Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green R, Clarke DB. “The Effect of Blood Alcohol on Outcomes in Patients with Major Traumatic Brain Injury in Nova Scotia”, Trauma Association of Canada 2016 Annual Scientific Meeting Conference, Halifax, NS, May 6, 2016.

Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green RS, Clarke DB. “A458: Alcohol-Related Major Traumatic Brain Injury: A Province-Wide Retrospective Analysis”, European Society of Intensive Care Medicine (ESICM) 29th Annual Congress, Milan, Italy, October 1-5, 2016; Intensive Care Medicine Experimental, 4 (Suppl 1):30, 2016.

Leck E, Dakson A, Christie S. A retrospective analysis of the clinical utility of the Tokuhashi scale, and its impact in the surgical management of spinal metastatic disease. 51st Annual Congress of the Canadian Neurological Sciences Federation. CJNS Vol 43 (S2), p51, 2016.

Leck E, Dakson A, Christie S. A retrospective analysis of the clinical utility of the Tokuhashi scale, and its impact in the surgical management of spinal metastatic disease. Canadian Spine Society 16th Annual Scientific Conference. Can J Surg Vol 59 (3 Suppl 2), 2016, S61.

Luke MP, LeVatte T, O’Reilly A, Smith B, Tremblay F, Brown R, Clarke DB. “Effect of NCAM on Aged-Related Deterioration in Vision”, Department of Ophthalmology and Visual Sciences 27th Annual Research Day, Halifax, NS, April 18, 2016.

Luke MP, LeVatte TL, O’Reilly A, Smith BJ, Tremblay F, Brown R, Clarke DB. “Effect of NCAM on Aged-Related Deterioration in Vision”, Clinical Neuroscience Research Day, Halifax, NS, March 23, 2016.

Munro V, Tugwell B, Doucette S, Clarke DB, Lacroix A, Imran SA. “Recovery from Chronic Secondary Adrenal Insufficiency in Patients with Pituitary Disorders”, 51st Annual Congress of the Canadian Neurological Sciences Federation, Quebec City, QC, June 23, 2016; Canadian Journal of Neurological Sciences, Vol 43, Supplement S2, June 2016, ppS41-S41.

Munro V, Elnenaei M, Doucette S, Clarke DB, Imran SA, “The Effect of Time of Day and Utility of 30- and 60-Minute Values in the 250-mcg ACTH Stimulation Test”, 19th Annual Canadian Society of Endocrinology & Metabolism Conference, Ottawa, ON, Abstract 210, October 28, 2016.

Munro V, Tugwell B, Doucette S, Clarke DB, Imran SA. “Recovery of Adrenal Function after Chronic Secondary Adrenal Insufficiency in Patients with Hypopituitarism”, Dalhousie University, Department of Medicine Research Day, Halifax, NS, April 7, 2016.

Paquet J, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Kuerban D, Dvorak M. The stable spine central cord syndrome (SCCS): a prospective surgical cohort. Canadian Spine Society 16th Annual Scientific Conference. Can J Surg Vol 59 (3 Suppl 2), 2016, S47.

Rivers C, Warner F, Noonan V, Fallah N, Fisher C, O’Connell C, Tsai E, Ahn H, Attabib N, Christie S, Drew B, Finkelstein J, Fourney D, Paquet J, Parent S, Kuerban D, Dvorak M. Delays in time from injury to specialized SCI centres increase in-hospital mortality in acute SCI. Canadian Spine Society 16th Annual Scientific Conference. Can J Surg Vol 59 (3 Suppl 2), 2016, S46.

Tee J, Paquet J, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Kuerban D, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Dvorak M. The modified extremity motor (MEM) classification: A neurological classification of traumatic central cord syndrome (TCCS). Canadian Spine Society 16th Annual Scientific Conference. Can J Surg Vol 59 (3 Suppl 2), 2016, S46.

Tso M, Bigder M, Dakson A, Elliott C, Guha D, Iorio-Morin C, Kameda-Smith M, Lavergne P, Makarenko S, Taccone M, Wang B, Winkler-Schwartz A, Christie S. Canadian neurosurgery operative landscape. 51st Annual Congress of the Canadian Neurological Sciences Federation. CJNS Vol 43 (S2), p12, 2016.

Vaninetti N, Munro V, Yip CE, Clarke DB, Doucette S, Zwicker D, Theriault C, Kaiser S, Imran S, “Clinically Manifesting vs. Incidental Sellar Masses – A Comprehensive Comparative Study”, 19th Annual Canadian Society of Endocrinology & Metabolism Conference, Ottawa, ON, Abstract 6, October 28, 2016.


Invited LecturesBarry, S. Medical Assistance in Dying: A neurosurgeons perspective. Canadian Neurological Society Meeting. Quebec City, Quebec. June 22, 2016.

Barry, S. Medical Assistance in Dying (MAID) and the spine surgeon. Atlantic Spine Society. Fox Harbour, NS. October 15, 2016.

Barry, S. Medical Assistance in Dying: Position Statement of the CNSS. Canadian Neurological Society Meeting. Quebec City, Quebec. June 22, 2016.

Christie S. Surgical Management of Cervical Rheumatoid Arthritis, Division of Rhuematology Academic Rounds, January 21, 2016

Christie, S. You can do Nothing for me… My back is shot though. Lord Nelson, Canadian Association of NeuroScience Nursing, 3rd annual workshop, April 18, 2016

Christie, S. SCI in the Elderly, 8th Annual Atlantic Canada Spine Meeting, Wallace, NS, October 14-16, 2016.

Christie, S. MIS complications, North American Spine Society, Boston, MA, October 25, 2016.

Christie S. Surgical Synergy and Posterior Cervical Fusion, Cervical Spine Research Society, Toronto, Dec 1, 2016.

Clarke, DB. Managing Patients with Pituitary Tumors: a brief Show and Tell. Atlantic Clinical Neurosciences Society, Saint John, NB. May 6-7, 2016.

Clarke, DB. Surgical Innovation, Simulation: Can it be used to teach anything in the real world of neurosurgery?, MaRS Discovery District, University of Toronto, ON. September 10, 2016.

Clarke, DB. The Role of Surgery Bootcamps in Postgraduate Medical Education. Canadian Neurological Sciences Federation Annual Meeting, Quebec City, QC. June 23, 2016.

Clarke, DB. Epilepsy Surgery Review. 4th Annual Ottawa Neurosurgery Review Course, Ottawa, ON. February 12, 2016.

Clarke, DB. PeriopSimTM Ipad Simulation Instrument Training. QEII Health Sciences Centre OR Nurses Education Day, Halifax, NS. April 29, 2016.

Clarke, DB. Simulation-Based Training for Perioperative Nurses. 27th Atlantic Operating Nurses Conference, Halifax, NS. September 24, 2016.

Clarke, DB. Simulation-Based Training for Surgical Instrument Recognition – a Training Initiative for Perioperative Nurses. Royal College Simulation Summit, St. John’s, NL. October 14, 2016.

Clarke, DB. Pituitary Surgery - A Complicated Affair? 19th Annual Canadian Society of Endocrinology & Metabolism Conference, Ottawa, ON, October 28, 2016.

Clarke, DB. Surgical Treatment of Epilepsy. QEII Health Sciences Centre Purple Day Presentation, Halifax, NS. March 29, 2016.

McNeely, D. Neurosurgery in Eloquent Regions. Canadian Association of Neurophysiological Monitoring, Prince George Hotel, Halifax, NS. Sept 30, 2016.

McNeely, D. Pediatric Neurosurgery Emergencies. Emergency Medicine Academic Half-Day, Tupper Building, Halifax, S. Oct 5, 2016.

Pickett, G. Management of Intracranial Aneurysms. Resident Review Course, CNSF Annual Congress, Toronto, Ontario. June 21, 2016.

Pickett, G. When To Refer To Neurosurgery. Atlantic Canada Stroke Conference, Halifax, NS. October 29, 2016.

Weise, L. Intradural pathologies of the spine. 67TH Annual Meeting of the German Society of Neurosurgery (DGNC), Frankfurt, Germany. June 2016.

Weise, L. Intraoperative Neurophysiology in DBS Surgery: From Microelectrode Recording to Evoked Potentials. 9th Annual CANM Symposium (Canadian Association of Neurophysiological Monitoring), Halifax, NS. Sept 2016.

Weise, L. Posterior Movement Preserving Surgeries (Frykholm, Laminoplasty). Basic Course of the German Spine Society-Operative Therapy Degenerative Diseases of the Spine. Germany. March 2016.


Dr. Dan McNeely – DirectorTiffany Webber – Program CoordinatorThe major objective of the Neurosurgery Residency Training Program at Dalhousie is the development of neurosurgeons who will excel in clinical care and possess all of the skills required to pursue an academic career or community practice. This is achieved by exposure to a broad range of technical problem solving and decision making aspects of neurosurgery over a six-year period. Residents begin training with graduated levels of responsibility in the care of neurosurgical patients, assuming greater responsibility of technical procedures and inpatient care as their training progresses. At the Senior Resident level, independent clinical and operative decision making is promoted and final year Residents achieve confidence in neurosurgical decision making and performance of operative procedures.

We strive to provide an academic environment in which residents are continually challenged to perfect their decision-making skills. Regular teaching rounds and seminars promote resident involvement in discussion of current issues with interaction between residents and attending staff. The emphasis on academic components in the program prepares residents for success in the Royal College Examinations and for laying down the foundation for those who want to develop an academic career. The Neurosurgery Residency Training

Program at Dalhousie includes clinical rotations at the QEII Health Sciences Centre and the IWK Health Centre in Halifax, Nova Scotia, and the Saint John Regional Hospital in Saint John, New Brunswick. This provides residents with exposure to a wide variety of neurosurgical problems, management approaches and excellent academic and clinical education experiences.

The Division of Neurosurgery promotes the role of research in residency training through research programs involving basic research and clinical investigation. There is a commitment to develop a multidisciplinary approach to research involving clinicians and basic scientists. We encourage residents who wish to pursue graduate studies to enroll in the Clinician Investigator Program. Currently there are seven neurosurgery trainees in this program.

Finally, since 2011, we have welcomed visiting neurosurgery residents from the University of West Indies, Kingston, Jamaica. We have been enriched by this experience, and are pleased to have them in our midst.

Neurosurgery Residency Training Program

T. Webber

Dr. D. McNeely


For the second year, the Division of Neurosurgery, University of Alberta, hosted the 5th Annual Canadian Neurosurgery Rookie Camp with Dr. David Clarke as the National Camp Director and Dr. Cian O’Kelly as Camp Host. On July 8 and 9, 2016, the Camp was held at the University of Alberta’s Surgical Medical Research Institute in Edmonton.

The Rookie Camp is a uniquely Canadian program that provides a learning-intensive environment forsuccessful initiation of neurosurgery residents from across Canada into their six-year training program. Based on real patient scenarios, they are introduced to the technical, cognitive and behavioural skills needed in neurosurgery, a field that often involves high-stakes and life-and-death situations where efficient decision making is crucial.Camp material is developed collaboratively by experts from across the country, with top-notch teaching faculty attending the event from various institutions. Faculty and residents representing virtually every training program across Canada were in attendance. Teaching Faculty from Halifax Neurosurgery included Drs. Sean Barry and David Clarke along with Ron Hill, our VR Technology Coordinator.

The Canadian Neurosurgery Rookie Camp is endorsed by the Royal College of Physicians and Surgeons of Canada’s Specialty Committee in Neurosurgery and the Canadian Neurosurgical Society. A special thank you to this year’s sponsors: The Canadian Neurosurgical Society, Medtronic, J&J Codman, Integra, Storz, and Synaptive Medical. We are also appreciative of the work that has been led by Halifax Neurosurgery, in partnership with Conquer Mobile, in successfully piloting the world’s first use of virtual reality simulation technology for neurosurgical instrument learning.

This year, Dr. Clarke completed his five-year term as Director of the Rookie Camp. As Founder of the Camp, Dr. Clarke’s term ends with a sense of pride in its national endorsement and its continuation under the leadership of Dr. Cian O’Kelly, University of Alberta, who starts his new appointment as Camp Director. We are delighted that Halifax competed successfully to host the Camp for 2017 and 2018, with our own Dr. Sean Barry as Camp Host.

Visit www.neurosurgeryrookie.ca

Neurosurgery Rookie CampTraining the next generation of Canada’s Neurosurgeons


Clinical Neuroscience Guest Speakers

DR. JENS DREIERProfessor of Neurology Center for Stroke Research, Berlin & Neurological Hospital, Berlin

Topic: Spreading depression, spreading depolarization and spreading ischemia in neurological diseases

DR. HERMONA SOREQProfessor of Molecular NeuroscienceVice-Dean for Research and DevelopmentThe Hebrew University of Jerusalem, Israel

Topic: From mice to man: Cholinergic gene regulators in brain health and disease.

DR. BIRGIT FRAUSCHERAssociate Professor of NeurologyQueen’s University, Ontario

Topic: Interactions between epilepsy and sleep: new insights based onintracerebral EEG

DR. MANDAR S. JOGProfessor of Neurology Western University, OntarioDirector of the National Parkinson Foundation Centre of Excellence in Parkinson Disease and Movement Disorders Program at London Health Sciences CentreAssociate Director of the Lawson Health Research Institute

Topic: New frontiers for treatment of Parkinson’s Disease


DR. KRISTIN IKEDAChief Clinical Fellow in EEG/Epilepsy Western University, Ontario

Topic: Gone “viral!” Network connectivity in epilepsy

DR. HELEN E. SCHARFMANProfessor of Psychiatry, Physiology & NeuroscienceNewYorkUniversityandtheNathanKlineInstitute,NewYorkOfficeofMental Health, New York

Topic: The overlap between Alzheimer’s disease and Epilepsy

DR. MARK HAMILTONProfessor of NeurosurgeryUniversity of Calgary, Alberta

Topic: Adult Hydrocephalus: Improving Management of a Treatable Dementia

DR. COLIN K. FRANZPhD Anatomy and Neurosciences, Dalhousie University, HalifaxPhysical Medicine and Rehabilitation, Emory University, University of Calgary, Alberta

Topic: “New Frontiers in Motor Neuron Disease and Nerve Injury - Lessons from Combining Human and Mouse Preclinical Studies”

Clinical Neuroscience Guest Speakers (cont’d)


Dr. Aaron Robichaud, Neurosurgery Resident• Dalhousie University Clinical Investigators Program Award The Dalhousie University Clinician Investigator Program (CIP) is an accredited postgraduate medical education training program of the Royal College of Physicians and Surgeons of Canada.

• Killam Scholarship, Dalhousie University The Killam Scholarship recognizes the very best in graduate and postgraduate education, allowing its recipients to conduct outstanding research and make significant contributions to their intellectual communities.

• Beatrice Hunter Cancer Research Institute The Beatrice Hunter Cancer Research Institute offers a limited number of trainee awards to outstanding applicants with interest in cancer research. As part of its Cancer Research Training Program (CRTP), training and funding is provided to graduate students, medical residents, postdoctoral fellows and clinical research fellows involved in cancer research at recognized institutions in Atlantic Canada.

• W.D Stevenson Award Recipient This award is presented annually to a Neurosurgery Resident for outstanding contributions in basic and clinical research in Neurosurgery.

Dr. Adrienne Weeks, Neurosurgeon and Dr. Aaron Robichaud, Neurosurgery Resident• SocietyforNeuro-OncologyAnnualScientificMeeting Drs. Weeks and Robichaud’s work “ Cytoplasmic RNA Stress Granules: A putative translational mechanism of mTOR regulation in glioblastoma was accepted for Oral E-talk presentation at the Society for Neuro-Oncology Annual Scientific Meeting.

Dr. David Brandman, Neurosurgery Resident• Dalhousie University Clinical Investigators Program Award The Dalhousie University Clinician Investigator Program (CIP) is an accredited postgraduate medical education training program of the Royal College of Physicians and Surgeons of Canada.

• Killam Scholarship, Dalhousie University The Killam Scholarship recognizes the very best in graduate and postgraduate education, allowing its recipients to conduct outstanding research and make significant contributions to their intellectual communities.

Dr. Sean Barry• Canadian Neurological Sciences Federation’s Annual Meeting Guest speaker; presented the hot topic of “Ethics/Physician – Assisted Death in Europe”. Panelist for the Canadian Neurosurgical Society’s Position Statement

Awards and Recognitions


Dr. Gwynedd Pickett• Canadian Neurological Sciences Federation’s Annual Meeting Guest speaker; presented at the Neurosurgery Residents Course Vascular Neurosurgery “Aneurysms, anterior/ posterior circulation and the rationale/criteria around clipping vs coiling”.

• 47th Atlantic Clinical Neurosciences Society Conference Dr. Pickett was President of the 47th Atlantic Clinical Neurosciences Society Conference and Annual General Meeting, Saint John, New Brunswick, May 6-8, 2016.

Dr. David Clarke• Canadian Neurological Sciences Federation’s Annual Meeting Guest speaker; presented at Innovations in Neurosurgical Education, “What’s New: Bootcamps and Workshops” and “Recovery of Adrenal Function after Chronic Secondary Adrenal Insufficiency in Patients with Hypopituitarism.

Dr. Sean Christie, Neurosurgeon and Dr. Ayoub Dakson, Neurosurgery Resident• Canadian Neurological Sciences Federation’s Annual Meeting Guest speakers; presented “The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spinal metastatic disease”; “Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumor histology” “The Natural history of central cord syndrome and the role of surgical intervention: a retrospective review from 2005-2010”. “The Canadian Neurosurgery Research Collaborative (CNRC): A novel, trainee-led, nationwide multicentre research network” (CNSS Chair’s Select Abstract)

Dr. Renn Holness • The Order of Jamaica (OJ) Professor Renn Holness received The Order of Jamaica (OJ) for outstanding work in neurosurgery. The OJ is considered the equivalent of a British knighthood, and members of the order are styled “The Honorable”.

• CNSS Lifetime Achievement Award This national award is given to a senior (including retired) individual who has made an outstanding, notable or special contribution to neurosurgical teaching, practice or science.

Neurosurgery Spinal Cord Injury Acute Services • Accreditation - Canada Spinal Cord Injury Acute Services This achievement, marking excellence in spinal cord injury (SCI), is recognized by the Rick Hansen Institute.

Dr. Simon Walling and Dr. Dan McNeely• The IWK Neurosurgery Kids Fund Drs. Walling and McNeely established the IWK Neurosurgery Kids Fund to raise funds for welcome packages for neurosurgery children as they arrive at the IWK. This initiative was supported by Murray Hong head and beard shaving event, a BBQ fundraiser and a neurosurgery team in the Pumpkin Regatta.

Awards and Recognitions (cont’d)


Department of AnaesthesiaDr. Ian Beauprie, MD, FRCPCDr. Adam Law, MD, FRCPCDr. Kirk MacQuarrie, MD, FRCPCDr. Thomas Coonan, MD, FRCPCDr. Orlando Hung, MD, FRCPC Dr. Michael Schmidt, MD, FRCPCDr. Carlo Mariotti, MD, FRCPCDr. Karim Mukhida, MD, FRCPC

Department of Diagnostic Radiology (Neuroradiology) Dr. William Maloney, MD, FRCPCDr. Robert Vandorpe, MD, FRCPCDr. Matthias Schmidt, MD, FRCPCDr. Jai Shankar, MD, DM, MSc

Department of Medicine (Endocrinology& Metabolism) Dr. Ali Imran, MBBS, MRCP, FRCPC

Department of Medicine (Physical Medicine & Rehabilitation) Dr. Christine Short, MD, FRCPCDr. Sonya McVeigh, MD, FRCPC

Department of Pathology Dr. Alex Easton, MD FRCPC

Department of Radiation OncologyDr. Liam Mulroy, MD, FRCPC Dr. Dorianne Rheaume, MD, FRCPC

Department of Surgery (Orthopaedics) Dr. Bill Oxner, MD, FRCSCDr. Ron El-Hawary, MD, FRCSC

Department of Surgery (Otolaryngology) Dr. Emad Massoud, MD, FRCSC Dr. David Morris, MD, FRCS (ORL-HNS) Dr. Manohar Bance, MB, MSc., FRCSCDr. Robert Hart, MD FRCS (C) Dr. Jonathon Trites, MD, FRCSC

Cross-Appointed Faculty

Department of Neurosurgery,The Moncton HospitalSouth East Regional Health Authority, Moncton, NBDr. Robert Adams Dr. Dhany CharestDr. Charbel FawazDr. Brendan Kenny Dr. Gilbert Quartey

Department of Neurosurgery,Saint John Regional HospitalSouth East Regional Health Authority, Saint John, NBDr. George KolyvasDr. Al-ShayjiDr. N. AttabibDr. le RouxDr. Wheelock

AffiliatedFaculty


DIVISION OF NEUROSURGERY

QEII Health Sciences CentreNova Scotia Health Authority1796 Summer Street, Halifax, NS CanadaB3H 3A7

neurosurgery.medicine.dal.ca

HALIFAXNEUROSURGERY

ANNUAL REPORT

Documents

HALIFAX NEUROSURGERY - Dalhousie University · HALIFAX NEUROSURGERY 2016 ANNUAL REPORT 3 Welcome to the Division of Neurosurgery’s 2016 Annual report. It is my pleasure to update