Every day, at every hospital in the United States, patients arrive with brain-related disorders ranging from tumors to delirium. Too often, these patients never see a specialist.
At UCSF, specialized care is the norm. “In the past decade, we’ve discovered many acute therapies for neurological disorders we see in the hospital,” says neurologist S. Andrew Josephson, MD, director of UCSF’s Neurohospitalist Program. “Patients need access to physicians who can safely and quickly connect them to these advanced treatments.”
The UCSF Neurohospitalist Program, the first of its kind in the country, achieves that aim. In doing so, it has reduced readmission rates and hospital-acquired complications for neurological conditions – and is leading a movement to create neurohospitalist programs nationwide.
The program is the latest example of an institutionwide commitment to what UCSF Chair of Neurological Surgery Mitchel Berger, MD, calls “superb, compassionate and comprehensive neurology and neurosurgery services.”
Ongoing Tradition of Excellence
While the neurohospitalist program began in 2006, other UCSF neurology and neurosurgery programs have been at the forefront of patient care for decades.
Mitchel S. Berger, MD, professor and chair, Department of Neurological Surgery
National surveys consistently rank patient care programs in neurology and neurosurgery at UCSF among the top 10 in the country. The most recent is the 2010-11 report on best hospitals by US News & World Report, which places UCSF fifth nationwide, making it the highest ranked center for these specialties in the West.
One program, for example, is the UCSF Neurovascular Disease and Stroke Center, which is a widely recognized leader in the care of life-threatening conditions such as stroke and aneurysm. UCSF is a Joint Commission Primary Stroke Center with 29 dedicated neurointensive care beds and an interdisciplinary team of cerebrovascular experts available 24 hours a day, seven days a week. Its work has extended the time window for treating stroke, which affects 800,000 people a year nationwide.
The center also has a surgery program for brain aneurysms (in which a weak blood vessel balloons and puts pressure on adjacent nerves) that is among the largest in the western U.S. “As protocols have changed, many hospitals have eliminated their surgical programs for aneurysm, but there are still a lot of cases where surgery is necessary,” says Berger. “Patients do significantly better if that surgery is with experienced surgeons, like we have at UCSF.”
Brain Tumor Treatments
Similarly, Berger and his team are among the most experienced in the world in removing brain tumors of all types and complications. The UCSF Brain Tumor Center is the second-largest brain tumor surgical treatment program in the U.S. Patients have the advantage of being treated by some of the most experienced surgeons in the world, who collaborate closely with oncologists, radiation oncologists and neuroradiologists, pushing the envelope on cancer care and easing the side effects of that care.
“Brain tumor surgery is always reminiscent of a minefield because we are working between areas that are functional and those that are not, as well as between arteries and veins that supply important areas,” says Berger.
Berger is internationally recognized as a pioneer in using brain mapping to safely remove tumors, while maintaining functional areas of the brain. To aid in the surgeries, neuroradiologists use precise imaging capabilities to reveal both anatomy and physiological functions.
“Using functional mapping, we create microscopic corridors that enable us to remove as much tumor as we can safely, and we are now moving forward with the most advanced intraoperative MRI scanner so we can be even better at removing tumors aggressively and safely,” says Berger.
From Alzheimer’s to MS
“Expert knowledge of neurological issues and treatment is essential to achieving the best patient outcomes, but it is equally important that experts from multiple disciplines work effectively together to pool knowledge and resources,” says Stephen Hauser, MD, chair of the Department of Neurology.
The patient care team may include, for example, experts in neuroradiology and neurointerventional radiology who specialize in the use of the latest minimally invasive techniques for imaging the brain, spinal cord, head and neck. The collaborative approach across disciplines ensures that UCSF can best address the full spectrum of neurological conditions:
Multiple sclerosis: At the UCSF Multiple Sclerosis (MS) Center, a diverse team of specialists provides individualized care for patients who suffer from this devastating, degenerative disease. The patient care team uses the latest imaging techniques and represents a wide range of expertise to complete a comprehensive clinical, social and personal evaluation of every patient. The teams also regularly review complex cases and hold weekly urgent care clinics for patients with pressing physical, cognitive or emotional concerns related to their diagnosis.
Nalin Gupta, MD, PhD, Director of Pediatric Neurological Surgery Program, with patient.
Epilepsy: Expert clinicians at the UCSF Epilepsy Center provide advanced, tailored medical management of the disease and advanced surgeries for those patients who do not respond to medication. When surgery is possible and necessary, skilled surgeons use diagnostic tools that precisely locate seizure activity and regions of the brain that may be at risk during surgery.
Spinal disorders: The UCSF Spine Center provides comprehensive diagnosis and therapeutic management of all diseases and disorders affecting the spine, spinal cord, nerve roots and peripheral nerves. “The Spine Center team has developed new ways of operating on complex spinal disorders that have reduced the incidence of failure from more-standard back or neck surgeries,” says Berger.
Memory: The UCSF Memory and Aging Center has pioneered new diagnostic and treatment approaches for adults with cognitive problems, including frontotemporal lobar degeneration and Alzheimer’s disease. For every new patient, a multidisciplinary team conducts a comprehensive neurological assessment, and then works with the patient’s primary physician, the patient and the caregiver to determine proper treatment.
Deep brain stimulation: Already leaders in a surgical procedure known as deep brain stimulation, commonly called DBS, for Parkinson’s disease and other movement disorders, UCSF neurosurgeons now also are expanding the potential of this procedure. Pending approval by the Food and Drug Administration, they will use DBS to address psychiatric disorders, such as obsessive-compulsive disorder and depression, when other forms of therapy have failed.
Autism: Housed in the Department of Psychiatry, the UCSF Autism and Neurodevelopment Program offers clinical services that draw on imaging, genetic, neuropsychological and behavioral research. Psychiatrists and neurologists work together to treat individuals with autism and related neurodevelopmental disorders.
Amyotrophic lateral sclerosis (ALS): The ALS Center at UCSF seeks to advance therapies, medications and clinical management of this disease – and apply those innovations to patient care. The clinical care is research-based, and the environment is designed to support all needs of patients and their families.