Neurosurgery

Neurosurgery is a primary area of medical expertise for Jackson Memorial Hospital.

Our neurosurgery department is an internationally recognized leader in patient care, research, education, and community service.

The department’s physicians and staff treat patients from South Florida, the Caribbean, Latin America and around the world. Our team is devoted to providing excellent patient care and seeking advancements in the treatment of a wide range of neurological conditions, including complex spinal and brain disorders and injuries.

Our physicians specialize in the management of patients with surgically treatable neurological diseases. This includes the care of patients with disorders of the brain, spinal cord and nerves including cerebrovascular disease, intracranial and spinal tumors, disorders of the spinal cord and vertebral column, pediatric neurosurgical problems, movement disorders, medically intractable seizure disorders, and head and spinal injuries. Comprehensive evaluation of our patients is made possible by the team of neurosurgeons who offer subspecialty expertise in these areas.

The medical team includes neurosurgeons, neurologists, intensivists, and pain rehabilitation specialists who provide a comprehensive approach to the evaluation and management of patients. Patients who come to the department usually have difficult problems, and our dedicated physicians, nurses, nurse-practitioners, and staff, strive to make each patient’s experience as pleasant as possible. Additionally, we are dedicated to advancing the field of neurosurgery through research programs and the training of neurosurgeons.

Jackson works in affiliation with the University of Miami Miller School of Medicine as well as the Miami Project to Cure Paralysis to ensure that each patient has access to the best available services and treatments.

Description

The department’s physicians and staff treat patients from South Florida, the Caribbean, Latin America and around the world. Our team is devoted to providing excellent patient care and seeking advancements in the treatment of a wide range of neurological conditions, including complex spinal and brain disorders and injuries.

Our physicians specialize in the management of patients with surgically treatable neurological diseases. This includes the care of patients with disorders of the brain, spinal cord and nerves including cerebrovascular disease, intracranial and spinal tumors, disorders of the spinal cord and vertebral column, pediatric neurosurgical problems, movement disorders, medically intractable seizure disorders, and head and spinal injuries. Comprehensive evaluation of our patients is made possible by the team of neurosurgeons who offer subspecialty expertise in these areas.

The medical team includes neurosurgeons, neurologists, intensivists, and pain rehabilitation specialists who provide a comprehensive approach to the evaluation and management of patients. Patients who come to the department usually have difficult problems, and our dedicated physicians, nurses, nurse-practitioners, and staff, strive to make each patient’s experience as pleasant as possible. Additionally, we are dedicated to advancing the field of neurosurgery through research programs and the training of neurosurgeons.

Jackson works in affiliation with the University of Miami Miller School of Medicine as well as the Miami Project to Cure Paralysis to ensure that each patient has access to the best available services and treatments.

Special Services

Cerebrovascular & Skull Base Surgery

Many techniques apply to both the surgical treatment of cerebrovascular disorders and the surgical treatment of difficult tumors along the base of the skull.

Surgery of Intracranial Aneurysms
Having one of the most experienced teams of physicians and medical professionals in this field, this program has earned a world-class reputation. In addition to a 24-bed neurosurgical intensive care unit, it includes a multidisciplinary aneurysm support group to address the social and psychological needs of patients and their families.

Arteriovenous Malformations
Our team of neurological surgeons has contributed extensively to international medical literature on cerebral and spinal arteriovenous malformations and fistulae. These surgeons share a strong collaboration with University of Miami Miller School of Medicine interventional neuroradiologists in the treatment of these complex lesions that frequently require both embolization and surgical excision. Additionally, Gamma Knife® treatment is available for small cerebral arteriovenous malformations that are located in areas of the brain where surgical removal would be too risky.

Carotid Endarterectomy
Medical experts in this program collaborate closely with the JMH stroke services team in the care of patients with ischemic cerebrovascular disease. Many of these patients can benefit greatly from carotid endarterectomies, which are performed under continuous intraoperative EEG monitoring by a neurologist specializing in this area.

Cerebral Revascularization and Bypass Surgery
Our neurological surgeons have extensive experience in performing bypass brain surgery using the patient’s own scalp arteries and leg veins for those who have suffered a stroke or have warning signs of a stroke, or those with complex aneurysms that are not correctable with traditional surgery. Patients undergoing these demanding operations benefit from our high-tech equipment, such as SPECT scanning, intraoperative angiography and direct bloodflow microrecordings.

Skull Base Tumors
Members of this program routinely collaborate with the neuro-otologists, head and neck surgeons, plastic surgeons and ophthalmologists for the treatment of tumors involving the base of the skull. An active skull base laboratory has been developed and a well attended international course on skull base surgery is conducted twice a year.

Transsphenoidal Surgery
Surgery of pituitary tumors via the transsphenoidal route is a subset of skull base surgery. Physicians in this program collaborate with neuroendocrinologists in the care and management of these patients. Through Gamma Knife® surgery, some of these tumors can be treated effectively in cases where traditional surgery is either inappropriate or will not adequately control the disease.

Acoustic Neuromas
The surgery of acoustic tumors is a very specialized subset of skull base surgery in which there is much collaboration with the neuro-otology team. Specialized monitoring techniques developed and supervised by our neuro-otologists have saved patients’ hearing and facial function. Additionally, Gamma Knife® radiosurgical treatment is available for patients with acoustic tumors for whom traditional surgery is considered inappropriate.

Functional Neurosurgery

A wide range of activities take place within the functional neurosurgery specialty, including the treatment of disorders such as epilepsy and Parkinson’s disease with stereotactic techniques which allow precise targeting of both abnormal and normal brain areas. A variety of hardware including MRI-compatible stereotactic frames and frameless stereotactic neuronavigation equipment is utilized. Stereotactic radiosurgery using the Gamma Knife® may also be performed within this specialty area (see the Radiosurgery/Gamma Knife® section for additional details).

Endovascular Surgery

A wide range of neuroendovascular procedures are performed by a group of highly specialized physicians at Jackson Memorial Hospital. All members are part of the cerebrovascular team within the department. The decision of how to best treat complex neurovascular diseases, such as aneurysms, arteriovenous malformations and others are made within the team. In addition, there is close collaboration with the JMH stroke services team for acute interventional stroke care. Highly sophisticated biplanar image technology is available to treat cerebral aneurysm, arteriovenous malformations, arteriovenous fistula using coils and various new embolic materials.

In addition, we use balloon and stent technology for optimal outcome and safety purposes in these patients. Stent placement for cervical or intracranial arteriosclerotic disease is done as well. Adjunctive or stand alone embolizations for brain tumors, tumors of the spine and the head and neck area are performed within our group.

A 24-bed neurosurgical intensive care unit and an 8-bed stroke unit are available for postoperative care. Daily morning conferences with team members, fellows and residents take place for teaching purposes and to optimize patient care.

A two-year neuroendovascular fellowship was recently established and involves extensive endovascular training in the angio suites. Currently, more than 1,000 endovascular cases are performed each year and this includes more than 400 complex neuro-interventional procedures. Physicians, fellows, and staff also work in an experimental angio suite, along with vascular biology and vascular surgery on various experimental projects and courses.

Learn more.

Radiosurgery (Gamma Knife & CyberKnife)

Gamma Knife® Stereotactic Radiosurgery offers a relatively non-invasive procedure in which a single highly concentrated dose of ionizing radiation is delivered to a precisely localized intracranial target. Using three-dimensional computerized dosimetry, the Gamma Knife® focuses narrow beams of cobalt-60 radiation through 201 portals distributed around the patient’s head, creating an exact intersection of beams meticulously conforming to the location, size and shape of the target. Candidates for Gamma Knife® treatment include selected patients with surgically difficult problems, such as:

  • Arteriovenous malformations
  • Benign intracranial tumors, including acoustic neuromas, meningiomas, pituitary adenomas, craniopharyngiomas, pineal tumors and hemangioblastomas
  • Metastatic intracranial lesions
  • Other malignant tumors, such as glial tumors, chordomas, glomus tumors and nasopharyngeal carcinoma
  • Patients with residual lesions left after previous open neurosurgical procedures
  • Patients undergoing conventional radiation therapy, needing boost dose
  • Patients with recurrent tumors
  • Patients at high risk for surgical complications, due to age or underlying medical problems
  • Selected patients with trigeminal neuralgia

CyberKnife

The CyberKnife Robotic Radiosurgery System is the world’s first and only radiosurgery system designed to treat tumors anywhere in the body with sub-millimeter accuracy. Using image guidance technology and computer controlled robotics, the CyberKnife System is designed to continuously track, detect and correct for tumor and patient movement throughout the treatment. Because of its extreme precision, the CyberKnife System does not require invasive head or body frames to stabilize patient movement, vastly increasing the system’s flexibility. Unlike traditional radiosurgery systems that can only treat tumors in the head and neck, the CyberKnife System can treat both intracranial and spinal tumors. The CyberKnife System provides an additional option to many patients diagnosed with previously inoperable or surgically complex tumors.

Movement Disorders

Inpatient consultation services for patients with movement disorders and Parkinson’s disease are provided at Jackson Memorial Hospital through the Center for Parkinson’s Disease and Movement Disorders, a division of the Department of Neurology at the University of Miami Miller School of Medicine..

Jackson Memorial has an active program for implanting deep brain stimulation (DBS), a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. DBS can offer therapeutic benefits for patients who suffer from movement and affective disorders including chronic pain, Parkinson’s disease, tremor and dystonia.

The DBS team includes neurologists, neurosurgeons, neuropsychologists, psychiatrists, nurses, anesthesiologists, research personnel and therapists.

Neuro-Intensive Care

State-of-the-art neurocritical care is provided within the 24-bed Neuroscience Intensive Care Unit at Jackson Memorial Hospital. Our neurosurgical and neurological physicians and staff have are experts in caring for critically ill patients. Brain tissue monitoring, induced hypothermia, and sedation and pain management are common procedures in caring for these very sick patients.

Our Neuroscience Intensive Care unit is the largest of its kind in the state of Florida and is actively involved in ongoing, prospective research projects in the areas of traumatic brain injury, spinal cord injury, and neurovascular disease. The multinational and multi-lingual nursing staff is considered among the best in the United States. The neurocritical care program is also served by a full-time clinical pharmacologist, nutritionist, respiratory therapist, and social service representative. All modalities of critical care medicine are available and in common usage within the Neuroscience Critical Care Unit.

Learn more.

Neuro-Trauma

Neuro-trauma services are provided at Jackson Memorial Hospital’s Ryder Trauma Center and include operative and non-operative care for head-injured patients. We perform more than 120 trauma craniotomies annually, as well as reconstructive and rehabilitative surgeries for the non-acute neurotrauma patient.

Our physicians and staff are also committed to conducting neuro-trauma research. Current research areas include:

  • Identification of serum and CSF markers in traumatic brain injury.
  • Surface vs. intravenous cooling in neurological injury.
  • Brain tissue oxygen monitoring and cerebral blood flow monitoring in traumatic brain injury.
  • The role of radical decompressive craniectomy in traumatic brain injury.
  • Cranial reconstruction following traumatic craniocerebral injury.

Pediatric Neurosurgery

Performing surgeries at Holtz Children’s Hospital, the physicians of the pediatric neurosurgery program, in association with the University of Miami Miller School of Medicine, are recognized for excellence among their peers for their surgical expertise, their many publications in textbooks and peer-reviewed journals, and their lectures both nationally and internationally. The program is one of the most highly recognized in the United States.

Services include state-of-the-art surgical management of disorders of the nervous system including:

  • Arachnoid Cysts
  • Brain Tumors
  • Chiari Malformations
  • Head & Spine Trauma
  • Hydrocephalus
  • Surgical Treatments for Epilepsy
  • Spinal cord tumors
  • Vascular malformations of the brain (moyamoya)
  • Brachial plexus repair
  • Congenital spine disorders
  • Tuberous sclerosis

Comprehensive Spina Bifida Program
The Comprehensive Spina Bifida Program at Holtz Children’s Hospital offers patients direct access to a multidisciplinary team of pediatric experts – all in one centralized location. Patients with spina bifida or spinal cord birth defects can receive comprehensive care in a child-friendly and compassionate environment. Our integrated team of experts addresses the needs of each patient from neurosurgical and urological treatment to dietary and transitional care.

The spina bifida clinic meets every first Tuesday of the month from 1 – 4 p.m. The practice is located on the Jackson Memorial Hospital campus in the Bachelor’s Center of Urology suite.

Self-parking is available in the North (blue) garage and valet services are located at the entrance of the Diagnostic Treatment Center (DTC).

Jackson Memorial Hospital
1080 N.W. 19th Street
Batchelor Center of Urology
Central Building, Suite 150
Miami, FL 33136
Phone: 305 585-3627
Fax: 305 585-3322
Email: holtz.spinabifida@jhsmiami.org

For more information about the spina bifida program at Holtz Children’s, click here.

Contact Us
Holtz Children’s Hospital
1611 N.W. 12th Avenue
East Tower
Miami, FL 33136-1096
Phone: 305-585-3627
Email: Holtz.pedineurosurgery@jhsmiami.org

Seizure Disorders

Jackson Memorial Hospital works in association with the University of Miami Miller School of Medicine’s International Center for Epilepsy to offer comprehensive evaluation and management to adult and pediatric patients with seizure disorders.

These seizure disorders may be a result of brain injuries from trauma or related to other disorders such as malformations of areas of brain tissue. In some of these patients the onset of the seizures can be localized to limited areas of brain tissue that may be relatively safely removed. Localization of these seizure focus requires extensive evaluation by a multidisciplinary team involving neurologists, neurosurgeons, psychologists and radiologists.

Many patients with epilepsy do not achieve adequate seizure control with medications alone.At the Epilepsy Center, surgical procedures are performed only after an in-depth evaluation is completed. Identification of the epileptic area may, when appropriate, be accomplished using surgically implanted epidural, subdural and depth electrodes in conjunction with EEG/video monitoring.

In some cases, intra-carotid methohexital (or Wada) testing may be necessary before surgery to determine hemispheric speech dominance and memory function. The surgical resection may be completed under local anesthesia. Functional mapping and electrocorticography by electrical stimulation of the cortex is then routinely performed. Thus, the critical language, motor and sensory areas of the cortex can be identified and the resection tailored to exclude these important areas. Some patients with intractable epilepsy are not good candidates for removal of a seizure focus but may be appropriate for other operations such as corpus callosotomy, multiple subpial transection, or vagus nerve stimulation.

Meet the Team

Students: Interested in getting training for Neurosurgery?