Researching the whole brain

The father of neurosurgery in America, Harvey Cushing, was a Yale undergraduate who returned to New Haven to join the medical school faculty late in his career. He brought with him a vast collection of papers, case records, photographs, medical illustrations—even tumor specimens and bottled brains accumulated during his years at the Peter Bent Brigham Hospital in Boston. Cushing brought not only a wealth of knowledge but also an appreciation for inquiry and research in neurosurgery. The recently established Department of Neurosurgery at Yale, which had been a section within the Department of Surgery, is regarded as one of the world’s premier research centers.

Under the leadership of Charles Greer, Ph.D., vice chairman for research, the department’s numerous research programs have followed a general principle of studying how the brain and spinal cord respond in both restorative and pathologic ways to trauma and disease. Dr. Greer himself is a leader in spinal cord research. Along with colleagues Anthony van den Pol, Ph.D., and Carole LaMotte, Ph.D., and others from around the medical school, he has been looking at pathways and projections of the central nervous system and how specific connections can be functionally altered. The work holds promise for developing new ways to help spinal cord injury patients regain function.

Beyond his regular administrative and teaching duties and surgical schedule, Dr. Spencer directs the department’s epilepsy research program, working with investigators Anne Williamson, Ph.D., and Nihal de Lanerolle, Ph.D. The program is unique in the world for its studies of the human tissue surgically removed to treat epilepsy. Dr. Spencer says, “Anatomical and electrophysiological study of this tissue is beginning to unravel the mechanisms of how seizures are maintained in humans.”

Many of the departmentís research areas have an emerging common theme in molecular genetics, including gene therapy. “This field,” says Dr. Spencer, “will be of critical importance to the understanding of basic disease mechanisms, which must precede rational therapy.” The department recently added a new faculty member, Murat Gunel, M.D., an alumnus of the department’s residency program who is internationally recognized for his genetic analysis of cerebrovascular malformations.

One of the most technologically complex fields, neurosurgery is constantly dealing with and evaluating new equipment. Part of the department’s research efforts include studying and applying new technology in the operating room. Clinical vice-chairman, Joseph Piepmeier, M.D., directs the state-of-the-art neuro-oncology program. Issam Awad, M.D., heads the neurovascular program, dedicated to the epidemiology of hemorrhagic stroke and basic research on angiogenesis.

Gene and cell replacement therapy is one of the most challenging fields in medicine. Recently, the department launched a clinical trial to replace the gene missing in the fatal childhood disease of Canavan, with Charles Duncan, M.D., chief of pediatric neurosurgery, providing neurosurgical support.