Schwannoma

December 6, 2012 By 1 Comment

Thank you for visiting my blog. My name is Dr. Ramin Rak and I am a surgeon with Neurological Surgery, P.C.

I specialize in treating complex spinal and brain complications at the eleven different medical facilities affiliated with Neurological Surgery, P.C. and I am a member of the organization’s Neurosurgeon Brain Tumor Team.

The Brain Tumor team includes an Endovascular Neuroradiologist, two Neuro-oncologists, a Neuropsychologist, myself, and seven other neurosurgeons:

  • Dr. Michael H. Brisman, M.D., F.A.C.S.
  • Dr. Jeffrey A. Brown, M.D., F.A.C.S.
  • Dr. Lee Eric Tessler, M.D., F.A.A.N.S.
  • Dr. Alan Mechanic, M.D., F.A.C.S.
  • Dr. Robert N. Holtzman, M.D.
  • Dr. Vladimir Dadashev, M.D.
  • Dr. Gerald M. Zupruk, M.D., F.A.A.N.S.

The rest of the Brain Tumor Team and I work to treat brain tumors and complications caused by tumors, including gioblastoma, medulloblastoma, acoustic neuroma, and schwannoma.

Schwannoma is a homogenous tumor that is made up entirely of Schwann cells, which conduct nervous impulses along axons, provide trophic support for neurons, and support nerve development and regeneration.

The tumor cells are always on the exterior of the nerve though the tumor itself can cause nerve damage by pushing the nerve aside or into bone. Schwannomas become malignant in less than 1% of cases and are slow growing, but should still be treated if weakness numbness, pain or other symptoms are seen.

The Brain Tumor Team at NSPC uses surgery or stereotactic radiosurgery to treat schwannomas with radiosurgery being an option when the tumor is located in the head or spine.

The most common treatment is stereotactic radiosurgery, or the use of a machine called the Gamma Knife to focus high-powered x-rays at the spot of the tumor. Between 80 and 90% of the patients who opt instead to have surgery report that pain, weakness, and numbness disappears following the procedure.

Learn more about how the Brain Tumor Team treats schwannomas here.

Thank you for reading,

Dr. Ramin Rak

 

Ramin Rak Schwannoma

This is an example of a schwannoma. It typically has dense areas called Antoni A (black arrow) and looser areas called Antoni B (blue arrows). The cells are elongated (spindle shaped) and the nuclei have a tendency to line up as you see here in the Antoni A area. (via ucsf.edu)

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My Second Awake Craniotomy

November 15, 2012 By 2 Comments

Good afternoon and welcome back to my blog.

My name is Ramin Rak, I am a neurosurgeon with Neurological Surgery, P.C. in New York and one of my specialties is performing awake craniotomies.

In July of 2010, I received media attention after completing the first awake craniotomy that had ever been performed at the North Shore-LIJ Huntington Hospital.

The procedure was notable for me because it was only my second awake craniotomy.

The need for the procedure was uncovered after 23-year-old Boris Arrazia experienced a seizure while driving his car. Arrazia’s passenger was able to navigate the car to the side of the road and put it in park, and a passerby performed CPR and then called for help.

Arrazia was brought to Huntington Hospital where doctors uncovered the cause of the stroke: a tumor located in the temporal lobe of his brain.

Due to the tumor’s unusual location, the tumor did not show up when using advanced imaging techniques. Because the tumor was right on his speech area, there was no way to map and understand how we are going to control the reception of the brain without the patient being awake. By performing an awake craniotomy, my team was able to make sure we did not damage areas of the brain dealing with speech during surgery by asking Arrazia to repeat phrases or describe pictures. Arrazia recounts:

“I was nervous when Ramin Rak first told me the diagnosis, but happy to hear that the tumor was operable,” Arriaza said. “Ramin Rak told me that I would be conscious for the surgery, and that it might be uncomfortable and possibly a little painful. During the surgery, they showed me pictures and asked me to name the objects [like] a horse [or] a table.”

Though there are a lot of risks associated with awake craniotomies, including serious bleeding, there were no complications seen while removing Arrazia’s tumor. Four days later, he walked out of the hospital and reunited with his family.

Learn more about this particular awake craniotomy by taking a look at the media coverage this procedure received:

http://www.northshorelij.com/NSLIJ/Islip+Man+Undergoes+Brain+Surgery+While+Awake  

http://huntington.patch.com/articles/huntington-hospital-doc-performs-awake-craniotomy

 

If you are interested in learning more about how I perform awake craniotomies, visit my Quora profile.

Thank you for reading,

Ramin Rak

Ramin Rak awake craniotomy

Boris Arrazia thanks Ramin Rak following completion of the awake craniotomy.

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Leslie Munzer Neurological Institute

November 12, 2012 By Leave a Comment

Hi all, Dr. Ramin Rak here with another blog post about neurosurgery.

Some of my past blog posts have focused on complex neurosurgical techniques that I use, but I do not spend all of my time in the operating room. Part of my success can be attributed to the education along the way, from my eight years of undergraduate and medical schooling at the Free University of Brussels to the countless residencies I completed in hospitals throughout the United States. For this reason, I make it a priority to give back to the medical community by educating them on the techniques that I use. One way that I do so is by keeping up this blog, but I also present lectures at medical seminars across the country.

Back in 2009 I was asked by the Leslie Munzer Neurological Institute (LMNI) to speak at a comprehensive educational seminar on Brain Tumor and Stroke Awareness.

This two hour seminar took place at the Jefferson’s Ferry Lifetime Retirement Community’s Community Center in New York, and lecture topics included, “Stroke- Treatment, Recovery, and Prevention,” “Current Treatments of Brain Tumors,” “A Stroke Overview,” and “New Chemotherapy Options for the Treatment of Brain Tumors.” My lecture was titled “Advancements in Brain Tumor Surgeries” and I discussed advanced microneurosurgical techniques like awake craniotomies, the Gamma Knife procedure, and the CyberKnife system.

The Leslie Munzer Neurological Institute was formed in 2006 by Neurological Surgery, P.C. and at the time was called The Long Island Neurological Institute, Inc.

This organization coordinated funds for research related to the brain and spinal cord while supplying information to patients and the medical community about neurological ailments.

The organization changed its name in 2008 in memory of Leslie Munzer, who passed away in 2004 from a ruptured arteriovenous malformation (AVM).

Shortly after her passing, the Munzer family had formed a charity in her name to raise funds for AVM research and awareness, and in 2008 donated the collected funds to The Long Island Neurological Institute, Inc.

You can learn more about my efforts to educate the neurosurgical community with The Leslie Munzer Neurological Institute and with other organizations by viewing my other blog posts.

Thank you for reading,

Dr. Ramin Rak

Ramin Rak at May 2009 Seminar

Dr. Ramin Rak (second from the right) and the other speakers asked to present a lecture for the May 2009 Leslie Munzer Neurological Institute (LMNI) seminar.

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Gamma Knife Procedure

October 31, 2012 By 2 Comments

Hello readers, Ramin Rak here with yet another blog post about a complex neurosurgical method that I have used to treat patients.

Gamma Knife is a procedure, like the CyberKnife System, that allows doctors like me to treat tumors and ailments without having to resort to surgery. Gamma Knife surgery was approved for use by the US Food and Drug Administration (FDA) thirty years ago and I am one of the few New York area neurosurgeons certified in this technique.

When I use Gamma Knife procedures for a patient, I can deliver over 200 beams of radiation right to the tumors and lesions.

Unlike with traditional radiation, patients do not experience the regular side effects because such low doses of radiation are injected. Patients can be given several shots of radiation during one session, and sessions can be repeated until the tumor has stopped growing.Gamma knife procedures can be used to treat:

  • Benign tumors, such as meningiomas, schwannomas, craniopharyngiomas, pineal tumors, acoustic neuromas, and pituitary adenomas.
  • Malignant tumors, such as metastatic tumors, chordomas, ependymomas, medulloblastomas, astrocytomas, and anaplastic astrocytomas.
  • Arteriovenous malformations (ATV)
  • Trigeminal neuralgia
  • Parkinson’s Disease

Generally Gamma Knife use is restricted to those tumors that are less than 4 centimeters in size.

This procedure has a success rate between 90 and 95 percent, as that is how often the procedure stops tumor growth. The majority of the time it also causes tumors to shrink, taking anywhere from one week to a year to stop growth.

When a patient undergoes Gamma Knife treatment, he or she will be fitted with a clear, plastic frame.  My team uses 3D computer imaging to determine where radiation must be aimed to successfully reach the tumor. Patients are then fitted with the Gamma Knife apparatus, which is a metal helmet that emits radiation beams. The apparatus then directs radiation beams to the tumor.

This is how I complete Gamma Knife treatments. If you have any questions, check to see if I have answered them on Quora, or reach out to me directly.

Thanks for reading,

Ramin Rak

 

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Neuronavigation

October 25, 2012 By Leave a Comment

Hi all, Ramin Rak here again with another blog post.

I am a neurological surgeon affiliated with Neurological Surgery, P.C. in New York. I specialize in using microneurosurgical techniques for the treatment of brain tumors and complex spine diseases. I also perform skull-based surgery and awake craniotomies.

Recently at Huntington Hospital, which is part of the North Shore-Long Island Jewish Hospital System, I had a chance to combine neuronavigation and microsurgery to treat a patient named Roger Sencer.

While out driving, Roger suddenly forgot where he was, who he was, and even forgot recent events in his life. He was brought to Huntington Hospital where he was diagnosed with a large tumor resting on the brain: a condition called meningioma.

The next day I met with Roger and we bonded quickly over our interest in spiritual matters.

The surgery took nearly 12 hours but luckily at the end of surgery I was confident that he had been cured. Roger’s wife explains the wait below in this excerpt from an article from Huntington Hospital’s website:

Jane, on the other hand, remembers every detail – the nearly 12 hours in the surgical waiting room surrounded by friends and loved ones, being impressed by the technology in place throughout the hospital, the compassion of the entire hospital staff, and most importantly, the serene look on Dr. Ramin Rak’s face when he finally emerged from the operating room and said, “This is one of those times when I can confidently say the patient is cured.” Their entire contingency of family and friends erupted in applause.

The surgery took so long because Roger’s tumor was at the base of the skull surrounded by essential neurovascular structures.

Using pre-operative navigation planning the day before the surgery, I was able to create a three-dimensional map of his head. This allowed me to avoid injury to blood vessels and preserve the olfactory nerve during surgery.

Fortunately, neuronavigation was possible thanks to this map and my neurosurgical techniques.

Three months later Roger returned to work.

In the future I will speak more about some of the intricate surgeries I have performed.

Thank you for reading,

Ramin Rak

Ramin Rak Neuronavigation

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Brain Tumor Walk and Neurological Surgery, P.C.

October 25, 2012 By Leave a Comment

Greetings!

My name is Dr. Ramin Rak and this is my first blog post. I am a Neurological Surgeon and I work for Neurological Surgery, P.C., which is the largest neurosurgical group in New York. I am also the Chief of Neurosurgery in the Neurological Surgery, P.C. office located in Rockville Centre, New York.

I am writing this blog post because some of my colleagues at the Long Island Brain Tumor Center (part of Neurological Surgery, P.C.) are sponsoring the second annual “Run for Rob” walk this Sunday, October 28th.

This annual fundraiser was created to honor the memory of Dr. Robert Bernstein, an obstetrician and gynecologist. At the time I wrote this blog, “Run for Rob” had already raised over $50,000 to fund research for brain cancer. The walk will take place at Bethpage State Park in Farmingdale, New York, with registration beginning at 9 AM. It is not too late to make a donation; simply head to the “Run for Rob” website to make a general donation or to donate to a specific team.

“Run for Rob” is organized by Voices Against Brain Cancer!

This organization was established in loving memory of Gary Lichtenstein, a 24-year old options trader at Wolverine Trading who lost his battle with brain cancer on October 1st of 2003. Gary’s family started “Voices Against Brain Cancer” to advance scientific research, increase awareness in the medical community, and to support patients and family members affected by this terrible disease. Funds raised by Voices Against Brain Cancer pay for research at Universities such as:

  • Columbia
  • Cornell
  • Duke
  • Harvard
  • John Hopkins
  • MD Anderson
  • Memorial Sloan Kettering
  • Yale

Voices Against Brain Cancer also sponsors a number of support groups including the New York Non-Malignant Brain Tumor Support Group, and support groups for family members and caregivers of brain cancer patients.

If you are able to donate to “Run for Rob,” your donation will help fund research that will uncover new methods of treating brain tumors.

Thank you for time, and be sure to stop by again to learn more about my work with Neurological Surgery, P.C.

Dr. Ramin Rak

Ramin Rak Brain Tumor Walk

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