‘Ask the Expert’ – A Neurosurgeon Answers Readers’ Questions

This month’s ‘Ask the Expert’ segment features Nader Pouratian, MD, a neurosurgeon whose biography is listed below.

1. Are there new therapies for glioblastomas?

Glioblastoma is one of the most challenging diagnoses that we treat as neurosurgeons. The mainstay of initial treatment is surgical resection followed by temozolomide and radiation. Approved second line therapies include bevacizumab (avastin) and novocure (electric fields). However, given the rate of progression, doctors and scientists are constantly looking for new therapies so there are countless clinical trials related to glioblastoma. The most common and promising areas of research and study are in immune modulating therapies, either using tumor “vaccines” to stimulate the immune system to fight the tumor or using therapies that enhance the immune system’s response to the tumor. To find out more, check out clinicaltrials.gov and use keyword “glioblastoma.”

2. I’ve heard about stimulation therapy for movement disorders- how helpful is this?
Deep brain stimulation (DBS) is an FDA approved therapy for the treatment of Parkinson disease, essential tremor, dystonia, and obsessive-compulsive disorder. DBS is similar to cardiac pacemakers that we are all much more familiar with, but instead of setting a rhythm for the heart, the system stimulates the brain in very specific regions. Each diagnosis has its own indications. For Parkinson disease, we use DBS when patients develop complications of the drugs used to treat Parkinson disease – like dyskinesias and dystonias – and when patients develop motor fluctuations. For essential tremor, on the other hand, we use DBS when patients have tried first line therapies (primidone and propranalol) and have unsatisfactory results. When used in the properly selected patients, the therapies are very effective at improving the symptoms of movement disorders. You can find more information at www.dbs.ucla.edu. I also have several youtube videos you can check out: https://www.youtube.com/playlist?list=PLgIjwMl7yCvA8Aw_J2Poyxy9zypA6rWR5


3. I watched the video you were featured in and was amazed- has there been progress in your research into quadriplegics moving objects with their thoughts?
The research is very exciting and indeed we have made progress, but there is much to be done. In our work, the subject uses her thoughts to move a cursor on the screen and do things like play the piano. In another similar subject, he has been able to use his thoughts: http://www.latimes.com/science/sciencenow/la-sci-sn-robot-arm-imagination-brain-20150521-story.html


4. Are there any new treatment for MS-related trigeminal neuralgia?
Treatment for trigeminal neuralgia for multiple sclerosis mirror the treatments we use for trigeminal neuralgia in patients without multiple sclerosis. Unfortunately, the treatments do not work as well though. There are 3 major classes of treatments, including radiosurgery (focused radiation), percutaneous treatments (in which we advance a needle through the face to the hole in the skull where the trigeminal nerve emerges and deliver focused treatments, either by balloon or radiofrequency energy), or brain surgery, in which we perform what’s called a microvascular decompression. In my experience, I use radiosurgery and percutaneous balloon compression as first line therapies, for which there is about a 60% success rate. When a treatment does not work, we try another one. We usually will not repeat a procedure unless it has worked at least once. We have more information on our website at: http://neurosurgery.ucla.edu/trigeminal-neuralgia


5. How many years does it take one to become a neurosurgeon?
Becoming a neurosurgeon takes several years of training. After completing 4 years of medical school, we must complete a 7 year residency in general neurosurgery. This includes learning all aspect of surgical and medical care of patients with neurosurgical diagnoses. After residency, some obtain further training with 1-2 years of fellowship specialty training. After that, we are ready to begin independent practice. But because of the continuous innovation in the field, being a neurosurgeon, like many other fields of medicine, is really a commitment to lifelong learning.


6. How do you cop with the long hours of work as a neurosurgeon and having a family?

This is one of the greatest challenges of having a busy career, not just in neurosurgery but in any field. Striking a balance is difficult and everyone does it in their own way. My family understands that I work very hard during the week and I try to reserve my weekends for family and friends.

Nader Pouratian, MD, the vice-chair of neurosurgery at UCLA and this month's 'Ask the Expert' featured physicianNader Pouratian, MD, is the Associate Professor and Vice Chair of Neurosurgery at UCLA. You can check out some of Dr. Pouratian’s latest work in some of the latest articles he’s been featured in, such as this one in Daily mail, in which he talks about the world’s first bionic eye, or this youtube video, in which his work shows a quadriplegic who can, once a chip has been implanted into her brain, move things on a screen using only her thoughts. Also check out this Eyewitness News feature, in which he discusses a new device that can help movement in Parkinson’s Disease.

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  1. Hi my name is Fasika and my mom has both meningioma and ddx-Pituitary macro adenoma her results show that the brain window there is a 3.5 *3 cm well defined sellar mass lesion with superasellar extention seen.
    the mass is isodense on the precontrast and highly enhancing on the post contrast images.there is narrowing of adjacent vessels but no sellar widening senn
    -normal mid brain,brain stem and cerebellar hemispheres.
    -no mid line shift
    -normal pineal gland
    -no epidural or sub dular collection.
    -normal bilaateral orbital contents
    Bone window:
    -no evidence of fracture
    -no lytic or scierotic bony change
    -normal orbits
    -well pneumatized sinuses and mastoids
    please tell me if there is any solution whether it is surgery or medication please help

    1. Hi Fasika, this site is not meant to treat individual cases, but rather provide general information on medical and non-medical topics. I recommend you speak with your physician your mother and wish both you and her good health.

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