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sites. Other w ise, there's a risk of the vessels rupturing." In order to determine a patient 's eli- g ibility for mecha nica l thrombectomy in the ca se of a stroke, the 512 speed low-dose CT sca n ner is used to f ind out if the patient is experiencing a large vessel occlusion and whether or not the surrounding brain tissue is still a live. If the brain tissue is still living, this treat- ment ca n be administered rega rdless of the time of ischemic stroke onset. " We don't wa nt to inter vene if t he pa r ticu la r pa r t of t he bra in in ques- tion ha s d ied, si nce t hat wou ld on ly increase the risk of bleeding in the area," Dr. Bekelis says. " The high-speed, low- dose sca nner a llows us to perform CT perfusion, which shows us the perfusion proper ties of the bra in. From there, we ca n deter m ine how wel l t he bra in is receiving blood a nd f ind the ischemic penumbra. This doubles our capacity to offer life saving treatment to patients." G o o d S a m a r i t a n a c q u i r e d t h e CT¤ s c a n ner i n Ju ly 2 017, a l low i n g the¤ machine to be optimized for pro- cedures t hat wou ld be per for med i n the Stroke & Bra in A neur ysm Center a nd g iving the tea m time to tra in with the machine. A SPECIALIZED TEAM Much of Dr. Mullins' time a nd effor t in crafting the program was spent recruit- i n g neu rolog i s t s , nu r ses , phy sici a n assista nts a nd other personnel. "A ll in a ll, we recruited about 60 new person nel t o bu i ld out t he St roke & Bra in A neur ysm Center," Dr. Mullins says. " We recruited a well-trained staff, from our inter ventiona l neurosurgeons performing the procedures to our nurses a ssisti ng i n t he neurolog ica l i ntensive ca re u n it ." Though simila r progra ms may sha re some of the mentioned components, the sta f f at Good Sa ma rita n is unique in that a ll members of the Stroke & Bra in Aneur ysm Center have dedicated train- ing in a f ield of neuroscience. Beyond the fellowship tra ining completed by neurointensivists like Dr. Bekelis, a ll suppor t sta f f — including nurses a nd adva nced practice prov iders — have ex per ience work ing w it h neurolog i- ca l patients. D u r i n g a t y pic a l neu r oi nt er ven- tiona l procedure, Dr. Bekelis receives a ssista nce from a nurse practitioner w it h a lon g h i s t or y of neu rolog ica l ex per tise. In addition, a technolog ist is on ha nd who ser ves as a n exper t on t he bipla ne a ng iog raphy machine. A neurophysiologist is present to monitor the bra in activity of the patient, who is usua l ly awa ke during the procedure. A n a nes t hesiolog i s t i s a l so present d u r i n g i n t e r v e n t i o n s . O n e o r t w o additiona l nurses round out the tea m during procedures. "Good Sa ma rita n made a g reat com- m itment to bui ldi ng a neu roscience prog ra m," Dr. Mullins says. POST-TREATMENT CARE AND TRANSITION The f ive-bed neurosurg ica l intensive ca re u n it ( ICU ) at G ood Sa m a r it a n prov ides fol low-up ca re for patients w h o h a v e u n d e r gon e n e u r olo g i c a l inter ventions or require ongoing neu- rocritica l ca re. " Patients w ith neurolog ica l condi- tions can see their situations deteriorate ver y quick ly a nd quietly, which is why it 's i mpor t a nt t o have a specia l i zed tea m that ca n recog nize sig ns a nd get them treated immediately," Dr. Bekelis says. " We wa nt patients who receive neurointer vention to be monitored for at least 24 hours to ma ke sure there is no additiona l clotting or bleeding before they a re discha rged." Through neurointervention, conditions such as strokes, brain aneurysms and tumors that are present in the delicate areas of the brain, neck or spine can be treated in a minimally invasive procedure. Kevin Mullins, MD, FACS, FAANS DR. MULLINS IS the Chair of the Neuroscience Service Line, Catholic Health Services and Chief of Neurosurgery at Good Samaritan Hospital Medical Center, and has performed over 4,500 neurosurgical operations and contributed to publica - tions including the Journal of Clinical Neuroscience and Surgical Neurology International. He completed his residency in neurological surgery at the University of Rochester and received advanced training in spine surgery from the University of Pittsburgh. 0 9 M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 018

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