Research in the Department of Neurosurgery at George Washington University
Our department is actively involved in both clinical and basic science research in many areas of neurological disease and surgical approaches to therapy for these conditions.

The George Washington University (GWU)
 
The Dr. Harvey Ammerman Microsurgical Lab was dedicated in 1998, and is designed to augment the training of Neurosurgery residents. In the Ammerman Lab the residents receive structured, programmed training in surgical approaches via cadaveric dissections. This lab is dedicated to training and research in Neurosurgery and combines the five components of training and research in skull base surgery, minimally invasive surgery, microvascular surgery and spine surgery as well as basic science research.
 
Microsurgical and endoscopic techniques are learned in this lab and in the endoscopic training lab in the Medical School. Clinical and basic science research projects are developed and pursued.
 
The laboratory research space consists of 2000 square feet and is currently directed by James Leiphart, M.D., Ph.D. The Harvey Ammerman Microneurosurgical lab has become an integral component of the residents’ educational training in Neurosurgery. The residents attend a neuroanatomy surgical dissection lab on Saturdays from 9:00 am to 2:00 pm. During this time a structured dissection course on cadaveric models teaches the residents basic surgical approaches. The dissections are supervised by the Neurosurgery faculty and are supplemented by anatomic lectures.
 
Collaborative efforts with the Departments of Pharmacology (Vincent Chipanelli, PhD, Chairman and Linda Werling, PhD), Anatomy (Ray Walsh, PhD and Janette Krum, PhD) and Physiology (Dr. William Weglicke) have been undertaken. Drs. Chipanelli, Werling, Walsh, and Krum have joint appointments in Neurosurgery.
 
Dr Janet Krum
 
NIH - NINDS R01 - NS 045189 Mechanisms of VEGF action in intact and grafted CNS. (Co-PI with Dr. J. Rosenstein) 7/03 - 6/08:
American Heart Association (Mid-Atlantic) 0355793U Cellular action of VEGF in hypoxic brain tissue in vitro. (PI) 7/03 - 6/05:
 
Dr. Linda Werling
 
Co-investigator (5% effort) on “Chronic Nicotine Effects on Receptor Subtypes” , David . Perry, P.I. 1R01DA015767-01A2 7/01/04-6/30/08. Total Direct costs $900,000.
 
Dr. John W. Philbeck, of the Department of Psychology, has been collaborating with the Departments of Neurosurgery and Neurology in studies on post operative patients following temporal lobectomy for epilepsy.
NIH funding has been obtained for the following investigation: Investigation of navigation defects in linear locomotion following medial temporal lobectomy John W. Philbeck (PI), A. Caputy, S. Potolicchio ( co- PI) @005. NIH funding for four years. $ 784,875. (530196584)
A recent grant has been submitted entitled: Small scale navigation in Alzheimer’s Dementia Anthony Caputy (Neurosurgery), Samuel Potolicchio, Jr. (Neurology), and John Philbeck (Psychology)
 
Dr. James Leiphart joined the full time faculty in 2004 and has been active in developing new research programs with resident involvement.
Dr. Leiphart is initiating animal studies in the Ammerman laboratory on receptor physiology in neuropathic pain. The George Washington University Medical School’s Ammerman laboratory is the Department of Neurosurgery’s laboratory for anatomical and basic science research. The basic science half of the laboratory is 782 square feet and is available for this research. The following will fund the research project:
A grant from the George Washington University of $75,594 over 3 years
The George Washington University Institute for Biomedical Engineering Interdisciplinary Research Fund. “Assessment of Complex Brain Stimulation for Control of Experimental Seizures in a Rat Model of Epilepsy.” Submitted March 14, 2008, $10,000.
Neurosurgery Research and Education Foundation Young Clinical Investigator Award Grant. “Dorsal Root Ganglion and Spinal Cord Alpha2-Adrenergic Receptors in Neuropathic Pain: A Binding Study.” 7/1/05-12/31/06, $40,000.
Neuropace Inc. - Neuropace Responsive Neurostimulator Pivitol Trial, 2006-2008, $400,000.
We are conducting a study of a new surgically implanted technology for the control of medically intractable epilepsy. Our corporate sponsors for the project will be Neuropace, Inc., the developer of the Responsive Neurostimulator. We are one of ten academic centers participating in this study. There will be a total of 80 patients enrolled in the study across all of the participating medical centers.

Children’s National Medical Center (CNMC)
 
The faculty at Children’s National Medical Center maintains an active research facility with funded investigations in the area of neuro-oncology.
Dr. Robert Keating has a number of ongoing research projects.
 
IRB PROTOCOLS
A Phase I/II Study of a recombinant chimeric protein composed of transforming Growth factor (TGF) and a mutated form of pseudomonas exotoxin termed PE38 in Pediatric Patients with recurrent or progressive supratentorial high grade gliomas.
Study Co-chair, Pediatric Brain Tumor Consortium Protocol, April 2003.
 
Research Interests
 
Spina Bifida
Co-investigator with Julianne Byrne (PI), Eileen Donovan (coPI) in project title: Prevention of Spina Bifida, Thrasher Research Fund. The purpose of this project was to generate a database of patients in the spina bifida group at Children's National Medical Center and evaluate the relative incidence of Spina Bifida among families previously affected with Spina Bifida.
 
Spasticity
A multidisciplinary clinic at two campuses (Rehab, PT, Neurosurgery, Orthopedics, Neurology, Social Services) currently evaluates patients with spasticity for consideration of therapeutic options. Patients are then referred for Botox injections, intensive PT/OT, soft tissue / hip surgery as well as selective dorsal rhizotomies, baclofen pumps and, recently, deep brain stimulation for selective dystonia. A database is currently being established with video recordings for eventual analysis of outcome and correlation with degree of selective dorsal rhizotomy as well as evaluating whether intrathecal baclofen therapy will ameliorate hip subluxation or reduce the need for subsequent orthopedic surgery .
 
Intracranial Pressure / Spectral Doppler
Drs. Marijean Miller (PI) and Craig Sable (coPI) have been investigating the value of spectral Doppler in assessing intracranial pressure in the setting of papilledema. Their IRB protocol is being modified to include neurosurgery patients suspected or directly observed to have elevated ICP (e.g. craniofacial , shunt malfunction, tumor, trauma) and will be correlated directly to the measurement of ICP via indwelling monitors or direct measurement via ventriculostomy. Should this technique prove efficacious, this may provide a means of non-invasive measurement of ICP which would have significant application in the treatment of patients with psuedotumo , complex craniofacial disorders and suspected shunt malfunction.
 
Delayed / Secondary Craniofacial Repair and ICP
Controversy continues today regarding the significance of increased ICP in patients with delayed craniofacial repair as well as individuals requiring secondary repair. These individuals are evaluated pre-operatively (fundoscopic , CT, neuropsych) and undergo measurement of ICP at the time of their craniofacial repair (via ventriculostomy) and followed during the calvarial reconfiguration.

National Institutes of Health (NIH)
 
Dr. Russell Lonser, Chief, Surgical Neurology Branch of the NINDS at the National Institutes of Health, has an appointment as Professor of Neurosurgery at The George Washington University and is working with the Department to ensure an optimal residency research experience. The resident has the opportunity to pursue basic research projects at the NIH on a fixed rotation. This collaborative relationship allows for the integration of projects at GWU and Fairfax Hospital with ongoing projects at NIH.
 
The responsibilities of the members of the Surgical Neurology Branch (SNB) include performance of original research, neurosurgical care for patients at the NIH Clinical Center, training of young investigators, collaboration when expertise in neurosurgery is needed by members in other branches and laboratories of NINDS and other institutes as well as serving as a resource for neurosurgical expertise for NINDS and NIH.
 
The research performed in the SNB emphasizes the use of advances in basic biology to understand clinical disease and for the development of new therapies for disorders of the nervous system. Considerations for selection of research topics also include the need for breadth in the program to maintain clinical skills by the neurosurgical staff and for the development of clinical knowledge and skills by neurosurgical resident trainees.
 
Research Interests
The research activities include clinical and clinically-oriented basic and translational research by the Clinical Section. Clinical studies of conditions involving neurosurgical intervention, including brain tumors, pituitary tumors, syringomyelia, von Hippel-Lindau disease and arteriovenous malformations of the spinal cord are ongoing. Activities include investigation of a new delivery technique to perfuse targeted regions of the brain. We have developed and used this technique in a clinical study using recombinant immunotoxins to treat malignant brain tumors. We have completed laboratory studies using excitotoxins to selectively eliminate neuronal cell populations in models of epilepsy and Parkinson's disease. Clinical studies are being developed to use this technique in the investigation of patients with medically intractable epilepsy and in the treatment of patients with Parkinson's disease. The genetics of familial Chiari I malformation is being examined. Potential therapeutic uses of nitric oxide for cerebral vasospasm and opening of the blood-brain barrier are being investigated.
 
Protocols
Evaluation and Treatment of Patients with Spinal Vascular Abnormalities 93-N-0151
Genetic Analysis of the Chiari I Malformation 00-N-0089
Evaluation of Biological, Immunological and Therapeutic Parameters in Brain Tumor Patients 79-N-0089
Research Study of Specimens Obtained During Epilepsy Surgery 02-N-0014
Establishing the Physiology of Syringomyelia 92-N-0226
Detection of Glioblastoma or Anaplastic Astrocytoma Cells in the Circulation During Surgical Resection 00-N-0009
Study of the Efficacy of Direct Intratumoral Injection of Absolute Ethanol in Treating Symptomatic Spinal Tumors 94-N-0158
Trial of Intracerebral Infusion in Patients with Medically Intractable Epilepsy 00-N-0158
Establishing the Pathophysiology of Primary Spinal Syringomyelia 01-N-0085
Gene Therapy for the Treatment of Brain Tumors Using Intratumoral Transduction with the Thymidine Kinase Gene and Intravenous Ganciclovir 92-N-0246
A Prospective Natural History Study of VHL Patients with CNS Hemangioblastomas 00-N-0140

Inova Fairfax Hospital (IFX)
 
Inova Fairfax Institute of Research and Education
 
Inova Fairfax Institute of Research and Education provides clinician researchers and statisticians to support in-patient and out-patient studies including support and assistance with research design, proposal and protocol preparation. They also provide administrative and technical support in the conduction of clinical trials, assistance in identifying sponsors, grant management as well as database development and data collection and analysis.
 
Inova Research Center (IRC) is based on a hub and spoke model. The IRC acts as the hub to the participating product line spokes. The IRC provides clinician-researchers with a variety of essential services to support their participation in in-patient and out-patient investigational studies.
 
Services include:

• Administrative and technical support in the conduct of inpatient and outpatient research trials
• Teaching and education for research personnel
• Research budgeting and contract management
• Technology transfer services