Gerald M Lemole
- Professor, Surgery
- Division Chief, Neurosurgery
- Professor, Otolaryngology
- M.D. Medicine
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
- A.B/A.M Biology (Cum Laude)
- Harvard University, Cambridge, Massachusetts, United States
- Professor – Neurosurgery (Tenured), University of Arizona College of Medicine - Tucson, Department of Surgery (2012 - Ongoing)
- Associate Professor – Neurosurgery (Tenured), University of Arizona College of Medicine - Tucson, Department of Surgery (2009 - 2012)
- Associate Professor and Award of Tenure, University of Illinois at Chicago, College of Medicine - Department of Neurosurgery (2009)
- Assistant Professor, University of Illinois at Chicago, College of Medicine - Department of Neurosurgery (2003 - 2009)
- Research Assistant, Department of Neuroscience - University of Pennsylvania, College of Medicine (1994 - 1995)
- Research Assistant, Department of Dermatology - Massachusetts General Hospital & Harvard University (1989 - 1991)
- Research Assistant, Eastern Laser Institute - Wilmington Veterans Administration Medical Center (1989 - 1990)
- Research Assistant, George R. Harrison Spectroscopy Laboratory - Massachusetts Institute of Technology (MIT) (1988)
- Society of Neurological Neurosurgeons (Senior Society)
- Spring 2017
- Endless Possibilities Leader Award
- Banner Medical Group, Spring 2015
- Philip Carter Award – 1st Place Award Resident Presentation, Integration of ICG videoangiography with operative microscope: augmented reality for interactive assessment of vascular structures and blood flow
- Arizona Neurosurgical Society, Annual Fall Meeting, Marana, AZ, Winter 2014
- DePuy Synthes Award – Abstract Award, Morbidity and Mortality of Endovascularly Treated Intracerebral Aneurysms: Does Specialty Matter?
- American Association of Neurological Surgeons, 82nd Annual Meeting, San Francisco, CA, Spring 2014 (Award Nominee)
- Best Doctors in America
- Best Doctors, Inc., Spring 2013
- Doximity Fellow
- Doximity, Spring 2013
- Recognition – Value Analysis Program
- University of Arizona Health NetworkLeadership Development Institute, Tucson, AZ, Spring 2013
- First Place Research Abstract (Technology & Program Innovation) Ventriculostomy Practice on a Library of Virtual Brains Using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes
- 12th International Meeting on Simulation in Healthcare, San Diego, CA, Spring 2012
- Top Doctors
- US News and World ReportCastle Connolly Medical Ltd., Spring 2012
- 2011 Physician of the Year Award
- Pima County Medical Society, Tucson, AZ, Fall 2011
- Congressional Citation (Services to Congresswoman Gabrielle Giffords), 2011 Annual Awards Gala, Washington, DC
- Friends of the National Library of Medicine, Fall 2011
- Honorary Commander, 355th Medical Group
- Davis Monthan Air Force Base, Tucson, AZ, Spring 2011
- Medscape News Physicians of the Year, Best of 2011
- Spring 2011
- UMC Trauma Team Merit Award, 4th Annual Health Care Leadership Awards, Phoenix, AZ
- Arizona Business Magazine, Spring 2011
- America’s Top Surgeons
- Consumers’ Research Council of America, Spring 2009
Licensure & Certification
- American Board of Neurological Surgery (Oral Exam) (2007)
- State of Arizona Medical Licensure (1999)
- Advanced Trauma Life Support (1995)
- State of Pennsylvania Licensure (1999)
- Advanced Cardiac Life Support/Basic Life Support (ACLS)/(BLS) (1995)
- State of Ohio Medical Licensure (2003)
- State of Illinois Medical Licensure (2003)
- State of Indiana Medical Licensure (2004)
- USMLE Step 1 (1993)
- USMLE Step 2 (1995)
- USMLE Step 3 (1996)
- American Board of Neurological Surgery (Written Exam) (2000)
- American Board of Neurological Surgery Maintenance of Certification Examination (Written Exam) (2016)
- Drug Enforcement Administration (2015)
- State of Nevada Medical Licensure (2012)
Complex Cranial Surgery,Skull Base Neurosurgery,Minimally Invasive Endonasal Approaches, Stereotactic Radiosurgery (Cyberknife, Accuray, Inc.) & (Novalis, BrainLAB, Inc.)Cerebrovascular Neurosurgery
Neurosurgery (Surgery Subspec)SURG 837C (Fall 2016)
Neurosurgery (Surgery Subspec)SURG 807C (Spring 2014)
Medical Sciences SeminarMDS 696A (Fall 2013)
Neurosurgery (Surgery Subspec)SURG 807C (Fall 2013)
Principles of SurgeryMDS 610 (Fall 2013)
- James, W. S., & Lemole, G. M. (2015). Neuron Based Surgery: Are we There Yet? Technical Developments in the Surgical Treatment of Brain Injury and Disease. In Technological Advances in Surgery, Trauma and Critical Care(pp 221-229). Springer Verlag.
- Martirosyan, N. L., Neckrysh, S., Charbel, F. T., Theodore, N., & Lemole, G. M. (2013). Vascular Lesions of the Spinal Cord. In Surgical Anatomy and Techniques to the Spine(pp 646-660). Philadelphia: Elsevier.
- Fennell, V. S., Martirosyan, N. L., Atwal, G. S., Kalani, M. Y., Ponce, F. A., Lemole, G. M., Dumont, T. M., & Spetzler, R. F. (2017). Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities. Neurosurgery.More infoThe understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.
- Palejwala, S. K., Rughani, A. I., Lemole, G. M., & Dumont, T. M. (2017). Socioeconomic and regional differences in the treatment of cervical spondylotic myelopathy. Surgical neurology international, 8, 92.More infoCervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in the world. Surgical treatment is both medically and economically advantageous, and can be achieved through multiple approaches, with or without fusion. We used the Nationwide Inpatient Sample (NIS) database to better elucidate regional and socioeconomic variances in the treatment of CSM.
- Palejwala, S. K., Sharma, S., Le, C. H., Chang, E., & Lemole, G. M. (2017). Complications of Advanced Kadish Stage Esthesioneuroblastoma: Single Institution Experience and Literature Review. Cureus.
- Palejwala, S. K., Sharma, S., Le, C. H., Chang, E., Erman, A. B., & Lemole, G. M. (2017). Complex Skull Base Reconstructions in Kadish D Esthesioneuroblastoma: Case Report. Journal of neurological surgery reports, 78(2), e86-e92.More infoIntroduction Advanced Kadish stage esthesioneuroblastoma requires more extensive resections and aggressive adjuvant therapy to obtain adequate disease-free control, which can lead to higher complication rates. We describe the case of a patient with Kadish D esthesioneuroblastoma who underwent multiple surgeries for infectious, neurologic, and wound complications, highlighting potential preventative and salvage techniques. Case Presentation A 61-year-old man who presented with a large left-sided esthesioneuroblastoma, extending into the orbit, frontal lobe, and parapharyngeal nodes. He underwent margin-free endoscopic-assisted craniofacial resection with adjuvant craniofacial and cervical radiotherapy and concomitant chemotherapy. He then returned with breakdown of his skull base reconstruction and subsequent frontal infections and ultimately received 10 surgical procedures with surgeries for infection-related issues including craniectomy and abscess evacuation. He also had surgeries for skull base reconstruction and CSF leak, repaired with vascularized and free autologous grafts and flaps, synthetic tissues, and CSF diversion. Discussion Extensive, high Kadish stage tumors necessitate radical surgical resection, radiation, and chemotherapy, which can lead to complications. Ultimately, there are several options available to surgeons, and although precautions should be taken whenever possible, risk of wound breakdown, leak, or infection should not preclude radical surgical resection and aggressive adjuvant therapies in the treatment of esthesioneuroblastoma.
- Ramey, W. L., Basken, R. L., Walter, C. M., Khalpey, Z., Lemole, G. M., & Dumont, T. M. (2017). Intracranial Hemorrhage in Patients with Durable Mechanical Circulatory Support Devices: Institutional Review and Proposed Treatment Algorithm. World neurosurgery, 108, 826-835.More infoSpontaneous intracranial hemorrhage (ICH) is frequently managed in neurosurgery. Patients with durable mechanical circulatory support devices, including total artificial heart (TAH) and left ventricular assist device (LVAD), are often encountered in the setting of ICH. Although durable mechanical circulatory support devices have improved survival and quality of life for patients with advanced heart failure, ICH is one of the most feared complications following LVAD and TAH implantation. Owing to anticoagulation and clinically relevant acquired coagulopathies, ICH should be treated promptly by neurosurgeons and cardiac critical care providers. We provide an analysis of ICH in patients with mechanical circulatory support and propose a treatment algorithm.
- Bina, R. W., Lemole, G. M., & Dumont, T. M. (2016). Measuring quality of neurosurgical care: Readmission is affected by patient factors. World neurosurgery.More infoThe Hospital Readmission Reduction Program section of the Patient Protection and Affordable Care Act uses readmission rates as a proxy for measuring quality of care. Multiple studies have demonstrated that readmission rates are highly imprecise proxies for quality of care as readmission rates contain large amounts of statistical noise and are dependent on disease type, insurance type, severity, population, and a multitude of other factors. The current study was conducted to investigate characteristics associated with readmission and the quality of neurosurgical care.
- Bina, R. W., Lemole, G. M., & Dumont, T. M. (2016). On resident duty hour restrictions and neurosurgical training: review of the literature. Journal of neurosurgery, 1-7.More infoWithin neurosurgery, the national mandate of the 2003 duty hour restrictions (DHR) by the Accreditation Council for Graduate Medical Education (ACGME) has been controversial. Ensuring the proper education and psychological well-being of residents while fulfilling the primary purpose of patient care has generated much debate. Most medical disciplines have developed strategies that address service needs while meeting educational goals. Additionally, there are numerous studies from those disciplines; however, they are not specifically relevant to the needs of a neurosurgical residency. The recent implementation of the 2011 DHR specifically aimed at limiting interns to 16-hourduty shifts has proven controversial and challenging across the nation for neurosurgical residencies-again bringing education and service needs into conflict. In this report the current literature on DHR is reviewed, with special attention paid to neurosurgical residencies, discussing resident fatigue, technical training, and patient safety. Where appropriate, other specialty studies have been included. The authors believe that a one-size-fits-all approach to residency training mandated by the ACGME is not appropriate for the training of neurosurgical residents. In the authors' opinion, an arbitrary timeline designed to limit resident fatigue limits patient care and technical training, and has not improved patient safety.
- Bina, R., Lemole, G. M., & Dumont, T. M. (2016). Editorial Response: On resident duty hour restriction and neurosurgical training. Journal of Neurosurgery, 124(3), 841.
- Dumont, T. M., Lemole, G. M., & Fennell, V. (2016). Editorial Response: Does physician specialty matter?. Journal of Neurosurgery, 124(1), 8.
- Fennell, V. S., Martirosyan, N. L., Atwal, G. S., Kalani, M. Y., Spetzler, R. F., Lemole, G. M., & Dumont, T. (2016). Effective Surgical Management of Competitive Venous Outflow Restriction After Radiosurgery for Cerebral AVMs: Report of 2 Cases. World neurosurgery.More infoIntracranial arteriovenous malformations (AVMs) are complex pathologies. For patients who do not present with hemorrhage, treatment strategies are often predicated on reducing the risk of hemorrhage and minimizing morbidity. Outcomes vary according to the efficacy of treatment selected. Radiosurgical treatment of certain AVMs can result in incomplete obliteration and may also have only a minimal effect on the presenting nonhemorrhagic symptoms.
- Frankl, J., Grotepas, C., Stea, B., Lemole, G. M., Chiu, A. G., & Khan, R. (2016). Chordoma Dedifferentiation After Proton Beam Therapy: A Case Report. J Med Case Rep, 10(1), 280.
- Palejwala, S. K., Barry, J., Rodriguez, C. N., Parikh, C. A., Goldstein, S. A., & Lemole, G. M. (2016). Combined Approaches to the Skull Base for Intracranial Extension of Tumors via Perineural Spread Can Improve Patient Outcomes. Clinical Neurology and Neurosurgery.
- Palejwala, S. K., Zangeneh, T. T., Goldstein, S. A., & Lemole, G. M. (2016). An Aggressive Multidisciplinary Approach Reduces Mortality in Rhinocerebral Mucormycosis. Surg Neurol Int. doi:10.4103/2152-7806.182964
- Watson, J. R., Martirosyan, N. L., Garland, S., Lemole, G. M., & Romanowski, M. (2016). Intraoperative Imaging using Intravascular Contrast Agent Proc SPIE9696. Molecular-Guided Surgery: Molecules, Devices, and Applications II, Proc SPIE 142296960L. doi:10.1117/12.2213867
- Joseph, B., Pandit, V., Khalil, M., Kulvatunyou, N., Aziz, H., Tang, A., OʼKeeffe, T., Hays, D., Gries, L., Lemole, M., Friese, R. S., & Rhee, P. (2015). Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients. Neurosurgery, 76(5), 601-7; discussion 607.More infoThe use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined.
- Martirosyan, N. L., Kalani, M. Y., Lemole, G. M., Spetzler, R. F., Preul, M. C., & Theodore, N. (2015). Microsurgical anatomy of the arterial basket of the conus medullaris. Journal of neurosurgery. Spine, 22(6), 672-6.More infoOBJECT The arterial basket of the conus medullaris (ABCM) consists of 1 or 2 arteries arising from the anterior spinal artery (ASA) and circumferentially connecting the ASA and the posterior spinal arteries (PSAs). The arterial basket can be involved in arteriovenous fistulas and arteriovenous malformations of the conus. In this article, the authors describe the microsurgical anatomy of the ABCM with emphasis on its morphometric parameters and important role in the intrinsic blood supply of the conus medullaris. METHODS The authors performed microsurgical dissections on 16 formalin-fixed human spinal cords harvested within 24 hours of death. The course, diameter, and branching angles of the arteries comprising the ABCM were then identified and measured. In addition, histological sections were obtained to identify perforating vessels arising from the ABCM. RESULTS The ASA tapers as it nears the conus medullaris (mean preconus diameter 0.7 ± 0.12 mm vs mean conus diameter 0.38 ± 0.08 mm). The ASA forms an anastomotic basket with the posterior spinal artery (PSA) via anastomotic branches. In most of the specimens (n= 13, 81.3%), bilateral arteries formed connections between the ASA and PSA. However, in the remaining specimens (n= 3, 18.7%), a unilateral right-sided anastomotic artery was identified. The mean diameter of the right ABCM branch was 0.49 ± 0.13 mm, and the mean diameter of the left branch was 0.53 ± 0.14 mm. The mean branching angles of the arteries forming the anastomotic basket were 95.9° ± 36.6° and 90° ± 34.3° for the right- and left-sided arteries, respectively. In cases of bilateral arterial anastomoses between the ASA and PSA, the mean distance between the origins of the arteries was 4.5 ± 3.3 mm. Histological analysis revealed numerous perforating vessels supplying tissue of the conus medullaris. CONCLUSIONS The ABCM is a critical anastomotic connection between the ASA and PSA, which play an important role in the intrinsic blood supply of the conus medullaris. The ABCM provides an important compensatory function in the blood supply of the spinal cord. Its involvement in conus medullaris vascular malformations makes it a critical anatomical structure.
- Martirosyan, N. L., Skoch, J., Watson, J. R., Lemole, G. M., Romanowski, M., & Anton, R. (2015). Integration of indocyanine green videoangiography with operative microscope: augmented reality for interactive assessment of vascular structures and blood flow. Neurosurgery, 11 Suppl 2, 252-7; discussion 257-8.More infoPreservation of adequate blood flow and exclusion of flow from lesions are key concepts of vascular neurosurgery. Indocyanine green (ICG) fluorescence videoangiography is now widely used for the intraoperative assessment of vessel patency.
- Ramey, W. L., Arnold, S. J., Chiu, A., & Lemole, M. (2015). A Rare Case of Optic Nerve Schwannoma: Case Report and Review of the Literature. Curēus, 7(4), e265.More infoSchwannomas are typically benign tumors of the peripheral nervous system that originate from Schwann cells. It is well known that the optic nerves are myelinated by oligodendrocytes since their cell bodies arise centrally within the lateral geniculate nuclei. Because of this basic cellular anatomy, optic schwannomas should theoretically not exist. It is possible, however, these rare lesions stem from small sympathetic fibers that innervate the vasculature surrounding the optic nerve and its sheath.
- Watson, J. R., Gainer, C. F., Martirosyan, N., Skoch, J., Lemole, G. M., Anton, R., & Romanowski, M. (2015). Augmented microscopy: real-time overlay of bright-field and near-infrared fluorescence images. Journal of biomedical optics, 20(10), 106002.More infoIntraoperative applications of near-infrared (NIR) fluorescent contrast agents can be aided by instrumentation capable of merging the view of surgical field with that of NIR fluorescence. We demonstrate augmented microscopy, an intraoperative imaging technique in which bright-field (real) and electronically processed NIR fluorescence (synthetic) images are merged within the optical path of a stereomicroscope. Under luminance of 100,000 lx, representing typical illumination of the surgical field, the augmented microscope detects 189 nM concentration of indocyanine green and produces a composite of the real and synthetic images within the eyepiece of the microscope at 20 fps. Augmentation described here can be implemented as an add-on module to visualize NIR contrast agents, laser beams, or various types of electronic data within the surgical microscopes commonly used in neurosurgical, cerebrovascular, otolaryngological, and ophthalmic procedures.
- Watson, J. R., Martirosyan, N., Skoch, J., Lemole, G. M., Anton, R., & Romanowski, M. (2015). Augmented microscopy with near-infrared fluorescence detection. Proc. SPIE. 9311. Molecular-Guided Surgery: Molecules, Devices, and Applications, 93110I. doi:10.1117/12.2077008
- Fennell, V. S., Klein, R., Polonski, L., & Lemole, G. M. (2014). Solitary Fibrous Tumor of the Orbit in Conjunction with Metastatic Prostate Cancer. J Neurol Surg B.
- Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Sadoun, M., Tang, A., O'Keeffe, T., Gries, L., Green, D. J., Friese, R. S., Lemole, M. G., & Rhee, P. (2014). Prospective validation of the brain injury guidelines: managing traumatic brain injury without neurosurgical consultation. The journal of trauma and acute care surgery, 77(6), 984-8.More infoTo optimize neurosurgical resources, guidelines were developed at our institution, allowing the acute care surgeons to independently manage traumatic intracranial hemorrhage less than or equal to 4 mm. The aim of our study was to evaluate our established Brain Injury Guidelines (BIG 1 category) for managing patients with traumatic brain injury (TBI) without neurosurgical consultation.
- Nielsen, V. G., Lemole, G. M., Matika, R. W., Weinand, M. E., Hussaini, S., Baaj, A. A., & Steinbrenner, E. B. (2014). Brain tumors enhance plasmatic coagulation: the role of hemeoxygenase-1. Anesthesia and analgesia, 118(5), 919-24.More infoPatients with brain tumors suffer significant thrombotic morbidity and mortality. In addition to increased thrombin generation via tumor release of tissue factor-bearing microparticles and hyperfibrinogenemia, brain tumors and surrounding normal brain likely generate endogenous carbon monoxide (CO) via the hemeoxygenase-1 (HO-1) system. CO has been shown to enhance plasmatic coagulation via formation of carboxyhemefibrinogen (COHF). Thus, our goals in this study were to determine whether patients with brain tumors had increased HO-1 upregulation/CO production, plasmatic hypercoagulability, and formation of COHF.
- Palejwala, S. K., Stidd, D. A., Skoch, J. M., Gupta, P., Lemole, G. M., & Weinand, M. E. (2014). Use of a stop-flow programmable shunt valve to maximize CNS chemotherapy delivery in a pediatric patient with acute lymphoblastic leukemia. Surgical neurology international, 5(Suppl 4), S273-7.More infoThe requirement for frequent intraventricular drug delivery in the setting of shunt dependence is particularly challenging in the treatment of central nervous system infection, neoplastic disease, and hemorrhage. This is especially relevant in the pediatric population where both hematogenous malignancy requiring intrathecal drug delivery and shunt-dependent hydrocephalus are more prevalent. Intrathecal and intraventricular chemotherapy agents can be prematurely diverted in these shunt-dependent patients.
- Ramey, W. L., Martirosyan, N. L., Lieu, C. M., Hasham, H. A., Lemole, G. M., & Weinand, M. E. (2013). Current management and surgical outcomes of medically intractable epilepsy. Clinical neurology and neurosurgery, 115(12), 2411-8.More infoEpilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10-15 years in particular has seen several major advances. As shown in relatively recent studies, resection is more effective for medically intractable epilepsy (MIE) than AED treatment alone, which is why most clinicians now endorse a neurosurgical consultation after approximately two failed regimens of AEDs, ultimately leading to decreased healthcare costs and increased quality of life. Temporal lobe epilepsy (TLE) is the most common form of MIE and comprises about 80% of epilepsy surgeries with the majority of patients gaining complete seizure-freedom. As the number of procedures and different approaches continues to grow, temporal lobectomy remains consistently focused on resection of mesial structures such as the amygdala, hippocampus, and parahippocampal gyrus while preserving as much of the neocortex as possible resulting in optimum seizure control with minimal neurological deficits. MIE originating outside the temporal lobe is also effectively treated with resection. Though not as successful as TLE surgery because of their frequent proximity to eloquent brain structures and more diffuse pathology, epileptogenic foci located extratemporally also benefit from resection. Favorable seizure outcome in each of these procedures has heavily relied on pre-operative imaging, especially since the massive surge in MRI technology just over 20 years ago. However, in the absence of visible lesions on MRI, recent improvements in secondary imaging modalities such as fluorodeoxyglucose positron emission computed tomography (FDG-PET) and single-photon emission computed tomography (SPECT) have lead to progressively better long-term seizure outcomes by increasing the neurosurgeon's visualization of supposed non-lesional foci. Additionally, being historically viewed as a drastic surgical intervention for MIE, hemispherectomy has been extensively used quite successfully for diffuse epilepsies often found in pediatric patients. Although total anatomic hemispherectomy is not utilized as commonly today, it has given rise to current disconnective techniques such as hemispherotomy. Therefore, severe forms of hemispheric developmental epilepsy can now be surgically treated while substantially decreasing the amount of potential long-term complications resulting from cavitation of the brain following anatomical hemispherectomy. Despite the rapid pace at which we are gaining further knowledge about epilepsy and its surgical treatment, there remains a sizeable underutilization of such procedures. By reviewing the recent literature on resective treatment of MIE, we provide a recent up-date on epilepsy surgery while focusing on historical perspectives, techniques, prognostic indicators, outcomes, and complications associated with several different types of procedures.
- Skoch, J., Ansay, T. L., & Lemole, G. M. (2013). Injury to the Temporal Lobe via Medial Transorbital Entry of a Toothbrush. Journal of neurological surgery reports, 74(1), 23-8.More infoObjectives Intracranial penetration by foreign bodies entering via the orbit represent an unusual form of traumatic brain injury. Nevertheless, much is at stake with high risk for cranial nerve and neurovascular injury. We present a case where the bristled end of a toothbrush entered the brain as a projectile via the superior orbital fissure and discuss considerations for surgical management. Setting A 35-year-old woman suffered a periorbital injury after her husband threw an electric toothbrush at a wall and the head of the toothbrush became a missile that projected through her superior orbital fissure and into her right temporal lobe. She complained of headache and incomplete vision loss in the affected eye. Intervention After obtaining a cerebrovascular angiogram, we proceeded with emergent orbital decompression and anterograde extraction of the foreign body via a modified frontotemporal orbitozygomatic approach with drilling of the skull base allowing for en bloc removal of the toothbrush. Conclusions The patient recovered well with improvement in her vision and partial third and sixth nerve palsies. This report illustrates a unique mechanism of injury with a novel intracranial foreign body. We review the neurosurgeon's need for prompt management with an approach customized to the structure of the offending object, the damaged elements, and the surrounding cranial nerves and vascular anatomy.
- Alaraj, A., Lemole, M. G., Finkle, J. H., Yudkowsky, R., Wallace, A., Luciano, C., Banerjee, P. P., Rizzi, S. H., & Charbel, F. T. (2011). Virtual reality training in neurosurgery: Review of current status and future applications. Surgical neurology international, 2, 52.More infoOver years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.
- Luciano, C. J., Banerjee, P. P., Bellotte, B., Oh, G. M., Lemole, M., Charbel, F. T., & Roitberg, B. (2011). Learning retention of thoracic pedicle screw placement using a high-resolution augmented reality simulator with haptic feedback. Neurosurgery, 69(1 Suppl Operative), ons14-9; discussion ons19.More infoWe evaluated the use of a part-task simulator with 3D and haptic feedback as a training tool for a common neurosurgical procedure--placement of thoracic pedicle screws.
- Stidd, D. A., Polonski, L., Anton, R., & Lemole, G. M. (2011). Transcranial Orbitotomy for Excision of Orbital Tumors: A Case Series. Skull Base.
- Yudkowsky, R., Luciano, C., Banerjee, P., Alaraj, A., Lemole, G. M., Schwartz, A., Charbel, F., Mlinarevich, N., Smith, K., Gandhi, S., & Rizzi, S. (2011). Ventriculostomy Practice on a Library of Virtual Brains using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes. Simulation in Healthcare.More infoFirst Place Research Abstract
- Lemole, G. M. (2009). Combined Skull Base Approaches for Extraction of Clival/Brain Stem Nail. Skull Base.
- Lemole, G. M., & Joe, S. (2009). Endonasal Skull Base Approach for Treatment of a Basal Encelphalocele in a Patient with Morning Glory Syndrome. Skull Base.
- Lemole, M., Banerjee, P. P., Luciano, C., Charbel, F., & Oh, M. (2009). Virtual ventriculostomy with 'shifted ventricle': neurosurgery resident surgical skill assessment using a high-fidelity haptic/graphic virtual reality simulator. Neurological research, 31(4), 430-1.More infoBased on a study of 48 neurological residents using a high fidelity haptic/graphic virtual reality simulator to perform ventricular cannulation, we recorded absolute Euclidean distance from the catheter tip to the foramen of Monroe within the ventricle. The data suggest that as expected, successful first attempts to cannulate the virtual 'shifted ventricle' are much less frequent than previous assessments with normal virtual ventricular anatomy. Furthermore, the significant improvement observed by the second attempt implies that the learning curve has been affected and the process 'jump started'.
- Lemole, G. M., Banerjee, P. P., Luciano, C., Neckrysh, S., & Charbel, F. T. (2007). Virtual reality in neurosurgical education: part-task ventriculostomy simulation with dynamic visual and haptic feedback. Neurosurgery, 61(1), 142-8; discussion 148-9.More infoMastery of the neurosurgical skill set involves many hours of supervised intraoperative training. Convergence of political, economic, and social forces has limited neurosurgical resident operative exposure. There is need to develop realistic neurosurgical simulations that reproduce the operative experience, unrestricted by time and patient safety constraints. Computer-based, virtual reality platforms offer just such a possibility. The combination of virtual reality with dynamic, three-dimensional stereoscopic visualization, and haptic feedback technologies makes realistic procedural simulation possible. Most neurosurgical procedures can be conceptualized and segmented into critical task components, which can be simulated independently or in conjunction with other modules to recreate the experience of a complex neurosurgical procedure.
- Luciano, C., Banerjee, P., Lemole, G. M., & Charbel, F. (2006). Second generation haptic ventriculostomy simulator using the ImmersiveTouch system. Studies in health technology and informatics, 119, 343-8.More infoVentriculostomy is a neurosurgical procedure that consists of the insertion of a catheter into the ventricles of the brain for relieving the intracranial pressure. A distinct "popping" sensation is felt as the catheter enters the ventricles. Early ventriculostomy simulators provided some basic audio/visual feedback to simulate the procedure, displaying a 3D virtual model of a human head. Without any tactile feedback, the usefulness of such simulators was very limited. The first generation haptic ventriculostomy simulators incorporated a haptic device to generate a virtual resistance and "give" upon ventricular entry. While this created considerable excitement as a novelty device for cannulating ventricles, its usefulness for teaching and measuring neurosurgical expertise was still very limited. Poor collocation between the haptic device stylus held by the surgeon and the visual representation of the virtual catheter, as well as the lack of a correct viewer-centered perspective, created enormous confusion for the neurosurgeons who diverted their attention from the actual ventriculostomy procedure to overcoming the limitations of the simulator. We present a second generation haptic ventriculostomy simulator succeeding over the major first generation limitations by introducing a head and hand tracking system as well as a high-resolution high-visual-acuity stereoscopic display to enhance the perception and realism of the virtual ventriculostomy.
- Lemole, G. M., Henn, J. S., Zabramski, J. M., & Spetzler, R. F. (2003). Modifications to the orbitozygomatic approach. Technical note. Journal of neurosurgery, 99(5), 924-30.More infoThe orbitozygomatic craniotomy is one of the workhorse approaches of skull base surgery, providing wide, multidirectional access to the anterior and middle cranial fossae as well as the basilar apex. Complete removal of the orbitozygomatic bar increases the angles of exposure, decreases the working depth of the surgical field, and minimizes brain retraction. In many cases, however, only a portion of the exposure provided by the full orbitozygomatic approach is needed. Tailoring the extent of the bone resection to the specific lesion being treated can help lower approach-related morbidity while maintaining its advantages. The authors describe the technical details of the supraorbital and subtemporal modified orbitozygomatic approaches and discuss the surgical indications for their use. Modifications to the orbitozygomatic approach are an example of the ongoing adaptation of skull base procedures to general neurosurgical practice.
- Henn, J. S., Lemole, G. M., Ferreira, M. A., Gonzalez, L. F., Schornak, M., Preul, M. C., & Spetzler, R. F. (2002). Interactive stereoscopic virtual reality: a new tool for neurosurgical education. Technical note. Journal of neurosurgery, 96(1), 144-9.More infoThe goal of this study was to develop a new method for neurosurgical education based on interactive stereoscopic virtual reality (ISVR). Interactive stereoscopic virtual reality can be used to recreate the three-dimensional (3D) experience of neurosurgical approaches much more realistically than standard educational methods. The demonstration of complex 3D relationships is unrivaled and easily combined with interactive learning and multimedia capabilities. Interactive stereoscopic virtual reality permits the accurate recreation of neurosurgical approaches through integration of several forms of stereoscopic multimedia (video, interactive anatomy, and computer-rendered animations). The content explored using ISVR is obtained through a combination of approach-based cadaver dissections, live surgical images and videos, and computer-rendered animations. These media are combined through an interactive software interface to demonstrate key aspects of a neurosurgical approach (for example, patient positioning, draping, incision, individual surgical steps, alternative steps, relevant anatomy). The ISVR platform is designed for use on a desktop personal computer with newly developed, inexpensive, platform-independent shutter glasses. Interactive stereoscopic virtual reality has been used to capture the anatomy and methods of several neurosurgical approaches. In this paper the authors report their experience with ISVR and describe its potential advantages. The success of a neurosurgical approach is contingent on the mastery of complex, 3D anatomy. A new technology for neurosurgical education, ISVR can improve understanding and speed the learning process. It is an effective tool for neurosurgical education, bridging the substantial gap between textbooks and intraoperative training.
- Riina, H. A., Lemole, G. M., & Spetzler, R. F. (2002). Anterior communicating artery aneurysms. Neurosurgery, 51(4), 993-6; discussion 996.More infoANTERIOR COMMUNICATING ARTERY aneurysms are complex lesions for which surgical success requires extensive preoperative and intraoperative planning. Adherence to the tenets of aneurysm surgery, including vascular control and preservation of perforating arteries, is essential for their exclusion from the circulation.
- Spetzler, R. F., Riina, H. A., & Lemole, G. M. (2001). Giant aneurysms. Neurosurgery, 49(4), 902-8.
- David, C. A., Vishteh, A. G., Spetzler, R. F., Lemole, M., Lawton, M. T., & Partovi, S. (1999). Late angiographic follow-up review of surgically treated aneurysms. Journal of neurosurgery, 91(3), 396-401.More infoThis study was undertaken to evaluate the long-term angiographic outcome of surgically treated aneurysms, which is unknown. Specifically, the incidence of recurrent aneurysms, the fate of residual necks, and the de novo formation of aneurysms were evaluated.
- Ashton, R. C., Oz, M. C., Lontz, J. F., Matsumae, M., Taylor, R., Lemole, G. M., Shapira, N., & Lemole, G. M. (1991). Laser-assisted fibrinogen bonding of vascular tissue. The Journal of surgical research, 51(4), 324-8.More infoCharacterization of the stress-strain profiles of welded tissue would provide an additional means of analyzing this new technology and comparing it with alternative anastomosing techniques. Rabbit longitudinal aortotomies were repaired with either 7-O polypropylene sutures or an 808-nm diode laser (power density, 4.8 watts/cm2) after topical application of fibrinogen mixed with indocyanine green dye (peak absorption, 805 nm). The rabbits were sacrificed between 0 and 28 days, and the fresh aortic specimens were strained axially in diluted plasma solution until ultimate breakage occurred in order to produce a stress-strain profile graph. No significant differences were noted between sutured and bonded aorta at any time interval. Nonincised aortic tissue (378 lb/in2) withstood significantly higher stress (P less than 0.05) than both sutured (257 lb/in2) and bonded (210 lb/in2) groups at the time of creation. By 7 days after operation, however, no significant differences were noted among any of the three groups. At 28 days after operation, the laser-bonded aorta was significantly stronger than the control aorta (P less than 0.05). The only significant difference in modulus (stretchability) identified the sutured aorta (373 lb/in2) to be more rigid than the control aorta (231 lb/in2) (P less than 0.05). Both sutured and laser-bonded anastomoses are weaker than control aorta initially; however, after an early critical period, both treatments achieve the strength of control aorta. By 1 month postoperatively, sutured anastomoses have the disadvantage of being less distensible.
- Ramey, W. L., Walter, C. M., Zeller, J., Dumont, T. M., Lemole, G. M., & Hurlbert, R. J. (2017, October). Neurotrauma after Jumping Over the United States-Mexico Border Wall: Demographics and Cost Analysis. EANS 2017 Annual Meeting Controversies and Solutions in Neurosurgery, Venice, Italy in October 1 - 5, 2017. Venice, Italy: EANS.
- Lemole, G. M. (2016, February). Combined Approaches to the Skull Base for Intracranial Extension of Tumors via Perineural Spread can Improve Patient Outcomes. North American Skull Base Society, 26th Annual Meeting.
- Lemole, G. M. (2016, February). Intraoperative Vascular Imaging with Augmented Microscopy. At Molecular-Guided Surgery: Molecules, Devices, and Applications II, SPIE BiOS.
- Bina, R., Lemole, G. M., & Dumont, T. M. (2015, Fall). Measuring quality of neurosurgical care: Readmission is affected by patient factors.. Arizona Neurosurgical Society Annual Meeting. Tucson, Arizona: Arizona Neurosurgical Society.More infoOral Presentation at regional meetingI was senior author of project.
- Lemole, G. M. (2014, May). Pseudoprogression and lesion response in metastatic disease of the brain treated by radiosurgery. 45th Annual Meeting of the Western Neuroradiological Society.
- Lemole, G. M. (2015, April). Response Assessment of Cerebral Metastases After High-Dose Stereotactic Radiation: Using Combined Diffusion and Perfusion MR Imaging. University of Arizona Cancer Center – Scientific Retreat.
- Lemole, G. M. (2015, November). Combined Approaches to the Skull Base for Intracranial Extension of Tumors via Perineural Spread Can Improve Patient Outcomes. Arizona Neurosurgical Society Annual Meeting.
- Lemole, G. M. (2015, November). Measuring quality of neurosurgical care: Readmission is affected by patient factors. Arizona Neurosurgical Society Annual Meeting.
- Lemole, G. M. (2014, April). Morbidity and Mortality of Endovascularly Treated Intracerebral Aneurysms: Does Specialty Matter?. American Association of Neurological Surgeons, 82nd Annual Meeting, San Francisco, CA, April 7, 2014 – DePuy Synthes Award.
- Lemole, G. M. (2013, October). Pseudoprogression and lesion response in metastatic disease of the brain treated by Radiosurgery. Western Neuroradiology Society, 45th Annual Meeting, Waikoloa, HI, October 16, 2013.
- Palejwala, S., Stidd, D. A., Skoch, J., Gupta, P., Lemole, G. M., & Weinand, M. E. (2012, November). Use of a stop-flow programmable valve to maximize CNS chemotherapy delivery in a pediatric patient with CNS leukemia. Arizona Neurosurgical Society Annual Meeting.
- Lemole, G. M. (2011, February). Nasoseptal Flap Harvest After Previous Transnasal Transseptal Surgery (#116). North American Skull Base Society, 21st Annual Meeting, Scottsdale, AZ, February 19, 2011.
- Lemole, G. M. (2010, April). Surgical Anatomy of the Sphenoid Sinus, Internal Carotid Artery and Distances to Critical Structures. Chicago Laryngologic and Otologic Society Lederer-Pierce Research Competition, Chicago, IL, April 12, 2010.
- Nisson, P. L., Mooney, M. A., Abassifard, S., Walter, C. M., Janke, H., Kim, H., Dumont, T. M., Lemole, G. M., Lawton, M., & Spetzler, R. (2017, October). The Mortality and Incidence of Residual for Posterior Fossa Arteriovenous Malformations. Congress of Neurological Surgeons, 66th Annual Meeting, Boston, MA, October 7-11, 2017. Boston, MA: Congress of Neurological Surgeons.
- Garland, S., Watson, J. R., Martirosyan, N., Lemole, G. M., & Romanowski, M. (2016, October). Modular Augmented Microscopy with Spatial Light Modulation. Biomedical Imaging and Optics Abstract Sub Track: Imaging Techniques in Neuroscience. Biomedical Engineering Society (BMES) Annual Meeting.
- Hassanzadeh, T., James, W. S., Borgstrom, M., & Lemole, G. M. (2016, November). Predictors of cerebral spinal fluid rhinorrhea following endoscopic endonasal skull base surgery: An institutional retrospective study. Congress of Neurological Surgeons, 5th Annual Meeting, Santa Monica, CA, November, 2016.
- Lemole, G. M. (2016, April). Ergonomic Assessment During Neurosurgical Procedures Using Body-Worn Sensors: Freedom of Motion Dictates Exhaustion. Association of Neurological Surgeons, 84th Annual Meeting, Chicago, IL, April 30-May 4, 2016.
- Lemole, G. M. (2016, September). Measuring quality of neurosurgical care: Readmission is affected by patient factors. Congress of Neurological Surgeons, 65th Annual Meeting, San Diego, CA, September 24-28, 2016.
- Lemole, G. M. (2015, October). Comparing Outcomes of Meningiomas Treated with Stereotactic Radiosurgery, Stereotactic Radiotherapy, or Intensity Modulated Radiotherapy: a 10-year Single-Institution Experience. American Society Therapeutic Radiation Oncology (ASTRO), San Antonio, TX, October 18-21, 2015.
- Lemole, G. M. (2014, April). Augmented Integration of ICG Videoangiography with Operative Microscope Allows Simultaneous Real-time Assessment of Vascular Structures and Blood Flow. American Association of Neurological Surgeons, 82nd Annual Meeting, San Francisco, CA, April 5-9, 2014.
- Lemole, G. M. (2014, April). Microsurgical anatomy of arterial ring of conus medullaris. American Association of Neurological Surgeons, 82nd Annual Meeting, San Francisco, CA, April 5-9, 2014.
- Lemole, G. M. (2014, April). Removal of Symptomatic Craniofacial Titanium Hardware Following Craniotomy: Case Series and Review. American Association of Neurological Surgeons, 82nd Annual Meeting, San Francisco, CA, April 5-9, 2014.
- Lemole, G. M. (2014, February). Solitary Fibrous Tumor of the Orbit in Conjunction with Metastatic Prostate Cancer. North American Skull Base Society, 24th Annual Meeting, San Diego, CA, February 14-16, 2014.
- Lemole, G. M. (2014, May). Removal of Symptomatic Craniofacial Titanium Hardware Following Craniotomy: Case Series and Review. University of Arizona Graduate Medical Education Scholarly Day, May 20, 2014; Tucson, AZ.
- Lemole, G. M. (2013, February). Nonspecific Inflammatory Tumors of the Skull Base: Case Series. North American Skull Base Society, 23rd Annual Meeting, Miami, FL, February 15-17, 2013.
- Lemole, G. M. (2013, October). Fat graft repair of skull base defects: An MRI evaluation of interval changes in size and quality. Congress of Neurological Surgeons, 62nd Annual Meeting, San Francisco, CA, October 19-23, 2013.
- Lemole, G. M. (2013, October). Removal of Symptomatic Craniofacial Titanium Hardware Following Craniotomy: Case Series and Review. Frontiers in Biomedical Research, Poster Forum, Tucson, AZ, October 30, 2013.
- Lemole, G. M. (2013, October). Review of Postoperative Infections Following Cranioplasty Performed at a Single Institution. Congress of Neurological Surgeons, 62nd Annual Meeting, San Francisco, CA, October 19-23, 2013.
- Lemole, G. M. (2013, October). Review of Postoperative Infections Following Cranioplasty Performed at a Single Institution. Frontiers in Biomedical Research, Poster Forum, Tucson, AZ, October 30, 2013.
- Lemole, G. M. (2013, October). Use of a stop-flow programmable valve to maximize CNS chemotherapy delivery in a pediatric patient with CNS leukemia. Congress of Neurological Surgeons, 62nd Annual Meeting, San Francisco, CA, October 19-23, 2013.
- Lemole, G. M. (2011, January). A Library of Virtual Brains for Ventriculostomy Practice on a VR/Haptic Simulator - Initial Validity Evidence. International Meeting for Simulation in Healthcare (IMSH) - 11th Annual International Meeting, New Orleans, LA, January 21-26, 2011.
- Lemole, G. M. (2011, March). Traumatic Thoracolumbar Fractures Treated with Short-Segment Pedicle Instrumentation (#8858). AANS/CNS Section on Disorders of the Spine and Peripheral Nerves, Annual Meeting, Phoenix, Arizona, March 9-12, 2011.
- Martirosyan, N. L., Carotenuto, A., Patel, A. A., Kalani, M. Y., Yagmurlu, K., Lemole, G. M., Preul, M. C., & Theodore, N. (2016. The Role of microRNA Markers in the Diagnosis, Treatment, and Outcome Prediction of Spinal Cord Injury(p. 56).More infoSpinal cord injury (SCI) is a devastating condition that affects many people worldwide. Treatment focuses on controlling secondary injury cascade and improving regeneration. It has recently been suggested that both the secondary injury cascade and the regenerative process are heavily regulated by microRNAs (miRNAs). The measurement of specific biomarkers could improve our understanding of the disease processes, and thereby provide clinicians with the opportunity to guide treatment and predict clinical outcomes after SCI. A variety of miRNAs exhibit important roles in processes of inflammation, cell death, and regeneration. These miRNAs can be used as diagnostic tools for predicting outcome after SCI. In addition, miRNAs can be used in the treatment of SCI and its symptoms. Significant laboratory and clinical evidence exist to show that miRNAs could be used as robust diagnostic and therapeutic tools for the treatment of patients with SCI. Further clinical studies are warranted to clarify the importance of each subtype of miRNA in SCI management.
- Horn, E. M., Henn, J. S., Lemole, G. M., Hott, J. S., & Dickman, C. A. (2004. Thoracoscopic placement of dual-rod instrumentation in thoracic spinal trauma(pp 1150-3; discussion 1153-4).More infoTraditionally, thoracic fractures that require anterior stabilization are treated through an open thoracotomy approach. Thoracoscopic instrumentation avoids many of the complications associated with an open thoracotomy but is technically challenging. We report the first cases of dual-rod internal fixation systems placed thoracoscopically for thoracic spinal trauma.
- Lemole, G. M. (2013, January). Retrosigmoid Intradural Inframeatal Approach: Indications And Technique. Neurosurgery.
- Yudkowsky, R., Luciano, C., Banerjee, P., Schwartz, A., Alaraj, A., Lemole, G. M., Charbel, F., Smith, K., Rizzi, S., Byrne, R., Bendok, B., & Frim, D. (2013, Spring). Practice on an augmented reality/haptic simulator and library of virtual brains improves residents' ability to perform a ventriculostomy. Simulation in healthcare : journal of the Society for Simulation in Healthcare.More infoVentriculostomy is a neurosurgical procedure for providing therapeutic cerebrospinal fluid drainage. Complications may arise during repeated attempts at placing the catheter in the ventricle. We studied the impact of simulation-based practice with a library of virtual brains on neurosurgery residents' performance in simulated and live surgical ventriculostomies.
- Lemole, G. M. (2012, November). Recession of Ommaya Reservoir Improves Cosmesis in Patients Undergoing Intrathecal Chemotherapy for Leptomeningeal Disease: a Technical Note. Cureus.
- Banerjee, P. P., Luciano, C. J., Lemole, G. M., Charbel, F. T., & Oh, M. Y. (2007, Unknown). Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback. Journal of neurosurgery.More infoThe purpose of this study was to evaluate the accuracy of ventriculostomy catheter placement on a head- and hand-tracked high-resolution and high-performance virtual reality and haptic technology workstation.