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INDIANA UNIVERSITYSCHOOL OF MEDICINEANNUAL REPORT 2022ARTMENT OFUROLOGICALURGERYDEPARTMENT OF NEUROLOGICAL SURGERY Message

Letter from the Chair ................................................4Department News and Faculty .......................................6Neurological Surgery Hires ...........................................Mission Exchange Trip to Kenya ....................................... 7Clinical Faculty ......................................................8Cinical Education Training and Development .......................10Message from Program Directors .................................... 12Residents/Fellows .................................................. 14Lectureships ........................................................ 16Campbell Lecture .................................................. 16Frew Lecture .......................................................17Kalsbeck Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Mealey Lecture .................................................... 19Clinical Care ........................................................20Neurosurgical Oncology.............................................22Spinal Disorders....................................................23Neurovascular Surgery..............................................24Pediatric Neurosurgery .............................................25Stereotactic and Functional Neurosurgery ............................26Neurotrauma ...................................................... 27Research & Innovation ..............................................28Neuroscience Institute,..............................................30Faculty Labs .......................................................32In Memoriam: Xiao-Ming Xu, PhD ....................................36NIH Awards and Clinical Trials........................................ 37Robotics...........................................................38Personal Stories ....................................................40Deeanna Harris ....................................................40Jordan Williams .................................................... 41Philanthropy ........................................................42Alumni ..............................................................44

Colleagues, Alumni and Friends,I’m grateful for the opportunity to lead the Department of Neurological Surgery that I have been part of for 29 years. Many challenges arose in 2022 related to the pandemic, but we achieved much even in the face of adversity. As clinicians, researchers and educators, there has never been a more exciting time to be involved in the eld of neurosurgery. How we assimilate the skills needed to care for our patients is about to go through a fundamental disruptive process. The disruption is in the realm of acquisition of knowledge and technical skills necessary to manage complex disease states. Moore’s Law states that the computational processing capability of a microchip doubles every two years. The processing of large data sets can now be done not only expeditiously but in the most ergonomic manner. The future is now in the elds of articial intelligence, machine learning, precision medicine, robotics, augmented reality and virtual reality. Our department intends to lead Indiana and beyond in the care of patients with nervous system disorders using state-of-the-art technology—doing so in a compassionate and caring environment that emphasizes quality and safety.The unique position of chair is that I get to lead people, programs and the education mission. I am proud of the people we have assembled, retained and recruited. I also realize many opportunities currently oered in our department were created by many distinguished former faculty. Dr. Scott Shapiro, who retired after 34 years, left an indelible legacy as a clinician, mentor and educator. We will honor his legacy by endowing a chair in his name. Dr. Xiao-Ming Xu lost his battle to cancer in 2022. He received 20 years of continuous support from the NIH, DOD and Department of Veteran Aairs studying neural protection, axonal regeneration and recovery from traumatic spinal cord and brain injuries. While you cannot easily replace someone who was listed in the world’s top 2% scientist list, we have an opportunity to recruit a major clinician-scientist or scientist to lead the Indiana Spinal Cord and Brain Injury Research Group inside Stark Neurosciences Research Institute. Our research program was recognized this year for being one of six departments in the school to experience greater than 25% NIH funding increase. Our total proposal dollars increased by 40% ($4.9 million) in 2022.Our residents and the education programs remain a great source of pride for the department. We continue to lead the country in the number of medical students matching into neurosurgery, a tradition that has strong roots at IU. A highlight of the year was to bring back four endowed lectureships that were given by national thought leaders in our eld. Our faculty member, Dr. Aaron Cohen Gadol, was honored this year with the prestigious Vilhelm Magnus medal for his work on the Neurosurgical Altas Video platform that gets 3,000 visits a day across the world. We are above the national average in gender and ethnic diversity for both faculty and resident subgroups. We are proud to say we have a diverse group of faculty and residents compared to our peers nationally. Uniquely, we also have a higher percentage of gender diverse faculty who are associate or full professors compared to the national average.Through a joint leadership model in the Neuroscience Institute, we have made signicant progress in many innovative multidisciplinary programs that are housed in the Spine, Neurovascular, Neuro-Oncology, Neurodegenerative, and Neurotrauma Centers. The spine program, led by Dr. David Stockwell, saw a 24% increase in volume in 2022. Our volume of adult craniotomies increased by 9% last year. With the acquisition of major capital equipment, including three robots, MRI-guided focused ultrasound and magnetoencephalogram, as well as recruiting new personnel, we are poised to establish destination centers for Movement Disorder, Epilepsy Surgery, Spinal Deformity, and Skull Base Surgery. While the department currently has 22 active clinical trials, we hope to focus our eorts on acquiring high-impact interventional clinical trials funded by the NIH or industry.The future is now. We must embrace the changes that are upon us in our research, clinical and education missions. Our collective shared vision will allow us to achieve the goal of making Indiana one of the healthiest states.Respectfully,Mitesh V. Shah, MDInterim Chair & Paul B. Nelson Professor of Neurological SurgeryDepartment of Neurological SurgeryIndiana University School of MedicineLETTER FROM THE INTERIM CHAIRMitesh V. Shah, MD Interim Chair, Department of Neurological Surgery

“Our department intends to lead Indiana and beyond in the care of patients with nervous system disorders using state-of-the-art technology—doing so in a compassionate and caring environment that emphasizes quality and safety.”DEPARTMENT NEWSIU School of Medicine Department of Neurological Surgery Annual Report4

5DEPARTMENT NEWSneurosurgery at Stanford University Medical Center in 2 0 1 7.She serves as the pediatric neurosurgery fellowship director and co-associate program director of the residency program.Wilson was an assistant professor of neurosurgery at the University of Iowa Health Care in Iowa City from 2011-2022. He also served as the department’s associate residency program director.Wilson completed his medical training at Louisiana State University Health Sciences Center and his residency in neurosurgery at the University of Iowa Hospitals and Clinics. He nished his rst fellowship in endovascular neurosurgery/interventional neuroradiology at Semmes-Murphy Neurologic and Spine Institute in Memphis, Tennessee, followed by a second fellowship in pediatric neurosurgery at IU School of Medicine.He leads the pediatric neurosurgical epilepsy program at Riley Hospital for Children and will also head the pediatric neurosurgery division’s movement disorder and spasticity programs.Neurological Surgery hires two pediatric surgeonsThe Department of Neurological Surgery welcomed two pediatric neurosurgeons to expand upon their growing presence at Riley Hospital for Children. Rabia Qaiser, MD, and Saul Wilson, MD both joined the department as associate professors in August 2022. They each had completed a pediatric neurosurgery fellowship at IU School of Medicine.Qaiser previously served as the director of the Division of Pediatric Neurosurgery at Baylor Scott & White McLane Children’s Medical Center in Temple, Texas, since 2018. She was also associate program director of the Neurosurgery Residency Program at Baylor Scott & White for the past three years.Qaiser, who completed a pediatric neurosurgery fellowship at IU School of Medicine in 2015, earned her medical degree from Karachi Medical and Dental College in Pakistan in 1999, followed by a neurosurgery residency at the University of Minnesota Medical School. Qaiser completed a second fellowship in cerebrovascular Rabia Qaiser, MDAssociate Professor of Neurological SurgerySaul Wilson, MDAssociate Professor of Neurological SurgeryAnnual Report IU School of Medicine Department of Neurological Surgery

DEPARTMENT NEWSDepartment of Neurological Surgery members fulll mission exchange trip to KenyaFor Ajay Patel, MD, the 11-day trip to Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, was promise of a unique training opportunity at an early stage in his residency journey.“I was certain it would push me and put me in an uncomfortable position,” said Patel, a PGY4 neurological surgery resident at Indiana University School of Medicine. “But by virtue of this, I knew I would be able to grow both as a person and a surgeon.”Patel was one of seven members of the Department of Neurological Surgery who made the trip in partnership with AMPATH to provide neurological care, training and support to physicians and residents at Moi University and MTRH. He was joined by Mitesh Shah, MD, department chair; Jesse Savage, MD, PhD, assistant professor; Brandon Lane, MD, assistant professor; Chris Wilson, MD, neuro-oncology fellow; and sta members Mary Gallagher and Tyler Harrison.AMPATH is a partnership between Moi University, MTRH, the AMPATH Consortium of universities around the world led by Indiana University, and the Kenyan Government. AMPATH partners work together at more than 300 clinical sites where care is provided throughout Kenyan communities.“The whole week was intense and exceeded our expectations,” Patel said. “The Kenyan surgeons were incredible in that they were able to do so much despite not having the same resources we have. The neurosurgery residents were also amazing as they worked tirelessly to help facilitate our work there.”Lane serves as the department’s Global Health Director and rst participated in the Kenya AMPATH exchange in 2019 as a PGY 7 resident.“My experiences on that trip were particularly poignant,” Lane said. “You can’t understand sadness and despair until you see the profound impact of resource deciency on neurosurgical care, and more globally, on the human condition in general. While we provided care and resources on that trip, we were gifted incredible perspective and fulllment in return.”Lane has since made it a goal to develop a more consistent and rigorous neurosurgical exchange within the AMPATH model.“We planned and executed this trip to lay the groundwork for a robust bilateral neurosurgery exchange of people, resources and knowledge between IU Neurological Surgery and Moi Teaching and Referral Hospital,” Lane said.IU School of Medicine Department of Neurological Surgery Annual Report6

7Mitesh V. Shah, MDInterim Chair, Professor of Neurological SurgeryKunal Gupta, MBBCH, PhDAssistant Professor of Neurological SurgeryAngela M. Richardson, MD, PhDAssistant Professor of Neurological SurgeryGordon Mao, MDAssistant Professor of Neurological SurgeryJesse J. Savage, MD, PhDAssistant Professor of Neurological SurgeryBrandon C. Lane, MDAssistant Professor of Neurological SurgeryDavid W. Stockwell, MDAssistant Professor of Clinical Neurological SurgeryJames C. Miller, MDAssistant Professor of Clinical Neurological SurgeryThomas C. Witt, MDAssociate Professor of Neurological SurgeryAaron A. Cohen-Gadol, MDProfessor of Neurological SurgeryBradley N. Bohnstedt, MDAssociate Professor of Neurological SurgeryJamie L. Bradbury, MDAssistant Professor of Clinical Neurological SurgeryCLINICAL FACULTYIUH - Neuroscience Center IndianapolisAnnual Report IU School of Medicine Department of Neurological Surgery

Laurie L. Ackerman, MDProfessor of Clinical Neurological SurgeryDavid Hart, MDAdjunct ClinicalAssociate Professor of Neurological SurgeryTodd A. Eads, MDAdjunct ClinicalAssistant Professor of Neurological SurgeryKarl W. Janich, MDAdjunct ClinicalAssistant Professor of Neurological SurgeryGautam Phookan, MDAdjunct ClinicalAssistant Professor of Neurological SurgeryBryan J Wohlfeld, MDAdjunct ClinicalAssociate Professor of Neurological SurgeryJulius A. Silvidi, MDAdjunct ClinicalAssistant Professor of Neurological SurgeryJason M. Voorhies, MDAdjunct ClinicalAssistant Professor of Neurological SurgeryGarrett J. Jackson, MDAdjunct ClinicalAssistant Professor of Neurological SurgeryRabia Qaiser, MDAssociate Professor of Neurological SurgeryJignesh Tailor, BMBCH, PhDAssistant Professor of Neurological SurgerySaul Wilson, MDAssociate Professor of Neurological SurgeryCLINICAL FACULTYIU School of Medicine Department of Neurological Surgery Annual ReportIUH-BallIUH - Riley Hospital for ChildrenIUH-BloomingtonIUH-ArnettIUH-Arnett8

Annual Report IU School of Medicine Department of Neurological SurgeryCINICAL EDUCATION TRAINING AND DEVELOPMENT9

CINICAL EDUCATION TRAINING AND DEVELOPMENT

11Message from the Director and Associate Residency Program DirectorsEducating future neurosurgeons is one of the core missions of the Department of Neurological Surgery at IU School of Medicine. Our faculty members take pride in teaching and training the next generation of neurosurgeons in clinical care, surgical competence and research. The diverse clinical and basic science faculty at IU create a rich and state of the art environment for achieving scholarly and technical skills to pursue a career in academic or private practice setting. The residency program’s curriculum stresses establishing early supervised independence. Most of our graduates complete enfolded fellowships in one of the neurosurgical subspecialities by the time they have completed residency. We provide opportunities to study basic science or clinical research as well as create independent study projects, which may be incorporated into the curriculum while pursuing an MBA or MPH degree.The residency training program is seven years in duration and is currently comprised of 19 residents. The depth of training covers all aspects of neurosurgery subspecialties, including neurovascular, neuro-oncology, skull-base, spinal, pediatric, neurotrauma and functional neurosurgery. Global health initiatives have a strong foundation in our department. A team of faculty and residents travel Annual Report IU School of Medicine Department of Neurological SurgeryRESIDENTS AND FELLOWS

IU School of Medicine Department of Neurological Surgery Annual Reportannually to Kenya to assist and train neurosurgeons and residents in Eldoret through the Academic Model Providing Access to Healthcare (AMPATH).We value diversity and inclusion in our residency program. Our trainees come from medical schools all across the country and world. We have gender and ethnic diversity in the resident complement that surpasses national neurosurgical benchmarks. Our program supports the DEIJ mission of IU, and we have dedicated faculty to help create not only a diverse but inclusive environment.James C. Miller, MD – Program DirectorRabia Qaiser, MD – Associate Program DirectorBrandon C. Lane, MD – Associate Program Director2021-22 Fellow GraduatesJacob Archer, MD, MBASpine FellowNeuroscience Specialists, Oklahoma City, OklahomaAndrew Koivuniemi, MD, PhDTransition to Practice FellowFairbanks Fellowship in Clinical EthicsFranciscan Health, Lafayette, IndianaStephen Mendenhall, MDSpine FellowVacaville Medical Center, Sacramento, CaliforniaRESIDENTS AND FELLOWS12

13Vincent J. Alentado, MDSpine FellowMedical School, Case Western Reserve University School of Medicine Miracle C. Anokwute, MDMedical School, Indiana University School of MedicineAndrew Huh, MDMedical School, Indiana University School of MedicineMohamed A. Zaazoue, MSC, MBBCHMedical School, Ain Shams UniversityAjay Patel, MDMedical School, Indiana University School of MedicineHailey C. Budnick, MDMedical School, Texas Tech University Health Sciences Center School Of MedicineJosue Ordaz, MDMedical School, Indiana University School of MedicineJonathan Weyhenmeyer, MDEndovascular FellowMedical School, Indiana University School of MedicineChristopher D. Wilson, MDNeuro-Oncology FellowMedical School, University of Oklahoma College of MedicineSteven Wakeman, MDResidency, Neurological Surgery, Virginia Commonwealth UniversityMedical School, Rush Medical College of Rush UniversityMedical CenterRESIDENTS AND FELLOWSEnfolded PGY 7 FellowsPediatric FellowPGY 6PGY 5Annual Report IU School of Medicine Department of Neurological SurgeryPGY 4

Ahmed M. Belal, MD, MSMedical School, Alexandria Faculty of MedicineJae Hyun Kwon, MDMedical School,Indiana University School of MedicineSarah A. Merrill, MD, MSMedical School, Mayo Clinic Alix School Of MedicineChiara A. Flores, MDMedical School, Drexel University College of MedicineKyle J. Ortiz Rodriguez, MDMedical School, University of Puerto Rico School of MedicineWeston C. Troja, MDMedical School, Indiana University School of MedicineAndy Witten, MDMedical School,Indiana University School of MedicineScott Mitchell, MDMedical School, University of Vermont College of MedicineMatthew K. Tobin, MD, PhDMedical School, University of Illinois College of MedicinePiiamaria Virtanen, MDMedical School, Indiana University School of MedicineRESIDENTS AND FELLOWSIU School of Medicine Department of Neurological Surgery Annual ReportPGY 3PGY 2PGY 114

15Campbell LectureshipThe Department of Neurological Surgery hosted the 26th Annual Campbell Lectureship on Nov. 16, 2022, and welcomed Jacques J. Morcos, MD, FRCS, FAANS, as the keynote speaker.Morcos, professor and co-chairman of the Department of Neurological Surgery at the University of Miami, spoke about “Cerebrovascular and Skull Base Surgery: The Inseparable Twins.”“This is a very prestigious lectureship known all over the US, so I’m very honored to follow the names of luminaries who have their photos on the department walls,” Morcos said.Morcos spoke about how the two subspecialties of cerebrovascular and skull base surgery are often thought of as separate but are actually inseparable. Each of the Jacques J. Morcos, MD, FRCS, FAANS, Professor and co-chairman of the Department of Neurological Surgery at the University of MiamiDEPARTMENT LECTURESHIPSAnnual Report IU School of Medicine Department of Neurological Surgery2022 CAMPBELLsubspecialties is at the service of the other and it helps our practice as neurosurgeonsDr. Robert L. Campbell, one of the giants in the neurosurgery specialty, was an outstanding clinician and surgeon. The Campbell Lectureship was named in his honor. He trained an entire generation of neurosurgeons, many of whom are still practicing in this area and around the country. Dr. Campbell passed away on August 16, 2018, at the age of 92. Goodman Campbell Brain and Spine was partly named in his honor.Dr. Campbell started a residency in neurological surgery at Indiana University Medical Center. He completed his residency in June 1957 and became a member of the neurosurgery faculty quickly rising to the leadership position of Section Head in 1964, which he remained at until 1992.Dr. Campbell faithfully attended nearly all of the Department’s annual lectureships, including one in his honor. He was a member of many neurosurgical organizations, including the Society of Neurological Surgeons. After his retirement, friends, grateful patients and former residents honored him by contributing funds that created the Robert Campbell Professorship and Robert Campbell Lectureship in 1994.

Frew LectureshipThe Department of Neurological Surgery welcomed Peter Hutchinson, MBBS, PhD, FRCS from the University of Cambridge for the 19th Annual Jack and Sabina Frew Lecture on May 3, 2022.Hutchinson, professor of neurosurgery and head of the division of academic neurosurgery at the University of Cambridge, gave a talk, titled, “Rescuing the Injured Brain.” Hutchinson specializes in neurotrauma, specically head and traumatic brain injury. He has a research interest in acute brain injury, utilizing monitoring technology to increase the understanding of the pathophysiology of brain injury, and in the investigation and treatment of concussion.Since 2003, the annual Jack and Sabina Frew Lecture has assembled esteemed neuroscience clinicians and professionals to share research and discuss medical Peter Hutchinson, MBBS, PhD, FRCS Professor and head of the division of academic neurosurgery at the University of CambridgeIU School of Medicine Department of Neurological Surgery Annual Report2022 FREWDEPARTMENT LECTURSHIPSadvances in neurosurgery, neurology, neuro critical care and trauma.Jack and Sabina Frew rst learned about IU Health Methodist Hospital by watching the Indianapolis 500 and hearing about the care IU Health provides professional racecar drivers.Not long afterward, Jack sought care from IU Health, traveling from Florida to Indianapolis to seek expert medical advice for himself. At that time, Jack and Sabina met the late Dr. Julius Goodman, who treated them with the utmost respect while providing care which allowed Jack to return to better health. Based on this patient experience and outstanding care, Jack and Sabina chose to honor Dr. Goodman by establishing the Jack and Sabina Frew Lectureship. The couple fullled their philanthropic passions, allowing Dr. Goodman the opportunity to create a lectureship so that generations of great minds would be able to learn from one another.After Jack died in 2016, Sabina has carried on the couple’s generosity and passion for learning. Their support realizes Dr. Goodman’s vision for fostering a cohesive culture for neuroscience professionals to advance innovative approaches to care.16

17Kalsbeck LectureThe Department of Neurological Surgery welcomed Frederick Boop, MD, as the inaugural speaker for the rst annual Kalsbeck Lecture on Sept. 14, 2022.Boop, Emeritus Professor in the Department of Neurosurgery at the University of Tennessee Health Science Center, addressed the “Surgical Management of Focal Brain Stem Tumors in Children,” but began by examining the disparities in receiving treatment for these tumors across the world.“The Number 2 cause of death in children is childhood cancer and the number one cause of cancer mortality is brain tumor,” said Boop. “The 5-year survival of a child with brain tumor is not determined by the biology of the tumor but instead by the country where they receive care.”Boop shared a history of approaches to focal low-grade gliomas of the brain stem in children from around the globe. Surgical videos were presented along with post-surgical videos of treated patients, mostly with favorable outcomes.“It’s a tremendous honor to speak on behalf of one of these pioneers of the eld that I’ve come to love and spent my life doing,” said Boop. “Kalsbeck was from a time where it was dicult, you didn’t have much in the way of diagnostic tests, and surgery often was done without microscopes. So, I’m fortunate that I live in an age where we’re relatively spoiled by all the technology we have, but we’ve also enjoyed the progress that has been made since his days.”The Kalsbeck Lectureship honors John Edward Kalsbeck, MD, for his years of dedication to pediatric neurosurgery. Dr. Kalsbeck was a professor of Neurological Surgery at IU School of Medicine for 42 years.He was the rst neurosurgeon in the state of Indiana dedicated to pediatrics. Dr. Kalsbeck graduated from Calvin College with degrees in Chemistry and Philosophy. He attended medical school at the University of Michigan and then completed a residency in neurology. Dr. Kalsbeck entered neurosurgical residency in 1956 and was one of the rst three residents in the newly created training program at IU.Dr. Kalsbeck was an innovator. He was generations ahead of his time, performing surgeries that would be considered “cutting edge” today. He pioneered techniques in performing hemispherectomies in children with epilepsy. He had a special interest in craniofacial surgery. During his career, Dr. Kalsbeck inspired multiple trainees to pursue a career in pediatric neurosurgery. Dr. Kalsbeck and Dr. Thomas Luerssen established the rst pediatric neurosurgery fellowship training program in Indiana. Dr. Luerssen and other faculty later honored his service by establishing the Dr. John E. Kalsbeck Professorship in Pediatric Neurosurgery in 2006. Dr. Kalsbeck passed away in 2017 at the age of 89.Frederick Boop, MDEmeritus Professor in the Department of Neurosurgery at the University of Tennessee DEPARTMENT LECTUERSHIPSAnnual Report IU School of Medicine Department of Neurological Surgery2022 KALSBECK

Ricardo J. Komotar, MD, FAANS, FACS Professor and program director in the Department of Neurological Surgery at the University of MiamiDEPARTMENT LECTUERSHIPSMealey LectureshipThe Department of Neurological Surgery hosted the Mealey Lectureship on Oct. 19, 2022, and featured Ricardo J. Komotar, MD, FAANS, FACS, as the keynote speaker.Komotar, professor and program director in the Department of Neurological Surgery at the University of Miami, discussed “Enhanced Recovery After Cranial Surgery.”Komotor spoke on how the University of Miami has adopted a multi-disciplinary fast-track approach for brain tumor surgeries that enable patients to recover quickly with better long-term outcomes. Multiple specialties, including cardiology, radiology and physical therapy coordinate to provide the patient pre-op care for the night before and day of surgery. Dedicated neuro-anesthesia is IU School of Medicine Department of Neurological Surgery Annual Report2022 MEALEYalso utilized for the lowest acceptable anesthetic doses.“Patients do better because they have less anesthesia, are discharged home quicker, and start physical therapy sooner,” Komotar said.The Mealey Lectureship honors Dr. John Mealey, Jr., for his years of dedication and passion for research in neuro-oncology. Dr. Mealey received his Doctorate of Medicine from the Johns Hopkins University School of Medicine and completed his internship at Johns Hopkins Hospital. He completed his residency at Massachusetts General Hospital and his fellowship at Harvard Medical School.In 1960, Dr. Mealey joined the IU School of Medicine Department of Surgery, Section of Neurosurgery, and became Professor of Surgery in 1969 and Professor Emeritus of Neurological Surgery in 1996. Dr. Mealey was a member of the National Brain Tumor Cooperative Group of the National Cancer Institute from 1968 until the mid-1990’s and served on the Clinical Cancer Training Committee of the National Cancer Institute from 1970–73. He co-authored more than 50 publications related to CNS neoplasia.18

Annual Report IU School of Medicine Department of Neurological SurgeryCINICAL CARE19

21CLINICAL CAREAnnual Report IU School of Medicine Department of Neurological SurgeryNeurosurgical OncologyClinical care for patients with brain and spine tumors is an essential component of the Department of Neurological Surgery at IU School of Medicine. Neurosurgeons specializing in neurosurgical oncology collaborate with physicians across the health system to provide the best treatment options for patients.Surgical InnovationIU neurosurgeons lead the way in surgical innovation in neuro-oncology. The department has the only gamma knife stereotactic radiosurgery program in the state. Additionally, the department has brought surgically implanted brachytherapy in the form of gamma tiles to the patients of Indiana. IU is one of the sites for a national clinical trial comparing local control of brain metastases with surgical resection as well as either external beam radiation or surgically implanted radiation therapy. Laser interstitial thermal therapy is also part of the armamentarium of IU’s surgical neuro-oncologists, allowing them to treat deep seated tumor or radiation necrosis through a 5 mm skin incision.Multidisciplinary TeamThe neurosurgery oncology section is part of a multidisciplinary team of physicians treating brain tumors at IU Health. These specialists are experts in their elds—and include the only fellowship-trained neuro-oncologists in Indiana. The care they provide to patients includes the most advanced medical and surgical treatments possible—thanks to their specialized training and years of experience. In addition to neurosurgeons, the team consists of neurologists, neuropathologists, neuro-oncologists and radiation oncologists. Surgical oerings include open complex microsurgical approaches for intrinsic and extra-axial tumors, complex surgical resection and reconstruction of spinal primary and metastatic lesions, intraoperative MRI assisted resection of low-grade brain tumors, awake craniotomy with cortical mapping, and advanced and minimally invasive and cutting-edge endoscopic skull base approaches in collaboration with the Department of Otolaryngology—Head and Neck Surgery. State-of-the-art equipment is available to advance the safety of these complex microsurgical procedures, including frameless stereotactic navigation, intraoperative imaging, uorescence guidance, O-arm and neuro-physiology/neuro-monitoring services.Oncology/Skull Base FellowshipThe one-year fellowship in skull base/oncology at IU School of Medicine oers a well-rounded experience in managing complex brain tumors. The fellowship opportunity oers participation in operative management of aneurysms and arteriovenous malformations and therefore encompasses a broad range of complex cranial procedures. Fellows are trained by department fellowship-trained faculty physicians at multiple hospitals in Indianapolis. The caseload includes approximately 350 operative cases each year—some with exposure to radio-surgical techniques using Novalis, Cyberknife and Gamma Knife.

CLINICAL CARESpinal DisordersSpine surgeons in the Department of Neurological Surgery at IU School of Medicine provide both non-surgical and surgical treatment options for patients. Through advanced technology and experience, spinal surgeons are nding new and eective surgical and non-surgical ways to care for the spine. As neurosurgeons, these faculty physicians have a unique understanding of how the bones of the spinal column not only support the back but also protect the delicate spinal cord. As national leaders and teachers in image guidance, these surgeons were among the rst groups in the United States to pioneer the use of the STEALTH/ISO-C system for cervical, thoracic and spine surgeries.Spine FellowshipFaculty treat and teach trainees about spine disorders that include complex and minimally invasive procedures, tumors, articial disc replacement, degenerative disease, trauma, kyphoplasty, and pain management, providing fellows in the one-year spine fellowship program excellent exposure to a range of patient cases. Fellows also benet from exposure to traumatic spine and brain disorders in amateur and professional athletes.AI TechnologyArticial intelligence (AI) is changing spine surgery, and neurosurgeons at IU are at the forefront of this new technology. Surgeons in the department use UNiD rods from Medtronic for some of the most complex spinal procedures. Following a surgical plan, the UNiD rods are designed for the specic needs of a patient and industrially fabricated to accurately match an AI-driven pre-operative surgical plan, rather than the surgeon manually bending the rod in typical spine procedures. This advanced technology has helped IU surgeons achieve the desired alignment for the spine, which can provide better outcomes to patients and their families. Robotic TechnologyThe Mazor is a spinal surgery robot that helps spinal surgeons perform the most complicated of surgeries with the utmost precision and accuracy. The Mazor acts like a GPS system, guiding the surgeons inside the body to exactly where they need to go. The robot assists in image guidance and screw placement for spine surgeries. Once it nds the right spot, the team uses the robot to insert the screw into the spine. The end result is that patients benet from minimally invasive surgery that is safer and less risky than it would be without these technological advances.IU School of Medicine Department of Neurological Surgery Annual Report22

23CLINICAL CAREAnnual Report IU School of Medicine Department of Neurological SurgeryNeurovascular SurgeryNeurovascular disease specialists in the IU School of Medicine Department of Neurological Surgery specialize in blood vessel abnormalities of the brain and spinal cord, such as stroke, brain aneurysms and arteriovenous malformations. Treatment is personalized for each patient by choosing from the most advanced medical, endovascular and surgical treatments.Multi-disciplinary SpecialtyNeurovascular disease is a Multi-disciplinary section that spans the Departments of Neurological Surgery, Neurology and Radiology and Imaging Services. Core faculty members include Brad Bohnstedt, MD; Aaron Cohen-Gadol MD; Mitesh Shah, MD; and Jesse Savage, MD, PhD from Neurological Surgery. Kaustubh Limaye, MD is an endovascular neurologist from Neurology, and Jerry Kovoor, MD is an interventional neuroradiologist from Radiology and Imaging Services. This team sees patients with cerebrovascular and spinovascular diseases, with symptoms that include aneurysms, arteriovenous malformations, carotid stenosis, vertebral stenosis, ICAD, dural arteriovenous stula, moya moya, cavernous malformations, subdural hematomas and venous sinus stenosis for idiopathic intracranial hypertension.Vascular FellowshipsThe Department of Neurological Surgery oers two fellowships. The multidisciplinary neuroendovascular fellowship accepts fellows from neurological surgery, neurology and neuroradiology for a two-year fellowship. The department’s one-year cerebrovascular fellowship is intended for neurological surgery trainees. Fellows for either program learn from department faculty vascular neurosurgeons and endovascular neuroradiologists, who treat patients suering from aneurysms, arteriovenous malformations and other cerebrovascular diseases. Training may be customized to include surgical, endovascular or a combined experience.Collaborative MedicineNeurosurgeons in the neurovascular section closely collaborate with neuroradiologists for non-invasive imaging with MRI, MRA, CTA, CTP and cranial dopplers. They also collaborate on cerebral ischemic and hemorrhagic disease treatment plans with neurologists. Each month, neurovascular surgeons participate in a multidisciplinary complex case review with faculty physicians from multiple departments; they treat close to 150 aneurysms and 150 stroke interventions each year thanks to this partnership. The department is also actively a member of seven endovascular multidisciplinary studies housed at locations across the United States.

CLINICAL CAREPediatric NeurosurgeryThe pediatric neurosurgery program in the Department of Neurosurgery at IU School of Medicine is dedicated to advancing children’s health through high-quality patient care, education and research. IU pediatric neurosurgeons treat a full range of complex neurological injuries and disorders, including seizures, skull and spine deformities, pediatric stroke, and benign and malignant tumors. When children require neurosurgical care, a heightened sense of urgency and importance naturally follows.Epilepsy ProgramThe comprehensive epilepsy program at Riley Hospital for Children under the guidance of pediatric neurosurgeons at IU oers all forms of medical and surgical diagnostics and treatments for epilepsy. For drug-resistant epilepsy, surgery is often a good option, and the department has the capability to perform robot-assisted stereo EEG lead placement, laser interstitial thermal therapy, neuromodulatory procedures, such as insertion of the responsive neurostimulator system (RNS) and vagal nerve stimulators, as well as resective or disconnection surgeries. Riley has the only laser ablation program in the state for children with epilepsy and brain tumors. The pediatric neurosurgery team collaborates with North American centers for research in the connectomics underlying vagus nerve stimulation and the ecacy of laser ablation in epilepsy.Movement DisordersThe department is a member of the cerebral palsy research network (CPRN) where they contribute prospective registry data to multi-center trials to study and improve the care of hypertonic patients. Pediatric neurosurgeons oer a baclofen pump program with one of lowest infection rates in country, intraventricular baclofen therapy, deep brain stimulation for dystonia, and selective and non-selective cervical and lumbosacral rhizotomy. IU is the only health system in Indiana to oer these services. The movement disorder program is patient-centric and multidisciplinary. Neurologic DiseasesPediatric neurosurgeons also treat a variety of neurologic disorders in children. They provide diagnostic and therapeutic options for vascular malformations and injuries of the nervous system, including endovascular (less invasive) approaches as well as surgical resection. These rare disorders are managed by a comprehensive team of pediatric providers across the gamut of care including neurologists, and interventional radiologists as well as neurosurgeons. Patients are seen in our neurovascular clinic with these providers. A variety of specialists, including neurosurgeons, plastic surgeons, physical medicine and rehabilitation specialists, occupational and physical therapists come together to provide care for a variety of peripheral nerve problems including injuries to the brachial plexus sustained at birth or from traumatic events, and peripheral nerve tumors. The multidisciplinary approach to neurobromatosis, an inherited disorder associated with tumors of peripheral nerves is unique in the region and there is signicant ongoing funded research in the Department of Pediatrics.IU School of Medicine Department of Neurological Surgery Annual Report24

25CLINICAL CAREAnnual Report IU School of Medicine Department of Neurological SurgeryStereotactic and functional neurosurgeons in the Department of Neurological Surgery at IU School of Medicine have a strong focus in the areas of epilepsy, movement disorders and radiosurgery. Epilepsy TreatmentAlongside excellent teams of epileptologists and movement disorder specialists, IU neurosurgeons have helped establish IU Health as a Level 4 Epilepsy Center, the highest possible accreditation by the National Association of Epilepsy Centers as well as a Center of Excellence by the National Parkinson’s Foundation. Department faculty provide comprehensive evaluation and management of patients with medically intractable complex partial seizures. All patients undergo an extensive protocol-driven, pre-surgical evaluation including inpatient video/EEG monitoring, MR scanning, neuropsychological evaluation and intracarotid sodium amytal testing.Neuromodulation TherapiesFaculty in the specialty are proud to oer the full range of epilepsy surgery, from open craniotomy for resection to Laser Interstitial Thermal Therapy (LITT), as well as the latest in neuromodulation therapies, including deep brain stimulation, responsive neurostimulation and vagal nerve stimulation. Kunal Gupta, MBBCH, PhD, introduced robotic neurosurgery to IU and launched the StereoElectroEncephaloGraphy (SEEG) program to precisely localize the origin of patients’ seizures and guide planning of subsequent therapeutic operations. In 2022, Gupta and Thomas C. Witt, MD performed eleven SEEG procedures that led to six temporal lobectomies, three laser ablations and two stimulator implants.Movement Disorders and Deep Brain StimulationMovement disorders, including Parkinson’s disease, essential tremor and dystonia, are treated with a multidisciplinary team approach that uses microelectrode-based deep brain stimulation (DBS) and ablative procedures. DBS is a minimally invasive surgical treatment that involves placing ne stimulating electrodes into specic areas of the brain that control movement. The interdisciplinary DBS clinical team is comprised of two functional neurosurgeons, ve movement disorders neurologists, two IU Health registered nurses and two neuropsychologists. Each patient’s treatment plan is customized specically to their health needs and a full range of novel advancements in DBS technology is available. In 2022, they performed 49 deep brain stimulation implants and one radiofrequency thalamotomy. Witt implanted Anterior Limb of the Internal capsule DBS electrodes in one patient with refractory obsessive-compulsive disorder, leading to signicant improvement in symptoms. Faculty have contributed to national deep brain stimulation registries, an investigator-led trial examining novel indications for deep brain stimulation and were instrumental in IU’s acquisition of Insightec Focused Ultrasound (FUS) technology which will broaden their therapeutic armamentarium for movement disorders in 2023.Stereotactic and Functional Neurosurgery

CLINICAL CARENeurotraumaNeurotrauma faculty in the Department of Neurological Surgery at IU School of Medicine manage mild to severe trauma to the head and spine and work to put trauma victims on the best road to recovery. The trauma program at IU School of Medicine, in partnership with IU Health, is the most advanced in the state of Indiana. This team of neurosurgeons treat complex brain and spinal cord injuries at hospitals across Indianapolis.Level 1 Trauma CenterIU Health Methodist Hospital is one of three Level 1 adult trauma centers in the state. Each year, hundreds of adults and children are injured and rushed to a trauma center in Indiana, most commonly at IU Health. Often, a neurosurgeon expertly assesses a patient’s injury and creates a plan of care that mobilizes a team of specialists. In 2022, neurosurgeons at IU consulted on 1,512 patients for trauma, 742 patients for traumatic brain injury and 64 patients for spinal cord injuries. IU also has one of the largest dedicated neurocritical care units in the country for bed capacity. Department of Defense TBI StudyIU School of Medicine is part of a multicenter clinical trial, funded by the Department of Defense, to study the eects of traumatic brain injury (TBI). The trial is part of TRACK-TBI, a National Institute of Neurological Disorders and Stroke funded initiative. The purpose of the study is to evaluate the clinical performance of the i-STAT TBI test. This plasma test determines the need for a CT scan in patients 18 years of age or older who are presenting with suspected mild traumatic brain injury. The study also collects data and specimens that may support other purposes related to the understanding of TBI. At IU School of Medicine, the clinical trial is led by Jamie L. Bradbury, MD, and is conducted at both the medical school and the Rehabilitation Hospital of Indiana.Neuro-critical Care FellowshipThe Department of Neurological Surgery oers a one-year neuro-critical care fellowship, providing high exposure to trauma and neurovascular disorders, including aneurysmal subarachnoid hemorrhage and intracerebral hemorrhage. The neurocritical care unit at IU Health Methodist Hospital is managed collaboratively between neurosurgeons, critical care physicians and trauma/critical care surgeons. Participating fellows have signicant opportunities for clinical research.IU School of Medicine Department of Neurological Surgery Annual Report26

Annual Report IU School of Medicine Department of Neurological SurgeryRESEARCH & INNOVATION27

29Neuroscience InstituteThe Neuroscience Institute, a partnership between IU School of Medicine and IU Health, draws on the longstanding national and international reputation of top talent and collaboration at the medical school and health system to further the advancements in disorders of the nervous system. The institute is led by co-directors Bruce Lamb, PhD, Laurie Gutman, MD and Mitesh Shah, MD, as well as Executive Director LaShelle Tipton, MBA.From bench research to translational and clinical research that crosses multiple specialties and diseases, the Neuroscience Institute is dedicated to providing Hoosiers access to the entire spectrum of services—from prevention to diagnosis to treatment. The vision of the Neuroscience Institute is that it will be a recognized leader and premier destination for the prevention, treatment, and cure of disorders of the nervous system through innovative multi-disciplinary patient care, research, and education. The institute combines the expertise of several IU School of Medicine departments—which includes the Department of Neurological Surgery RESEARCH & INNOVATIONAnnual Report IU School of Medicine Department of Neurological Surgeryas a major contributor to the institute—that focus on disorders of the nervous system in how they treat patients, practice research and educate trainees.

Beth M. Ansel, PhDSenior Research Professor of Neurological SurgeryNaikui Liu, MD, PhDAssociate Research Professor of Neurological SurgeryWei Wu, PhDAssistant Research Professor of Neurological SurgeryXiangbing Wu, PhDAssistant Research Professor of Neurological SurgeryMedicineAmol P. Yadav, PhDAssistant Professor of Neurological SurgeryNur P. Damayanti, PhDAssistant Research Professor of Neurological SurgeryLingxiao Deng, PhD, Assistant Research Professor of Neurological SurgeryXiang Gao, PhDAssistant Research Professor of Neurological SurgeryRESEARCH & INNOVATIONIU School of Medicine Department of Neurological Surgery Annual ReportKunal Gupta, MBBCH, PhDAssistant Professor of Neurological SurgeryAngela M. Richardson, MD, PhDAssistant Professor of Neurological SurgeryJignesh Tailor, BMBCH, PhDAssistant Professor of Neurological SurgeryBASIC SCIENCE RESEARCHERSCLINICAL RESEARCHERS30

31Investigating the Molecular Mechanisms Relating to Spinal Cord Injury and Traumatic Brain InjuryThe Laboratory of Spinal Cord Regenerative Medicine, built on decades of research of the late Xiao-Ming Xu, PhD, is comprised of a critical mass of investigators in the department who study the molecular mechanisms underlying spinal cord injury (SCI) and traumatic brain injury (TBI), and work to develop novel repair strategies to promote neural reorganization and functional recovery in experimental models of these injuries. The long-term goal of these studies is to translate promising treatments from animal models to humans. Researchers investigate the modulation and generation of neural circuitries in the central nervous system (CNS) for the functional recovery after SCI and to develop therapeutic strategies by protecting, regulating, and inducing new neural circuitries in the CNS for the treatment of spinal cord injury. The lab also investigates bladder voiding dysfunction resulting from SCI that can lead to severe complications. Few eective therapies are available to achieve bladder function recovery, largely due to a poor understanding of the pathophysiological mechanisms after SCI. The lab is working toward functionally dissecting the specic neuronal population within the intraspinal neural network that mediates the spontaneous and therapeutic recovery of lower urinary tract (LUT) voiding function after SCI using optogenetic and chemogenetic approaches.RESEARCH & INNOVATIONAnnual Report IU School of Medicine Department of Neurological SurgerySpinal Cord & Brain Injury Lab

RESEARCH & INNOVATIONTargeting immune checkpoints for regulation of neuroinammation after traumaXiang Gao, PhD, assistant research professor, focuses his investigations on the mechanisms that control the intensity and duration of neuroimmune/neuroinammatory responses in traumatic brain injury (TBI). Collaborating with Andy Yu, MD, PhD, from the Department of Microbiology & Immunology, Gao studies the role of immune checkpoints (ICPs) in the regulation of neuroimmune/neuroinammatory responses in the injured brain in vivo using the controlled cortical impact model of TBI. They found that de novo expression of a key inhibitory ICP was robustly and specically induced in reactive astrocytes post trauma. These astrocytes were highly enriched to form a dense zone around the TBI lesion, which likely played a critical role in restricting the spread of damage. Inhibition of the cell signaling increased inltration of inammatory blood cells, which aggravated brain tissue cavity size and subsequent motor dysfunction in TBI mice. The goal of the research not only opens a novel avenue to study the role of ICPs in trauma, but it also provides insights into development of ICP regulators to treat TBI.Patient-derived anaplastic glioma modelsNur P. Damayanti, PhD, assistant research professor, develops her research by integrating multi-omics approaches and patient-derived models to obtain precision medicine for rare gliomas patients, specically, but not limited to, Pleomorphic Xanthoastrocytoma (PXA) and its anaplastic form (APXA). Anaplastic gliomas are not only heterogenous in their histology and genetic landscape but also in their prognosis and response to treatment. Her works involve model establishment, molecular characterization, biomarker identication, tumor classication and targeted therapy validation. Her rst bona de anaplastic glioma model was developed from a leptomeningeal spread of APXA from a patient treated at Riley Hospital for Children at IU Health. Integrated omics validate the delity between the patient’s tumor and its models (patient-derived xenograft, xenoline and spheroid) in histology as well as its molecular landscape at genomic, transcriptomic, proteomic, and post-translational level. Damayanti identied a pathway as a potential target and it was validated preclinically in the PDX models.IU School of Medicine Department of Neurological Surgery Annual ReportXiang Gao, PhDAssistant Research Professor of Neurological SurgeryNur P. Damayanti, PhDAssistant Research Professor of Neurological SurgeryXiang Gao LabTBI 12hr hippocampal DGNur Damayanti Lab32

33Understanding Mesial Temporal Lobe EpilepsyThe laboratory of Kunal Gupta, MBBCH, PhD, assistant professor, works to understand the mechanisms responsible for pathological and therapeutic remodeling in the development of epilepsy. Working primarily using animal models, he studies the function of dierent genes and molecular pathways responsible for the development of mesial temporal lobe epilepsy, the most common form of focal epilepsy. The goal is to discover novel therapeutic targets that might prevent the development of epilepsy or recurrence after epilepsy surgery. The lab has previously determined that the Wnt pathway is dysregulated early in epileptogenesis in the temporal lobe and that Wnt pathway modulation directly aects pathological remodeling in the hippocampus. Gupta’s NIH-funded work will determine if Wnt pathway modulation aects the development of epilepsy in this model. They are also actively investigating other pathways that may be responsible for pathological remodeling during this early critical period. Dr Gupta is one of three Pls leading a collaborative multi-department clinical study on the use of Deep Brain Stimulation to treat laryngeal dystonia.Brain-Spine-Machine InterfacesThe Brain-Spine-Machine Interfaces Lab, led by Amol Yadav, PhD, assistant professor, works at the interface of neuroscience and engineering. The laboratory’s goal is to develop neural engineering-based therapies to treat neurological disorders and understand how neurological disorders impact the brain-spine network and its role in sensorimotor control. They collaborate with surgeons, clinicians, basic scientists, and engineers to bridge the gap between pre-clinical and clinical research and to develop therapeutic solutions. The lab has ongoing projects focusing on generating articial sensations using electrical stimulation of the spinal cord and understanding how these sensory experiences are encoded in the brain as well as creating brain-spine interfaces to treat sensorimotor decits caused by neurological disorders like Parkinson’s disease, spinal cord injury, and traumatic brain injury. Some of their techniques include high-density stimulation, high-density neurophysiology, computational modeling, behavioral experiments in rodents, computational analysis of neural data and sensor/sensor-less movement tracking.RESEARCH & INNOVATIONAmol P. Yadav, PhDAssistant Professor of Neurological SurgeryKunal Gupta, MBBCH, PhDAssistant Professor of Neurological SurgeryAnnual Report IU School of Medicine Department of Neurological Surgery

Pediatric Brain Tumors and Neural Stem CellsThe research of Jignesh Tailor, BMBCH, PhD, assistant professor, is devoted to understanding the pathogenesis of pediatric brain tumors. The laboratory uses human neural stem cells as in vitro models of progenitors in the developing brain/spine and investigates the molecular and cellular eects of cancer predisposition genes on neural stem cell self-renewal and dierentiation. He focuses his work on two primary areas. The rst is to understand medulloblastoma, the most common malignant brain tumor of childhood. He has pioneered a unique stem cell model of Shh-subgroup medulloblastoma to study brain tumorigenesis from human iPSCs that he has developed and to identify novel therapeutic targets. A second line of study is to help understand the pathogenesis of spinal ependymoma and to develop useful drug therapy to stop progression of this disease. The overall objective of Tailor’s research is to develop a human stem cell model of ependymoma formation using human iPS derived NES cells with germline or somatic NF2 mutation. Tailor and his team believe that understanding the early steps of brain tumorigenesis will lead to novel therapeutic strategies to prevent malignant tumors in patients with brain cancer predisposition syndrome.Improving Brain Tumor TreatmentBrain tumors can be deadly, and the typical treatments—surgery, chemotherapy, and radiation—carry signicant risks. The Richardson lab, led by Angela M. Richardson, MD, PhD, focuses on developing novel therapeutic strategies and preclinical models to enable improved translation from the laboratory to the clinic. Her group aims to improve preclinical modeling of brain tumors to more accurately mimic the environment within patients. Oxygen levels within the body and within tumors are signicantly lower than oxygen levels within ambient air. One set of studies is aimed at understanding the eect of these dierent oxygen levels on brain tumorigenesis and chemoresistance. In related studies, the Richardson lab is exploring the use of viral vectors for suicide gene activating therapy to treat disseminated brain cancer (leptomeningeal disease) as well as solid tumors. This combination of studies aims to optimize delivery methods, mimic the treatment conditions of patients, and improve understanding of immune responses within the tumor microenvironment.IU School of Medicine Department of Neurological Surgery Annual ReportAngela M. Richardson, MD, PhDAssistant Professor of Neurological SurgeryRESEARCH & INNOVATIONJignesh Tailor, BMBCH, PhDAssistant Professor of Neurological SurgeryRichardson lab34

35In Memoriam: Xiao-Ming Xu, PhDThe Department of Neurological Surgery at IU School of Medicine remembers the life of Xiao-Ming Xu, PhD, the Mari Hulman George Professor of Neuroscience Research, who passed away on Dec. 2, 2022, at the age 70 after a courageous battle with cancer.Xu joined the research faculty in the Department of Neurological Surgery in 2007. He received continuous support for his research for more than 20 years from the National Institutes of Health, Department of Defense and the Department of Veteran Aairs. His work concentrated on neuroprotection, axonal regeneration and recovery from traumatic spinal cord and brain injuries. Xu led the Indiana Spinal Cord and Brain Injury Research Group (ISCBIRG) at Stark Neurosciences Research Institute, where Xu was a primary member.Xu published more than 200 research papers, and in 2020, he was listed among the world’s top 2 % scientists. During his legacy at IU, Xu served as a valuable mentor to undergraduate students, residents and postdoctoral candidates in their pursuit of careers in neurosurgery.The Department of Neurological Surgery and Stark Neurosciences Research Institute held the inaugural Xiao-Ming Xu Memorial Symposium, to honor his accomplishments in the eld. More than a dozen neuroscience investigators spoke about Xu’s impact on spinal cord and brain injury research and shared about their own research during the four-hour symposium.RESEARCH & INNOVATIONAnnual Report IU School of Medicine Department of Neurological Surgery

Neurological Surgery Clinical TrialsEVOLVE: Endovascular Treatment Of Wide-Neck Aneurysms PI: Bradley N. BohnstedtINSIGHT: Clot in Ischemic Stroke and Hematoma EvacuationPI: Bradley N. BohnstedtSEGA: Sedation v. General Anesthesia for Endovascular Therapy in Acute Ischemic StrokePI: Bradley N. BohnstedtSURF: Embolization of Neurovascular lesions using WAVE™ Extra Soft coilsPI: Bradley N. BohnstedtRAGE: Ruptured Aneurysms Treated with Hydrogel CoilsPI: Bradley N. BohnstedtSUCCESS: Comaneci-assist Coils Embolization Surveillance StudyPI: Bradley N. BohnstedtCITADEL: Embolization Device Study, Brain aneurysmPI: Bradley N. BohnstedtPENS: Placebo-Controlled Eectiveness in iNPH ShuntingPI: Jesse J. Savage, MD, PhDsTaRT: Observational Study of GammaTile™ Surgically Targeted Radiation TherapyPI: Mitesh V. Shah, MDNew Mets: Post-Surgical Stereotactic Radiotherapy (SRT) versus Surgically Targeted Radiation Therapy (STaRT) with Gamma Tile, Newly Diagnosed GlioblastomaPI: Angela M. Richardson, MD, PhDTRACK TBI: Clinical Evaluation of the i-STAT TBI TestPI: Jamie L. Bradbury, MDENRICH: Early Minimally-invasive Removal of ICHPI: Mitesh V. Shah, MDASSIST RegistryPI: Bradley N. Bohnstedt, MDParke Reeves Syringomyelia Research ConsortiumPI: Laurie L. Ackerman, MDThe Genetics of Chairi MalformationsPI: Laurie L. Ackerman, MDBioengineering Strategies to Investigate Treatment Failure in IU School of Medicine Department of Neurological Surgery Annual ReportRESEARCH & INNOVATIONHydrocephalusPI: Rabia Qaiser, MDHCRN: Hydrocephalus Clin. Res. Network, Characterizing Patient PopulationsPI: Jignesh Tailor, BMBCH, PhDRole of Inammatory Mediators in Congenital HydrocephalusPI: Jignesh Tailor, BMBCH, PhDMRgLITT: MRI-Guided Laser Interstitial Thermal Therapy, EpilepsyPI: Jignesh Tailor, BMBCH, PhDVNS: Predicting Seizure Responsiveness to Neuromodulation Using Connectomic ProlingPI: Jignesh Tailor, BMBCH, PhDDissecting the cellular heterogeneity of epileptogenic zonesPI: Jignesh Tailor, BMBCH, PhDCPRN: Cerebral Palsy Research Network Registry2022 NIH awardsWei Wu, PhDModulation of lumbar motor circuitry after an above-level SCI and NT-3 gene therapyR01National Institute of Neurological Disorders and Stroke (NINDS)9/30/2017-8/31/2023$378,432 (per scal year)Wei Wu, PhDReprogramming reactive glial cells into functional new neurons after SCIR01National Institute of Neurological Disorders and Stroke (NINDS)8/1/2020-6/30/2025$522,093 (per scal year)Ling-Xiao DengPlasticity of spinal L3 propriospinal neurons in urination recovery after thoracic SCIR21National Institute of Neurological Disorders and Stroke (NINDS)9/22/2022-8/31/2024$435,865 (per scal year)36

37Dr. Robot: IU Neurosurgery provides advanced technology to casesWhen complex surgeries arise for neurosurgeons at Indiana University School of Medicine, a robot is a helpful hand away.Faculty physicians in the Department of Neurological Surgery are assisted in the operating room by three types of cutting-edge robots—The Mazor, ROSA and Modus V—all designed to navigate the most intricate of areas in a patient’s brain or spine. These robots have made procedures safer and less risky than without these technological advances.Mazor (robotic spine surgery)RESEARCH & INNOVATIONThe Mazor is a spinal surgery robot that helps neurosurgeons perform the most complicated of surgeries—from correcting scoliosis to repairing broken spines—with precision and accuracy. The robot, which became operational in July 2022, provides support in two ways: image guidance and screw placement. Image guidance is provided through the robot’s built-in, advanced software, which helps surgeons and their teams to nd the exact location, down to a single millimeter, of where the spinal screw needs to be placed during surgery. Once it nds the right spot, the team uses the robot to insert the screw into the spine.The end result is that patients benet from minimally invasive surgery that is safer and less risky than it would be without these technological advances.ROSA (cranial guidance system)The robotic stereotactic assistant, or ROSA, is a neurosurgical robot which assists the stereotactic Robotic guidance systems for neurosurgeryAnnual Report IU School of Medicine Department of Neurological Surgery

38 IU School of Medicine Department of Neurological Surgery Annual ReportRESEARCH & INNOVATIONplacement of electrodes into a target with high accuracy. IU School of Medicine and IU Health is the only health system in the state of Indiana that owns and operates the ROSA for highly accurate neurosurgical procedures.This leading-edge technology is used during stereotactic electroencephalography (sEEG). This is a procedure that involves the placement of electrodes on or in the brain for epilepsy patients. Using the ROSA, neurosurgeons can program where each electrode should be placed in the brain. The ROSA’s robotic arm moves to each location to precisely insert the electrodes. This technology creates a more precise, faster and less invasive surgery for the betterment of patients.Modus V (enhanced visualization)Neurosurgeons at IU School of Medicine use exoscopes to see high-denition magnied images deep within the brain and spinal cord. Some tumors sit in hard-to-reach areas in the brain, such as where the brain stem and cervical spine meet. Using Modus V exoscope (a robotic arm holding a camera) neurosurgeons can navigate down into the brain and remove tumors. This has expanded the type of cases IU neurosurgeons are able to treat. Since acquiring the technology in fall 2016, the department has used it on hundreds of surgeries, making it a common go-to in the operating room for complex tumors.The camera mounted on the robotic arm hovers above the surgical theater, following a pointer that surgeons hold in their hands, telling the camera where it should go. The camera projects images of a patient’s tissue onto a screen, much more clearly than a common microscope.The exoscope can also provide doctors with detailed imaging that allows them to map how they plan to wend their way around the white matter in quest of a tumor, clot or other abnormality.Sources: Indiana University Health, Riley Hospital for Children, Indianapolis Star

39PERSONAL STORIESAnnual Report IU School of Medicine Department of Neurological SurgeryThanks to spine surgery, 27-year-old patient can hike Indiana trailsBy IU Health Senior Journalist, TJ BanesDeeanna Harris looks forward to spring. She will hit the trails around her Hendricks County Home and the state parks in southern Indiana. Hiking is something that she has come to enjoy these days.There was a time however, when it was painful to even walk a few steps.At the age of nine, Harris was diagnosed with scoliosis. In the years that followed she developed a degenerative disease. At the age of 12, she said her spine was curved 60 degrees - considered severe scoliosis. Generally, diagnosed in childhood, scoliosis is an abnormal curvature of the spine. It aects two to three percent of the population, an estimated six to nine million people in the United States. The primary age of onset is 10 to 15 years of age in both males and females.The American Association of Neurological Surgeons reports symptoms include uneven shoulders, the head is not centered above the pelvis, one or both hips are raised or unusually high, the rib cages are dierent heights, the waist is uneven, and the texture of the skin overlying the spine can change to show dimples, patches of hair, or color abnormalities.“When I was little, they told my parents that my lungs could be crushed if I kept progressing and I wouldn’t live a full life,” said Harris. She rst looked into surgery at the age of 21, specically to fuse the bottom half of her spine. As a result of her degenerative disease, the pain increased over the years. She also had some arthritis build up.“It got so bad that I could only go a little way before I had to sit,” said Harris. The lack of movement combined with depression caused her to gain weight. At one point, another facility advised her to lose weight before surgery would be an option.“It was like Catch-22. I needed surgery to relieve the pain and improve my movement, but I couldn’t get the surgery because I was gaining weight because I wasn’t moving,” said Harris. When she became familiar with David Stockwell, MD, at IU Health West, she found the answers she was looking for.On March 28 and 29, 2022, Harris was admitted to IU Health Methodist Hospital. In the care of Stockwell, she underwent the intricate surgery that would bring relief from her pain.She spent three months in a brace to stabilize her core. Afterward, she said she felt pain free. Her favorite activities are playing with her 10-year-old son at local parks, and hiking state parks.“Last summer I went to North Carolina and climbed a mountain and saw a waterfall,” said Harris. “I never would have been able to do that without surgery.”

PERSONAL STORIESFour days after surgery for a brain tumor he was at his sister’s weddingBy IU Health Senior Journalist, TJ BanesHe’s never had a broken bone or a cavity. He had annual checkups and never had an indication that he was anything other than healthy.“I don’t think I’d even been to a hospital except maybe to visit a grandparent,” said Jordan Williams, 35. “There were no red ags on my checkups. This just came about so slowly at a time I was transitioning to a new job that I thought it might be stress related.”A lifelong Indianapolis resident, Williams graduated from Lawrence Central High School and earned bachelor’s and master’s degrees in Civil Engineering from Purdue University.He had just accepted a job as a project manager with the City of Indianapolis Department of Public Works when he started experiencing some unexplained symptoms. His right leg would fall asleep, so he’d get up and walk to get the blood owing. Maybe a dozen or so times a day, he’d experience cloudy vision.In August 2020, Williams married his wife Ellen. They have one son, who is ve months old.It was his mother-in-law, a retired nurse who encouraged Williams to go for a thorough health check. She was with him when his leg became numb and he wasn’t able to bear weight. He rst made an appointment with an optometrist for his blurry vision. That was in July 2022. A followup appointment was scheduled with a neuro-ophthalmologist the next month.“He looked at my nerves and wrote a letter and said I needed to go to the ER right away for an MRI and CT. He said with an extremely high degree of condence that it looked like I had a brain tumor,” said Williams. He remembers the day well.It was the middle of his work day and everything just stopped.“We had a baby shower scheduled in Chicago that was cancelled. My sister’s wedding was coming up. I didn’t know what to think,” said Williams.The MRI conrmed he had a grade II meningioma, the most common type of primary brain tumor. It starts in the outer three layers of the protective tissue located between the skull and the brain. The severity is determined by the classication and location.“It was outside my brain matter and was compressing on my brain in the top left of my skull. I’m told it doesn’t impact as many of the high functioning features as the tumor in the front so I was very fortunate,” said Williams.On Aug, 23, 2022, in the care of Aaron Cohen-Gadol, MD, he went in for a surgery that took about six hours. Williams was told that the team was able to remove 97 percent of the tumor.“The days that followed were a blur but I was in high spirits and never really felt any pain. The sta at IU Health were tremendous - from the people who cleaned my room to the residents and the surgeons,” said Williams.As the days progressed into a week, he had one goal - to make it to his sister’s wedding. On August 27 - just four days after brain surgery, Williams walked with a cane, up to the front of the church to do a reading during the ceremony.“The therapist was impressed by my recovery rate and said that in all good conscience she couldn’t keep me in the hospital,” said Williams.He and his wife welcomed their son on October 7, and Williams began radiation in November. We joke that we had all these hospital visits under the same calendar year, but the truth is we had such a positive experience with IU Health that we wanted our pediatrician to be in the IU Health Network,” said Williams. Their son was delivered at IU Health North.After his surgery, and radiation, Williams said his CT scans look good and he hasn’t experienced any cognitive decline.“I think I’m going to come out stronger and I have an overwhelming sense of gratitude. Every step of the way could have gone a dierent direction and this has been a blessing in disguise. I have been able to take a step back, not worry about silly things and refocus at a time that we have become parents,” said Williams.IU School of Medicine Department of Neurological Surgery Annual Report40

41PHILANTHROPYAnnual Report IU School of Medicine Department of Neurological SurgeryRevNeurological Surgery PhilanthropyThe future of education, research and clinical care in neurological surgery is bright at IU School of Medicine. From research investigating brain tumor treatment options and stem cell models to better understand pediatric cancer to state-of-the-art robotic technologies that help surgeons in the operating room, the Department of Neurological Surgery is well situated to lead Indiana and beyond in the care of patients with nervous system disorders and advance research to discover novel therapeutic treatments.Part of IU Health, the department is uniquely positioned to support the goals of the IU Foundation, the IU Health Foundation and Riley Children’s Foundation. In addition to four annual lectureships, the department is honored to have endowed professorships that pay tribute to past faculty who were giants in the neurosurgery eld and left a tremendous impact at IU. The department participates each year in the Neurocharity Softball Tournament at Columbia University. Forty teams of neurosurgeons from top medical institutions compete in a softball tournament at Central Pak in New York City to benet brain tumor research.Rev, the IU Health Foundation’s annual philanthropic event, raises support for IU Health’s care in trauma, critical care and services provided to drivers and patrons at the Indianapolis Motor Speedway. The Department of Neurological Surgery has been deeply invested in this event, as funds from the sponsors have aided the department in obtaining equipment in treating patients with neurotrauma. IU Health provides care to some of the most critically ill and injured patients in Indiana, with over half requiring behavioral health support following admission to the hospital. These funds will continue to support and focus on initiatives for this vulnerable population.

Sloan said each of the faculty physicians had their own strengths, providing him with a well-rounded education. Paul B. Nelson, MD, the department chair at the time of Sloan’s residency, taught Sloan to treat patients conservatively: rst do a thorough physical exam and determine their core issue before beginning surgery. Sloan said Nelson’s goal for patients wasn’t to immediately operate but instead get to know the patient and their problem on a deeper level to make the best decision. “In today’s world, some people get big surgeries when they need a little surgery,” Sloan said. “It takes a lot more work to do a little surgery because you have to go through the process and nd out where the exact problem is happening and make a very focused x to it as opposed to retreating to everything that looks abnormal on the imaging.” Sloan said the Department of Neurosurgery has a family environment for its residents. He said Nelson set the tone to not only teach neurosurgery well but to take care of and respect residents. They were encouraged to have a life outside of the hospital, Sloan said. Most residents had families and spent time together at homes and participated in hobbies. That camaraderie of faculty, residents and sta, coupled with a robust neurosurgical education, still has a positive impact on Sloan now nearly two decades since his time at IU. “To this day, in the back of my head when I’m looking at patients, I hear my teachers, like Dr. Scott Shapiro, Dr. Mitesh Shah and Dr. Paul Nelson, reminding me about the core values that they taught me, and I don’t forget that,” Sloan said. Sloan treats patients at Community Hospital East with a myriad of neurological ailments as a general neurosurgeon, and most of his practice is spent seeing patients with spinal cord issues. He continues to collaborate with the Department of Neurological Surgery by building referral relationships with IU neurosurgeons to treat patients that need more specialized care. “It’s been a good relationship,” Sloan said. “As much as I can send down to IU, I do.” Neurosurgery alum reects on medical education at IURobert B. Sloan, MD, looks back on his time at Indiana University fondly. The Indianapolis physician spent his entire higher education career at IU. He earned his bachelor’s degree at IU-Bloomington and his medical degree and residency at IU School of Medicine. Sloan, who is the sole neurosurgeon at Community Hospital East, carried out the bulk of that time at IU studying medicine, specically neurosurgery. As a resident in the Department of Neurological Surgery from 2000-2006, Sloan said he studied neurosurgery “during the perfect time.” He said he received a classical medical education in his residency, and he was taught and experienced newer technologies making their way into the eld of neurosurgery at the time. “I can do it the old school way, and I can do it the new school way,” Sloan said. “I got great training at IU.” Studying medicine wasn’t the rst choice for Sloan. He was a nance major at IU as an undergraduate student and then worked for his father’s company before making a career change to medicine. Ever since graduating from IU School of Medicine, Sloan has been practicing general neurosurgery at Community Health Network in Indianapolis. Reminiscing on his time at IU School of Medicine, “I hear my teachers, like Dr. Scott Shapiro, Dr. Mitesh Shah and Dr. Paul Nelson, reminding me about the core values that they taught me, and I don’t forget that.” IU School of Medicine Department of Neurological Surgery Annual Report ALUMNIRobert B. Sloan, Jr., MDNeurological Surgery42

Annual Report IU School of Medicine Department of Neurological Surgery2022Jacob ArcherAndrew KoivuniemiStephen Mendenhall2021Wei HuNicolas Villelli2020Thomas GianarisBrandon LaneGina Monaco2018Shaheryar F. AnsariTimothy Kovanda2017Kashif ShaikhIan White2016Andrea G. SchererCharles G. Kulwin2015John R. EdwardsNeal B. PatelTodd D. Vogel2014Bradley N. BohnstedtDavid Lewis2013Daniel L. KimJason M. Voorhies2012Zachary H. DoddJessica Wilden2011Gregory M. HelbigTodd A. Eads2010Jamie L. BradburyShannon P. McCanna2009Daniel H. Fulkerson2008Philip Yoder SmuckerThomas J. Altstadt2007Jordan JudeJames C. Miller2006Robert Blake Sloan2005Richard B. RodgersScott Hoyle Purvines2004Patrick J. ConnollyKevin M. Jackson2003Francesca D. Tekula2002Jill W. DonaldsonTodd B. Abel2001Rajesh K. BindalSubrata Ghosh2000Carl Gorman Bevering IIIJames K. Kaufman1999David P. FritzKen SatoWilliam E. Snyder1998Richard V. Chua1997Christopher E. WolaRobin M. Bowman1995James D. CallahanKimball N. Pratt1994Thomas B. ScullyThomas C. WittALUMNI43

44 1993Steven Goodwin1992Timothy K. PuttySteven Sanders1991Constance Kayser1990Carl J. SartoriusTariq Javed1989Joel C. Boaz,1988John CummingsJoseph L. Voelker1987Christopher L. MarquartScott A. Shapiro1986Luis Rodriquez1985Mark C. GlazierRobert Yount1984David Hall1982Jack DeckardRalph C. Loomis1981Thomas LuerssenMichael Turner1979Alonzo DeSousa1978Thomas Keucher1977Peter HallRobert Schultz1975Larry Schulhof1974Michael BurtBertil Loftman1973Daniel CooperRobert M. Worth1972Henry FeuerRichard Gilmor1971Joseph C. Maroon1970James Franco1968C. Courtney Whitlock1967John E. Joyner1966Carl KaoAndrievs Dzentis1965Sam Assam1959Eldon Hann1957Robert L. Campbell

45 Annual Report IU School of Medicine Department of Neurological SurgeryAnnual Report IU School of Medicine Department of Neurological SurgerySupport the Work of the Department of Neurological Surgery Each year, thousands of people entrust the IU Department of Neurological Surgery a to provide them with excellent medical care. Many people turn to us because of our long history and reputation for attracting the nest surgical trainees and surgeons in the country. One of the reasons we have been able to build such a strong program-and to establish new standards of surgical care is because of philanthropic contributions from people like you. Gifts from our alumni, patients and friends help us to train our sta in the latest surgical techniques, to make advances in surgery through research and to achieve the best possible outcomes for patients. When you make a gift to the IU Department of Neurological Surgery, you enable our medical team to provide the most advanced care and make a dierence for every patient and family member we see. There are many ways to support the Department of Neurological Surgery, including annual giving, creating endowed funds and gifts of assets. If you would like to discuss how you can be part of this critical work, please contact any or all the representatives.IU Foundation: Andrea Spahn-McGraw at anspahn@iu.eduor 317-278-2124IU Health Foundation: Heather Perdue at hperdue@iuhealth.orgor 317-962-2207Riley Children’s Foundation: Liz Elkas at riley@rileykids.orgor 317-634-4474The new IU Health Hospital and IU School of Medicine Medical Education and Research Building in downtown Indianapolis will combine adult services into one location with inpatient and observation beds, a full-service outpatient center, on-site faculty oces and a state-of-the-art medical education facility. We are creating a new model of care for our community.This will enhance ongoing collaboration with the Indiana University School of Medicine and support the mission of clinical care, research and education.New Medical Education and Research Building at IU School of MedicineIU Health New Downtown Indianapolis HospitalBUILDING THE FUTURE

INDIANA UNIVERSITY DEPARTMENT OF NEUROLOGICAL SURGERYDEPARTMENT OF NEUROLOGICAL SURGERY355 W. 16th StreetGoodman Hall Suite 5100Indianapolis, IN 46202Phone: 317-963-1300https://medicine.iu.edu/neurological-surgery