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Huntington neurosurgeon touts procedure’s success

This diffusion tensor imaging shows the patient’s nerve, brain and other tissue matter surrounding the white mass, which makes it easier for surgeons to diagnose and treat their patients. Photo from Ericca Ardito

When Jean Noschese’s left hand started to go numb, she didn’t expect her doctor’s visit to lead to brain surgery at Huntington Hospital, where she met Dr. Robert Kerr, a neurosurgeon who had a new way of operating on the brain.

On Oct. 16, 2013, Noschese experienced a head-on collision while driving in Hauppauge. The car accident left her in need of several surgeries, including ones to repair her rotator cuff and replace her hip. But it was when she started losing sensation in her left hand, in 2014, that she went to a specialist. Noschese, who initially wondered if her issue with her hand was related to her crash, was rushed to the hospital after her hand specialist thought Noschese was experiencing a stroke.

But instead of a stroke, the doctors found a three-by-four-centimeter lesion on the right side of her brain that caused paralysis on the left side of her body. Her lesion wasn’t caused by the crash, but from Noschese’s breast cancer that had metastasized to her brain. Noschese was diagnosed with breast cancer in 2005.

Doctors wanted to perform brain surgery the following day, on Dec. 22, 2014, according to Noschese,

“It’s overwhelming to hear that you need brain surgery,” she said.

A large mass is located in the left hemisphere of the brain prior to the operation where Dr. Robert Kerr used Synaptive Medical’s BrightMatter Plan. Photo from Ericca Ardito
A large mass is located in the left hemisphere of the brain prior to the operation where Dr. Robert Kerr used Synaptive Medical’s BrightMatter Plan. Photo from Ericca Ardito

But Kerr, who met with Noschese when she entered the hospital, reassured her and reviewed the procedure with her. A new brain-mapping technique, using the Synaptive Medical’s BrightMatter Plan product, involves several new tools, including a highly engineered tube that splits brain tissue fibers and allows neurosurgeons to access difficult and deep parts of the brain easily. The procedure also utilizes a fiber optic, high definition telescope that creates a “cone of visualization” that allows surgeons to clearly view all planes of the brain they are working on.

The technique also features a procedure called the myriad, which uses a blunt suction device that peels off tumors from dangerous or sensitive areas without damaging surrounding areas in the brain.

“Traditionally, surgeries for deeper regions actually involve destroying a certain amount of tissue to get to the target area,” Kerr said.

According to Kerr, in traditional brain surgeries, metal retractors are used to create a pathway so surgeons can access target areas of the brain. Doctors use the retractors to pull the edges of the brain apart and create a pathway.

Kerr said the issue with this technique is that, regardless of how careful a surgeon is, he or she may still push on these retractors, which widens the pathway the surgeon created from surface of the brain to the target area. As a result, the patient is left with a hole in part of the brain, which means the patient will take longer to recover from the surgery.

Stony Brook Medicine Neurosurgeon Dr. David Chesler said Synaptive Medical’s BrightMatter Plan procedure is only appropriate under certain circumstances.

“Tumors that come right to the surface, where they’re easily approachable, I don’t think there’s any benefit to using this technique, because the tumor is right there,” Chesler said. Chesler took a course for the procedure about two years ago. While he thinks the technique is beneficial, he does not think it is a be-all and end-all procedure for brain surgery.

While the procedure is minimally invasive, may decrease the chance of injuring the patient during the operation and allows surgeons to approach lesions or blood clots, Chesler said there are some downsides to the technique. He said that the technology of this technique is not new, but simply creates a new system that makes it easier for surgeons to implement.

Additionally, minimally invasive procedures double or triple the length of an operation, depending on the surgeon and the nature of the surgery. Surgeons who may not be very experienced may leave parts of lesions or tumors and blood clots behind because of limited visualization.

A large mass is located in the left hemisphere of the brain has been removed with the use of Synaptive Medical’s BrightMatter Plan. Photo from Ericca Ardito
A large mass is located in the left hemisphere of the brain has been removed with the use of Synaptive Medical’s BrightMatter Plan. Photo from Ericca Ardito

Surgeons can only see what is at the end of the tube, which is around the diameter of a dime.

Kerr said this procedure will decrease patients’ recovery time. Patients are usually tired following the surgery and require extensive amounts of rest before they are discharged from the hospital. Noschese, however, was alert and speaking two hours after the surgery. Not only did she regain sensation in her hand, but she was also able to grab and hold onto a variety of objects.

Chesler, like Kerr, said patients who receive traditional surgeries for deep-seated lesions or blood clots can do well. He said his patients’ deficits were more related to the “structures involved with the tumor,” as opposed to the approach used. Chesler has seen both good and bad outcomes from this technique

According to Kerr, few surgeons are using this technique.

“Neurosurgeons are skeptics and slow adopters and I think that’s appropriate,” Kerr said, explaining why more surgeons may stick to traditional brain surgery practices.

While Chesler said the procedure should be used for the right case and with an experienced surgeon, he said staff are looking to adopt this technique at Stony Brook University Hospital. Chesler, who does both pediatric and adult neurosurgery, said he is simply looking for the right case. Recently he hasn’t come across a case that calls for the technique.

Doctors must demonstrate the procedure and illustrate its benefits when introducing the technique to the hospital. Hospitals need to invest in the procedure for a surgeon to officially implement it.

Although Chesler said there are other systems that surgeons can use to reach a similar goal, Kerr said the technique is a glimpse into the future of this type of surgery.

“I think this technology reflects the future of neurosurgery and accessing deep-seated lesions in a kinder, gentler, more precise way,” Kerr said. “I think this is representing a future paradigm shift in the way that brain surgery is done, and I think that we will see many more adopting this in a very short period of time.”

Stony Brook’s 100,000th baby Luca Michael Picarella cries in his mother’s arms at Stony Brook University Hospital. Photo By Giselle Barkley

It’s a boy. It’s also a major milestone.

Katie Picarella of Rocky Point was wheeled into the room with her new bundle of joy and her husband Mike and daughter Gianna, 5, to celebrate the birth of Stony Brook Hospital’s 100,000th baby, Luca Michael Picarella on Thursday, Aug. 20. And by the time she was wheeled out, she had much more than a new member to her family.

The hospital presented blue cupcakes surrounded several pink cupcakes that spelled “100K,” in the Stony Brook University Hospital’s lobby in celebration of the event.

Todd Griffin, chair of the department of obstetrics, gynecology and reproductive medicine, said he expected Katie Picarella to give birth near the end of August, and he was right. Attending OB/GYN and former Stony Brook student Julie Welischar delivered Luca the morning of Monday, Aug. 17.

Until a week ago the Picarella family was unaware of the news that Stony Brook was expecting its 100,000th birth.

Members of the hospital arranged blue and pink cupcakes to celebrate the 100,00th birth at the Stony Brook University Hospital. Photo By Giselle Barkley
Members of the hospital arranged blue and pink cupcakes to celebrate the 100,00th birth at the Stony Brook University Hospital. Photo By Giselle Barkley

“A friend of ours told us [that they] had been following this,” Mike Picarella said. “I started looking at it and [the friend] said, ‘you guys are getting close. It’d be funny if you guys are the couple.’”

But the expecting father said he was still surprised when the doctors informed him that his newborn son was the 100,000th baby.

The family didn’t just leave with their new baby boy, they also left with a gift basket, which awarded the Picarella family with $10,000 scholarship from the Island Federal Credit Union, a $2,500 scholarship toward tuition at the North Shore Montessori School, a $500 shopping spree among other gifts for the parents and their newborn.

Luca’s older sister Gianna, who was also delivered at Stony Brook, was also awarded with a brand new American Girl doll.

“Truly from the bottom of our hearts and all of our family’s hearts, we greatly appreciate it,” Mike Picarella said.

The entire Picarella family said they were thankful for the gifts and shocked by the news that they were the couple who birthed the 100,000th baby.

“Stuff like this doesn’t happen to us,” Katie Picarella said when speaking to the media. According to Picarella, the birth was scheduled for Friday after doctors realized Picarella’s baby would come before the end of August. But Picarella rescheduled the C-section delivery date because she wanted to have enough time to recover in order to attend her daughter’s Kindergarten screening.

The family of four also had the opportunity of meeting Jeff Solomon, who was the first baby born at Stony brook University Hospital on May 28, 1980 at 8:15 a.m. Solomon’s father Bob Solomon and step-mother Hope also attended the conference and met the family.

Before the family prepared to go home, Griffin highlighted the importance of the birth.

“For years the number of births on long island have been going down,” Griffin said. “We’re actually starting to see in the last year or two that the births have been going up.”

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A makeshift memorial is erected at the scene of the fatal Cutchogue crash. Photo by Phil Corso

Tragedy hit close to home over the weekend — countless lives were shattered when an alleged drunk driver slammed into a limousine carrying a group of eight young women, killing four who hailed from our own North Shore communities.

Saturday’s Cutchogue crash captivated communities near and far. Those who knew the women, and even those who didn’t, mourned, as the crash sent shock waves across the Island.

Brittney Schulman, Lauren Baruch, Stephanie Belli and Amy Grabina were friends, daughters, girlfriends, sisters and young women just starting their adult lives. Tragic doesn’t even begin to explain what happened on that Cutchogue road.

But the women weren’t alone, and the surviving four women, who remain hospitalized as of Monday, need our support.

At a press conference on Monday, Suffolk County District Attorney Tom Spota told a crowd of reporters, many of whom came from affiliate stations and out-of-town papers, to be reasonable, in light of a recent incident in which a member of the press entered the hospital in an attempt to see one of the survivors.

“We have four who survived, who certainly have suffered horrible, horrible trauma,” Spota said. “Not only bodily trauma, but certainly mentally. And we have people — reporters — who are trying to sneak in to talk to these young women. I just think that we really should — let’s all think about it and let’s be reasonable here.”

We find these actions disrespectful to the victims and survivors and their families and do not stand behind them. As journalists, we understand the responsibility news organizations have to inform the public about events such as this, but sneaking into a hospital room is excessive, and it is not right to serve a readership at a victim’s expense.

As a community newspaper, we are protective of the neighborhoods we cover because we live here. When we get word of car crashes, many of us have to wonder if a loved one was involved. What happened on Saturday could have happened to any one of us.

To the women recovering, the families affected and the communities trying to come to terms with these losses, we will still be here to listen if and whenever you are ready to speak. Our thoughts are with you.