Current Research Projects

Current Research Projects

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Carilion's neurosurgery team is dedicated to advancing patient care through integrated clinical research. Our team members actively participate in and/or originate research projects to discover new ways to prevent disease, diagnose illness, and treat patients. Some of our current research projects include:

  • Morphological characteristics of aneurysms prone to clinically significant coil compaction. Logan, Simonds. Poster presentation ACOS 2012. Retrospective evaluation of what types of aneurysms are more likely to fail initial endovascular obliteration. Manuscript in preparation presented ACOS. Logan, Simonds, Krishner
  • Deep wound contamination and downstream major infection in complex spinal surgery. McNeal, Marvin, Sawvel, Qandah, Simonds. IRB approved. Acquiring data. Is there a correlation between deep wound intra-operative bacterial contamination and eventual major infection in large scale spinal surgery. McNeal, Synkowski, Pricket, Kirshner. IRB approved.
    • Superficial wound contamination and downstream major infection in complex spinal surgery. Sawvel, Danison, Synkowski, Qandah, Simonds. IRB in preparation. (A variation of above.)
  • Impact of antiplatlet and anticoagulant therapy on care of neurosurgical patients. Danison, Logan, Prickett, Elias, Simonds. In design. Retrospective study of patients hospitalized with intracranial hemorrhage and the impact antiplatlet and anticoagulation therapy has had on their outcomes.
  • Depression and anxiety in brain surgery patients. Syncoski, Marvin, Simonds. IRB in preparation. Similar to a completed study of ours of depression and anxiety in back pain patients. Uses a quick simple inventory and hopefully will help direct patients to appropriate care. Logan, Krishner. IRB accruing.
  • Brain tumor chemotherapy resistance on the molecular pathology level. IRB in preparation. Collaborative project with VTCRI molecular characteristics of brain tumor cells that may lead to their resistance to chemotherapy agents. Multi-phased study of Dr. Sheng. We will provide fresh specimen on a regular basis and lab support.  Prickett, Rogers, Synkowski, Danison, Simonds, Sheng (VTCRI). IRB
    • Medulloblastoma chemotherapy resistance on the molecular pathology level. Synkowski, Prickett, Simonds, Sheng. IRB in preparation. See above.
  • Cognitive deficits following major spinal surgery. Danison, A study of potential significant impact precipitated by anecdotal observations of several patients’ family members - that there seems to be a cognitive decline in some patients undergoing major spinal surgery. Presumably we will involve neuropsych and MRI imaging. Synkowski, Fraser, Simonds. In design.
  • Exposure density of neurosurgical attendings and residents to tragedy and human suffering. We are interested in the effects of a neurosurgeon’s constant exposure to human tragedy and suffering. Initially we want to quantitate the exposure and then study the psychological and performance impact of the exposure on the surgeons. Prickett, Sawvel, Danison, Simonds.
    • Impact of exposure to human suffering on neurosurgical residents. Sawvel, Danison, Simonds. In design. See above.
  • Ethical dilemma density in everyday neurosurgical practice. We plan an ongoing tally of the volume and types of ethical decision making made by neurosurgical residents and attendings, and to subsequently study the potential repercussions of such decision making. Synkowski, Simonds. In design.  
  • Waste production in standard neurosurgical procedures. Synkowski, Prickett, Simonds. In design. An evaluation of waste generation of typical neurosurgical procedures and identification for opportunities to limit such generation. Synkowski. Acquiring data.
  • “Maximal neurosurgical benefit” – additional patient hospital days beyond what is deemed neurosurgically necessary. We plan to identify patients who remain hospitalized beyond their neurosurgical needs and identify reasons behind these stays. We will also evaluate for added morbidity due to prolonged stays as well as enumerate related incidents of patient and family dissatisfaction. Sawvel, Danison, Marvin, Simonds. IRB in preparation. Chine, Eric
  • Predictive value of neurological exam and CT findings in patients with minor structural head injuries. In preparation. We will retrospectively study the outcomes of patients referred in to our institution for minor structural head injuries and evaluate whether neurological findings and/or initial CT findings can accurately predict stability vs. deterioration. Sawvel, Synkowski, Simonds. In design.
  • Impact of gross motor manipulation on fine motor performance. McNeal, Synkowski, Bircher (VTCSOM student), Simonds. Initial study completed and presented ACOS 2011. Second stage in preparation for IRB. Generated from an internal grant- a mini-lab that quantitates fine motor performance. We vary conditions and evaluate the impact on dexterity. Initial studies demonstrated a detrimental effect of heavy gross motor movement on subsequent fine motor tasks. We are refining this study, expanding the assays, and altering the variables. We plan to thoroughly study the variables that could impact upon surgical fine motor performance. Rogers.
    • Impact of major spinal surgery manipulation on fine motor performance. Synkowski, Bircher, Simonds. In design. See above.
    • Impact of clinically-related sleep deprivation on fine motor performance. Synkowski, Bircher, Simonds. In design. See above.
    • Impact of caffeine intake on fine motor performance. Prickett, Simonds. In design. See above.
    • Impact of aerobic exercise on fine motor performance. Simonds. In design. See above.
    • Impact of hunger on fine motor movements. Sawvel, Simonds. In design. See above.
    • Impact of cold on fine motor performance. Sawvel, Simonds. In preparation. See above.
    • Impact of related fine motor practice on fine motor performance. Danison, Simonds. In design. See above.
  • Pre-intervention patient knowledge base of low back pain disease and treatment. Marvin, Simonds. IRB approved. Data acquired. Presented at ACOS 2011. Evaluation of sophistication of patient knowledge with respect to low back pain. We established a large volume baseline and will study the effects of educational intervention on patient knowledge, outcomes, and satisfaction.
  • Negative pressure hydrocephalus. Sawvel, Danison, Fraser, Simonds. Review of Carilion experience with this poorly described phenomenon. Possible construction of model.
    • Impact of standardized educational packet on patient comprehension of low back disorders and their treatments and eventual patient outcome. Marvin, Prickett, Simonds. In preparation. IRB prepared. See above.
  • Outcomes in patients with minor structural head injuries - chart review and performance survey. Little is known or published about the long term impact on patients of minor head injuries that involve more than a concussion (positive but minor CT findings). We plan to gather data on several hundred such patients cared for by the neurosurgical and trauma teams over the past few years. We hope to qualify for grants for prospective studies. Sawvel, Synkowski, Simonds.
    • Outcomes in patients with minor structural head injuries - cognitive and neuropsychological performance. Sawvel, Synkowski, Danison, Prickett, Simonds. In design. See above.
  • Impact of A-line transducer positioning on recording and manipulation of cerebral perfusion pressure in brain injured patients. Danison, Simonds. IRB complete. Resident generated challenge to neurosurgical dogma - where exactly should an arterial line be transduced to reproducibly generate a cerebral perfusion pressure value.
  • Prediction OC bracing failure in treatment of cervical spine fractures. Marvin, Simonds. Poster presentation (award winner) ACOS 2012.  Evaluation of a subset of cervical spine fractures that are more prone to bracing therapy failure.
  • Establishment of brain tumor bank at Carilion Clinic research laboratory. Qandah, Simonds.  In discussion. Carilion neurosurgery performs high-volume tumor surgery. We would like to establish a bank of tissue for downstream investigational study. There are resources available at the Carilion Clinic research lab.
  • Response of spinal multi-level internal fixation constructs to High G impact. Qandah, Simonds. In design- with VCOMM, Virginia Tech impact sled lab. An impact sled lab is available at VCOMM/ Virginia Tech. We would like to study the response of complex spinal instrumentation in cadaveric spines to sudden, High-G impacts (as opposed to typical repetitive stress models).
  • Multi-level anterior locking plate vs. multiple single-level zero profile plate fixation- clinical study. Simonds, Qandah. Globus Medical grant. IRB submitted. Institutional grant negotiations in process. A multi-centered industry grant study funded by Globus Medical.
  • Obesity and other co-morbidities in the care of the neurosurgical patient. Synkowski, Danison, Simonds. IRB in preparation. Medical mistake literature does not take into account the significant co-morbidities of patients undergoing complex neurosurgical care. We plan to quantitate and characterize the co-morbidities of neurosurgical patients and study the impact on complications and outcomes these co-morbidities may have.
  • The effects of obesity in the operative positioning of neurosurgical patients. Prickett, Simonds. In design. Operative positioning of neurosurgical patients often requires significant patient manipulation, lifting, and turning without any mechanized assistance. Such positioning can be a challenge for an operating room team with potential patient and staff injury. Profound obesity complicates matters further. We plan initially to quantitate the degree of the problem, the variety of weights lifted by individual operating room staff, and the biomechanics involved in standard neurosurgical positioning. We hope to then evaluate how to  ameliorate the difficulties and risks involved in positioning these, and all patients.
  • Predictive value of tender spine in trauma patients. Synkowski, Sawvel, Simonds. In preparation. A typical trauma survey of an injured patient involves the trans-cutaneous palpation of their spine. It is unclear whether this maneuver adds anything to the evaluation of a trauma patient in this era of rapid CT spinal column analysis. It may also incur some patient risk. We plan to perform the exam on all neurosurgically consulted patients and compare with CT findings.
  • Adjacent level junctional kyphosis - relationship to instrument construct. Danison, Qandah. Testing various constructs using range of motion assay system at Globus Medical research center.
  • Fungal intra- and extra-dural infection following epidural steroid injections, clinical series. Logan, Elias, Simonds. Study of recent severe fungal spinal infections treated at Carilion.
  • Tricalcium phosphate vs. tricalcium phosphate and bone marrow aspirate in spinal fusion, a clinical study. Marvin, Danison, Qandah. Evaluation of fusion quality using various graft materials.
  • Pain control in major spinal surgery using subcutaneous infusion pump. Synkowski, Qandah. Evaluation of pain control via quantization of PCA use and pain scales in spinal surgery - using a percutaneous analgesic pump system.
  • Transcranial doppler evaluation in brain death. Danison, Elias. Use of TCD as cooperative study in brain death patients.
  • CV Stroke volume variation analysis in aneurysmsmal sah patients.