Think Neuro

Sometimes the best surgery is no surgery. That's what Howard R. Krauss, MD believes. Dr. Krauss is one of the four founders of Pacific Neuroscience Institute, and Director of the Pacific Eye, Ear and Skull Base Center. He is a surgical neuro-ophthalmologist specializing in diagnostic neuro-ophthalmology, including visual field analysis and optical coherence tomography, as well as strabismus, orbital and anterior skull base surgery.

If surgery is necessary, Dr. Krauss has the experience to provide minimally invasive treatments. He was a cofounder of the UCLA Skull Base Surgery and Orbitocranial Tumor Programs, and is presently active in skull base and orbital disease, and tumor care at PNI.

In 2001, Dr. Krauss and fellow PNI founder Dr. Chester Griffiths were the first in the world to devise and carry out Transnasal Image-Guided Endoscopic Orbital Tumor Surgery, a safer, less invasive and more efficacious approach to the management of orbital apex tumors.

Moyamoya disease is a rare neurovascular condition that can affect both children and adults and is caused by progressive narrowing or blockage of the major blood vessels supplying the brain.

The result is a lack of necessary blood flow to the brain, which can cause stroke, mini-stroke (TIA – transient ischemic attack) or bleeding into the brain. Numerous tiny vessels develop around the blockage in an attempt to compensate for the lowered blood flow, leading to a smoky appearance of these vessels on imaging. This smoky appearance is what gives the disease its name, as “moyamoya” means puff of smoke in Japanese.

Aditya (Adi) Iyer MD, MS, is a fellowship-trained neurosurgeon with a focus on vascular diseases of the brain and spine at Pacific Neuroscience Institute. As one of California’s few dual-trained neurosurgeons, Dr. Iyer is able to offer both minimally invasive open surgical techniques as well as incisionless catheter based procedures to treat patients with strokes, aneurysms, AVMs, tumors and pain.

For people with hearing loss, properly-fitted hearing aids can be a miracle, restoring sounds of life that have been lost to aging or disease. But sometimes hearing aids aren’t enough, or a patient’s hearing deteriorates beyond the devices’ capabilities. Then, it’s time to consider cochlear implants—small electronic devices that go beyond hearing aids. They bypass damaged hair cells in the ear and send electronic signals straight to the auditory nerve. Dr. Rebecca Lewis is an audiologist who specializes in evaluating patients who might be eligible for cochlear implants. Until recently, doctors installed the devices only after people had lost almost all of their hearing. But because hearing is crucial to social connection, and social connection is key to staving off dementia, the bar for cochlear implants is coming down. Anyone who has tried a few sets of hearing aids and still can’t understand conversation should consider cochlear implants, Dr. Lewis says. Listen to this episode to learn some fascinating things about how our ears and nerves allow us to hear the world, and whether you or a family member should consider cochlear implants.

Our multidisciplinary team is here to help you and your loved ones understand your condition and determine an optimal treatment plan. Because of our expertise, we treat many patients with the most challenging of pituitary and skull base tumors, including many with prior treatments (recurrent or residual tumors) and patients who have been deemed “non-operative."

Chordomas are rare tumors of the brain and spine that have limited surgical and neuro-oncological treatments. Learn about potential new treatment from a clinical trial published in 2023.

Transcranial magnetic stimulation (TMS) represents an exciting non-medication and noninvasive option for treatment of some brain health conditions, specifically TMS for depression. TMS works by using magnetic therapy in the form of magnetic field pulses to stimulate the brain’s nerve cells to alleviate the symptoms associated with depression. In addition, there is growing research exploring the effectiveness of TMS in other neurological conditions, including Alzheimer’s disease and other memory disorders.

At Pacific Brain Health Center, Dr. David Merrill offers TMS for depression using a MagVenture device. It offers a unique, short, 3 minute TBS (theta burst) protocol for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvements from prior antidepressant medication in the current episode.

In the wake of the COVID-19 pandemic, there’s another scourge raging in the U.S: loneliness. About 17% of Americans reported feeling lonely “a lot of the day yesterday,” when polled by Gallup earlier this year, and a staggering 41% of single people said they did. Doctors at PNI discover loneliness in their patients, often for specific causes that can be treated. Dr. Courtney Voelker, director of PNI’s Adult & Pediatric Cochlear Implant Program, sees patients with hearing so compromised that they can’t follow conversations with loved ones. Dr. Amit Kochhar, director of the Facial Nerve Disorders Program at PNI, has patients who are unwilling to socialize because their facial paralysis prevents them from smiling or expressing other emotions. And Dr. Shanthi Gowrinathan, Director of Psycho-Oncology at the Pacific Brain Health Center, works with patients struggling with depression from a cancer diagnosis. Each of them has tools to help. Dr. Voelker restores hearing with cochlear implants. Dr. Kochhar repairs facial nerves to restore facial function. Dr. Gowrinathan offers cognitive therapy, writing groups, and even horse therapy. Horses have some of the highest emotional intelligence in the animal world, and cancer patients often find relief from just being around them. Listen to this podcast to learn more about how PNI doctors are fighting the loneliness epidemic.

Jason W. Tarpley, MD, PhD is a board-certified neurologist with fellowship training in vascular and interventional neurology. He specializes in the clinical care of patients with neurovascular disorders and has specific interest in ischemic and hemorrhagic stroke, cerebral aneurysms, and carotid artery stenosis.

He is an investigator in many phase 2 and phase 3 clinical studies examining the safety and effectiveness of innovative therapies in stroke patients. He has published several papers and presented his research at domestic and international conferences. Dr. Tarpley serves as the Stroke Medical Director for Pacific Stroke and Neurovascular Center. He is also the clinical lead for Providence’s system-wide Clinical Stroke Research.

There are no specific diets that have been shown to reduce the progression of PD. However, there is good reason to believe that a well-balanced, nutritious diet would be best. In those without other medical conditions, the Mediterranean-DASH Intervention for Neurogenerative Delay (MIND) diet may be of benefit in Parkinson’s as well since both are neurodegenerative diseases such as Alzheimer's disease.

A brain aneurysm is also called a cerebral aneurysm or an intracranial aneurysm and refers to the same diagnosis. Muscular-walled tubes blood vessels called arteries are part of our circulation system. These tubes are how blood is conveyed from the heart to the brain, carrying oxygen and nutrients to support the brain and its functions. A diagnosis of a brain aneurysm means that a bulging, weak area exists in the wall of one of the arteries that supplies blood to the brain.

Sandra Narayanan, MD, FAHA, FANA, FSVIN, FAAN, is board-certified in neurology and vascular neurology by the American Board of Psychiatry and Neurology and CAST (Committee on Advanced Subspecialty Training)-certified in neuroendovascular surgery. She is a vascular neurologist and neurointerventional surgeon at Pacific Stroke & Neurovascular Center, Pacific Neuroscience Institute. She is director of the neurointerventional program and co-director of the stroke program at Providence Saint Joseph Medical Center in Burbank.