Archive for July, 2012

Novalis TX is a linear accelerator utilizing high dose radiation to treat both intracranial and spine pathology.  Intracranial applications primarily include trigeminal neuralgia, tumors, craniopharyngiomas, hamartomas, epilepsy, and vascular malformations.  Spinal applications primarily include tumors and vascular malformations.

Like other stereotactic radiosurgical systems, Novalis TX offers a noninvasive way to treat pathology with ~1.5mm accuracy in an outpatient setting.  Unlike other systems such as Gamma Knife or Cyberknife, Novalis TX may have certain advantages.  Intracranial lesions can be treated using a stereotactic frame, or as a “frameless” procedure using a sophisticated image guidance system.  Additionally, extracranial applications exist, and the body may be treated circumferentially.  Probably the most unique attribute is the ability to treated lesions with a very conforming homogenous dose and sharp drop-off dose to surrounding tissue.  Numerous collimator options allow the radiation to be delivered in the traditional cylindrical fashion, or as a conformational beam, dynamic conformal arc, or IMRT.  This allows physicians to accurately treat non-spherical lesions with limited exposure outside the target.  Furthermore, the avoidance of purely cylindrical cones limits overlap of isocenters that produce “hot zones”, or non-uniform radiation doses within the target itself.

At the Medical Center of Aurora, we are thankful to have a Novalis TX on campus at the Rocky Mountain Cancer Center.  This technology is just another way our radiation oncologists, physicists, medical oncologists, and surgeons are able to provide the best cancer treatment to our patients.  Both Dr Adam Smith and John Oro are trained and certified in Novalis TX treatment.  Please contact our office today for more information at 303-481-0035.


Heat Stroke

HEAT STROKE– is generally defined as the inability of the body to cool down after physical activity. Persons most at risk for heat stroke include the very young child, elderly, persons who work outdoors in the heat, and persons who exercise in the heat of the day. Obesity can increase the risk of heat stroke. Persons who take certain medications, such as diuretics, blood pressure pills and diet pills are also at higher risk.        

The symptoms of heat stroke include: chills, weakness, dizziness, extreme muscle fatigue, nausea, shortness of breath, rapid heart rate, confusion and absence of sweating. If you feel these symptoms, stop activity immediately, drink water, rest in a cool place, and seek medical attention immediately if the symptoms persist. If left untreated, heat stroke can lead to damage to the kidneys, and other organs. True heat stroke is a medical emergency and treatment (call 911) should be sought immediately.        

 Take these precautions to help prevent heat stroke:

  • Drink at least 8-12 ounces of water- both before and after exercise. Take a full water bottle with you when you exercise, so it is readily available.
  • Drink electrolyte solution before and after extreme/strenuous exercise
  • Avoid drinking caffeine or alcohol
  • Wear light colored, loose clothing. Wear clothing appropriate to the temperature
  • Wear clothing with SPF >20
  • Stay out of direct sunlight if possible. If you feel yourself becoming too hot, rest in the shade and drink water
  • If possible, exercise early in the morning or late in the evening- avoid the heat of the afternoon.
  • Humidity decreases the ability of the body to cool down- exercise indoors during high humid times.
  • Do not participate in sports or exercise if you have a fever or upper respiratory infection
  • Remove helmet/padding and any excess clothing immediately if symptoms of heat exhaustion are noted
  • NEVER leave a child or pet in a hot car for any length of time– this can be life-threatening




Epilepsy Surgery

The surgical treatment of epilepsy is a valuable option for well-selected patients.  Patients who are not adequately treated with medications, who are proven to have a localized seizure focus, and who can accept the risks and consequences of surgery are candidates for surgery.  The most common location of seizure focus in adults is in the temporal lobe, where surgical removal is associated with a seizure-free rate of ~60-70%.  This patient population with temporal lobe epilepsy (TLE) has the greatest success rate from surgery.  A large study comparing surgery versus treatment with medications for TLE showed that 58% of the surgically treated patients were free of disabling seizures compared to 8% of the patients treated with medications alone.  However, treatment with medications is still first-line and surgery is reserved for intractable cases.  Most patients recover extremely well after surgery, including patients undergoing temporal lobectomy, with little disability attributable to the procedure.

Primary generalized (idiopathic) epilepsy is rarely aided by surgery, although vagal nerve stimulation (VNS) is an option.  Generalized epilepsy occurs when multiple different areas of the brain exhibit seizure activity, so no single area can be resected to decrease the seizures.  VNS involves placing an electrode around the vagal nerve, usually on the left side.  The theoretical mechanism of VNS is alteration of diffuse signals throughout the brain to suppress the generalized spread of seizure activity after it starts.

Other surgical treatments are tailor-made for specific problems.  Corpus callosotomy (CC) is used to stop the transmission of seizure activity from one side of the brain to the other.  Patients who suffer seizures that spread from one side to the other may suddenly fall to the ground during their seizure leading to a high risk for injury.  CC prevents this spread of seizure activity.  Hemispherectomy is a term used when the patient’s entire half of the brain is removed, or “disconnected” from the rest, when the entire side is dysfunctional due to widespread seizures.  Both CC and hemispherectomy are rare procedures used for very carefully selected patients.  Multiple subpial transection (MST) is another procedure that is used in carefully selected patients who have seizures that start in important areas of the brain that cannot otherwise be removed without causing extensive neurologic dysfunction.

New epilepsy research focuses on computer devices that are implantable.  These systems, such as Neuropace, use a computer to detect the very first signs of a seizure and then give a localized electric shock (similar to a cardiac defibrillator) to the part of the brain where the seizure is starting.  This then stops the seizure activity before it can spread to other areas of the brain.  Other implantable devices use a similar computer to detect the first signs of a seizure and then release an anti-seizure medication directly into the brain to disrupt the seizure activity.  These devices are still in early trials.

For a patient evaluation or possible surgical treatment of epilepsy, please call The Neurosurgery Center of Colorado at 303-481-0035 to make an appointment with Dr. Adam P. Smith, MD.


The temperature in Denver broke several records in June this year.  This is a sure sign that summer has arrived. If you are among the millions of persons who spend time outdoors during the summer, you need to be aware of the dangers of excessive heat exposure. Persons who work out in the sun every day (such as roofers, construction workers, road repair and lawn maintenance) are at higher risk for heat related health problems.

Heat Exhaustion is an illness that is directly related to exposure to high temperatures for an extended period of time. Persons at higher risk for heat exhaustion are those who exercise in the sun or during the highest temperatures of the day, and those who work outdoors in the heat daily. The main reason people experience heat exhaustion is due to dehydration (not enough fluid).

The common symptoms of heat exhaustion include muscle cramps, dizziness, headache, light-headedness, nausea, sweating and fast heart beat.

Ways to avoid heat exhaustion include:

  • Drink plenty of water- try to drink at least 8 ounces every 30 minutes
  • Avoid alcohol or caffeinated beverages
  • Wear sunscreen with a minimum SPF 30- reapply frequently
  • Wear a wide brim hat
  • Rest under shade or in a cool place every few hours
  • Wear clothing with SPF rating >20
  • Wear light color, loose fitting clothing
  • Avoid strenuous outdoor activities during the peak heat hours of the day

If you feel you have the symptoms of heat exhaustion, you need to take the following measures immediately

  • Move out of the heat to a cool area- in a shady spot or indoors with a fan or air conditioner
  • Drink plenty of water- do not drink beverages with caffeine or alcohol
  • Remove clothing that is damp
  • Take a cool shower
  • Wrap a cool towel around your neck

If the symptoms do not improve within 30 minutes of taking the above cooling measures, seek medical attention. Heat Exhaustion that is untreated can lead to Heat Stroke— check for future blogs on heat stroke