ANS PHYSICIANS HAVE BEEN TRAINED AT SOME OF THE MOST PRESTIGIOUS PROGRAMS

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1 JULY 2012 Atlantic NeuroSurgical Specialists Pioneers of Advanced Technologies in Brain, Spine, and Neurovascular Surgery After more than 50 years ANS Continues as New Jersey s Leader in Providing Innovative, Supportive and Compassionate Care to Patients and Their Families

2 Atlantic NeuroSurgical Specialists Pioneers of Advanced Technologies in Brain, Spine, and Neurovascular Surgery After more than 50 years ANS Continues as New Jersey s Leader in Providing Innovative, Supportive and Compassionate Care to Patients and Their Families By Iris Goldberg Anyone who has been stricken with a disorder of the brain or spine knows how drastically life can change as a result. Whether from a life-threatening illness such as a brain tumor or stroke, or from a disabling condition like Parkinson s disease or something as common as chronic back pain, the life of the patient and that of his or her family may be significantly affected. Obtaining treatment from physicians who are exceptionally trained and highly skilled can make a dramatic difference in that patient s ultimate outcome. Choosing a practice that prioritizes the importance of providing its patients with a positive overall experience throughout the course of that treatment can be immeasurably important in terms of helping the entire family progress through the process with greater ease and less anxiety. photography by Michael Goldberg Based in Morristown and with additional offices conveniently located throughout New Jersey, Atlantic NeuroSurgical Specialists (ANS) is the largest private neurosurgical practice in the state. Comprised of a group of sub-specialized neurosurgeons who have been trained at some of the most prestigious programs in the country, ANS is affiliated with the leading local hospitals and major health systems throughout New Jersey. ANS PHYSICIANS HAVE BEEN TRAINED AT SOME OF THE MOST PRESTIGIOUS PROGRAMS The Physicians THE BARROW INSTITUTE, COLUMBIA of UNIVERSITY, ANS CORNELL UNIVERSITY, MASSACHUSETTS Jonathan J. Baskin, MD, FACS Dr. Baskin John H. Knightly, MD Dr. Knightly is a ANS PHYSICIANS HAVE BEEN TRAINED AT SOME is OF a fellowship THE MOST trained in PRESTIGIOUS spine surgery and PROGRAMS IN THE fellowship NATION trained spine INCLUDING surgeon who ANS PHYSICIANS HAVE BEEN TRAINED AT SOME specializes OF THE in MOST minimally PRESTIGIOUS invasive and complex PROGRAMS IN THE specializes NATION in complex INCLUDING and minimally invasive THE BARROW INSTITUTE, COLUMBIA UNIVERSITY, CORNELL UNIVERSITY, MASSACHUSETTS GENERAL AND MOUNT SINAI. THE ANS BARROW PHYSICIANS INSTITUTE, HAVE COLUMBIA BEEN TRAINED UNIVERSITY, AT SOME CORNELL spine OF surgery, THE MOST tumors UNIVERSITY, of PRESTIGIOUS the spine, imageguided OF THE neurosurgery MOST UNIVERSITY, for PRESTIGIOUS brain tumors, MASSACHUSETTS PROGRAMS GENERAL IN trauma, THE NATION Cyberknife AND MOUNT stereotactic INCLUDING SINAI. surgery, and MASSACHUSETTS PROGRAMS GENERAL IN spine THE surgeries. 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3 Since its establishment in 1958 by Henry Liss, MD, ANS has devoted itself to the treatment and management of patients with the full spectrum of neurosurgical disorders, performing surgical procedures involving the brain, spine/peripheral nervous and neurovascular systems. Treatments and conditions include: Aneurysm/Neurovascular Artificial Disc Replacement Back and Spine Pain Back and Spine, Complex Surgery Brain and Spine Tumors Brain Endoscopy Brain Mapping Brain Stimulators Cranium, Minimally Invasive Neurosurgery Endovascular Neurosurgery Essential Tremor/Parkinson s Facial Pain/Trigeminal Neuralgia Functional neurosurgery Head Injury Hydrocephalus Kyphoplasties Minimally Invasive Spine Surgery Neck Pain Neuro-Oncology Pain Management Peripheral Nerve Disorders Physiatry and Rehabilitation Medicine Pituitary Disorders Radiosurgery Seizure Surgery Spasticity Stroke Treatment (For detailed information on each, visit At ANS the goal is to provide patients with access to a multidisciplinary and comprehensive approach to the surgical and in many cases, non-surgical treatment of disease. Besides its mission to provide excellent neurosurgical care, utilizing the most advanced technologies, the fundamental philosophy at ANS is to ensure that every patient has an exceptional experience that includes open, direct and supportive interaction with clinicians and in fact, with each staff member involved in his or her care. Thomas J. Wood, BS RT CIT is Director of Marketing / Outreach / Education at ANS. He shares the somewhat unique ideals upheld at ANS that separate it from a number of other practices. We want people to know that surgery is the last option here, Mr. Wood emphasizes. We have a huge network of specialties, including physical therapy and pain management that we can try before And we re known for this. That s why we are so busy, he adds. If you come here for treatment, it doesn t necessarily mean that you will end up having Another interesting and unique piece of information that Mr. Wood would like to share with referring physicians and prospective patients is that ANS runs one of the largest brain tumor support groups in the state. We started the ANS Center for Hope Foundation about a year ago with eight brain tumor patients, Mr. Wood relates. We now have over fifty or more attendees at each monthly meeting, he adds. Mr. Wood goes on to explain that the meetings are not only for ANS patients. All brain tumor patients are welcome. Hope means different things for different people. Yes, it can be hope for a cure but in many cases that doesn t happen. So, there can be hope that you won t suffer or hope that family members won t have to watch you suffer, or, perhaps hope to tolerate chemotherapy without feeling too ill. So, hope for everyone is different and that s what the name refers to, Mr. Wood points out. All of the information concerning the Center for Hope Foundation is available at the website designed by ANS for patients and their families. Certainly one of the most unique and impressive facts about ANS is that the neurosurgeons in its endovascular division treat the largest number of ischemic and hemorrhagic strokes statewide, having affiliation with the three major comprehensive stroke centers in New Jersey. All three centers receive patients who can be transported from any of the facilities within each of their own health systems. As a result, the vast majority of stroke victims within the state can have access to the experienced endovascular neurosurgeons at ANS who are on call 24/7. Utilizing the most advanced technologies and techniques, the ANS surgeons quickly determine the precise location of the stroke, its cause and resulting damage in order to initiate the appropriate treatment as soon as possible. In a great number of cases, this is accomplished before damage is irreversible. Ronald Benitez, MD, President of ANS and Director of the Endovascular Division, has taken over the reigns recently to guide the group and continue its success during these changing times in medicine. For Dr. Benitez, the first priority has always been the patient. We must understand that although we treat illness, we are treating the person, he states. Dr. Benitez shares that the effort spent by ANS to ensure that patients have a great over-all experience, helps patients to feel supported throughout their treatment. Dr. Benitez We created the largest private practice in the state but we still keep those oldtime values ever-present in all we do, he informs. With expertly-trained physicians from the most elite programs in the country, Dr. Benitez explains that ANS can offer its patients the highest level of subspecialized expertise. We use a collaborative approach in everything we do from the minute a patient enters our offices, Dr. Benitez emphasizes. We know neurosurgery is very scary, so we make sure to give our patients the answers they need and offer them next generation treatments, he elaborates. ANS is so successful because we go the extra mile for our patients to make certain each person gets the best treatment possible, even if surgery is not an option. ANS neurosurgeon Kyle T. Chapple, MD sub-specializes in endovascular neurosurgery, minimally invasive, complex spine surgery and also neurovascular skull base His specialties include the treatment of cerebrovascular diseases such as stroke, aneurysms and arterial venous malformations (AVMs). We are uniquely situated with the

4 amount of people we have doing this, to be on call twenty-four hours a day seven days a week, Dr. Chapple reports, referring to the other neurosurgeons at ANS, in addition to himself, that are specialty trained in the treatment of cerebrovascular diseases. In fact, Dr. Benitez and Dr. Chapple, along with David Wells-Roth, MD are often called upon by physicians and hospitals statewide to intervene on some of the most complex endovascular and vascular neurosurgical cases. Dr. Wells-Roth makes a point of emphasizing the significant advantages for stroke patients who are treated by the physicians of ANS. There are not many places in New Jersey that have the infrastructure to treat strokes on an emergent basis 24/7, he mentions. Additionally, the volume of stroke patients treated by ANS throughout the state provides the ability to access the latest technology available. For example, for the past six months, Dr. Chapple and his colleagues at ANS have been amongst the first endovascular neurosurgeons to use a newly FDAapproved device that can actually remove the clot from the blocked artery. A stent retriever is deployed inside of the clot, expands to open the clot and re-establish blood flow and then, grips the clot and pulls it out. It s remarkable how well this device re-opens vessels, how much clot we can get out and how successful these procedures are now becoming, Dr. Chapple exclaims. A hemorrhagic stroke, that results from a ruptured aneurysm, although less common than an ischemic stroke, is also emergent. Dr. Chapple, Dr. Benitez and Dr. Wells-Roth are specialty trained to treat the aneurysm in the endovascular suite from inside the blood vessel by filling it with special coils, or by taking the patient to the OR and doing an open craniotomy. During the open procedure a clip is placed across the blood vessel. Although things are evolving, it still is a rarity to find neurosurgeons that are able to do both, Dr. Benitez states, reiterating that ANS is uniquely equipped to offer exceptional care. Edward J. Zampella, MD, FAANS, FACS is one of the two most senior members of ANS and as such is well-suited to discuss the aspects of the practice that distinguish it. He shares how ANS has evolved over the years, becoming more sub-specialized with each of the neurosurgeons all with advanced specialty training - to join. This is really the great thing about our practice, Dr. Zampella emphatically states. We see the patients and make sure they are directed to the appropriate physician. Dr. Zampella sub-specializes in the surgical management of brain and tumors, cord stimulation, intra drug infusion, neurosurgical treatment of movement disorders, epilepsy, stereotactic radiosurgery and Cyberknife He co-chairs the ANS Center for Hope Foundation along with Brian Beyerl, MD, FACS, who also specializes in brain tumor treatment and Cyberknife Once deployed inside the clot, the stent retriever expands to open the clot and reestablish blood flow. Then, it grips the clot and pulls it out. Dr. Chapple performs an aneurysm repair using a surgical microscope. The aneurysm is exposed.

5 Another unique specialty ANS offers is deep brain stimulation (DBS) for Parkinson s disease. This makes an enormous difference in patients lives, Dr. Zampella states. He would like neurologists and other physicians in New Jersey with Parkinson s patients to know about DBS, which uses a surgically implanted neurostimulator to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal signals that cause tremor and other symptoms of Parkinson s disease. This technology is greatly underutilized, he says, alluding to the preference amongst many physicians to treat the symptoms of Parkinson s with oral medications. Although medications do work in the early stages, there comes a time that the side effects of the medications make them more problematic than beneficial, Dr. Zampella asserts. There is a huge population of patients out there who would be eligible to benefit from this procedure, he emphasizes. Dr. Zampella While discussing his own specialized skills, Dr. Zampella again shares the diversity of specialization within ANS. I think what makes us great is that we have experts in every area of neurosurgical practice, he offers. And when patients come here they will be referred to the physician who is the expert on their particular condition. Specialty trained in complex and minimally invasive spine surgery, ANS neurosurgeon, John J. Knightly, MD shares some of the specialized treatment services available at ANS from his perspective. We do the complete breadth of spine surgery, from simple disc-type operations all the way up to complex scoliosis and tumor work and trauma work, as well, Dr. Knightly shares. During an open procedure, a clip is placed across the blood vessel. There are very few things in our chest of tools that we don t have to offer, he continues. Where we really excel is from a diagnostic standpoint, Dr. Knightly adds, mentioning that a great many people have degenerative changes in their back that may not be responsible for the pain they are having. Back surgery has gotten a bad reputation which is welldeserved because people are having the wrong procedures done at the wrong time for the wrong indications, he strongly asserts. Our mantra here is make sure the symptoms match the physical findings and match the x-ray findings. Then you can craft an appropriate treatment regimen for the patient, Dr. Knightly states. We pride ourselves on being diagnosticians first and proceduralists second, he reports. In fact, as Dr. Knightly explains, at ANS, many times surgery is not the answer and other, more conservative treatment modalities are utilized. Even when a procedure is indicated, in most cases Dr. Knightly would much prefer starting with one that is minimally invasive. We can always do a bigger operation but we can t undo a big operation. Once you perform a fusion on a patient, you have changed the mechanics in the back forever, he says, adding that between 80 and 90 percent of the spine procedures Whether less invasive or open spine surgery is required, the advanced sub-specialty training received by Dr. Knightly and the other fellowshiptrained spine surgeons: Jay Y. Chun, MD, PhD, Jonathan J. Baskin, MD, FACS, Charles Blair Stillerman, MD, FACS and Scott Meyer, MD - plus access to the latest technologies, translates into the best possible outcomes. Dr. Meyer, for example, in addition to his expertise in complex and minimally invasive spine surgery, has extensive clinical experience in treating adult deformity (kyphosis and scoliosis). Dr. Meyer shares that in most cases he spends up to a year or longer with patients overseeing non-surgical treatments such as physical therapy, oral medications and injections in order to avoid Dr. Knightly and Dr. Chun.

6 I really enjoy this extended period of time because I get to know the patients very well, he offers. When, however, a surgical procedure to correct a deformity becomes necessary, Dr. Meyer makes every effort to choose an approach that is as least invasive as possible. It depends on what the goal of the surgery is, Dr. Meyer says, regarding how to determine whether a procedure can be done minimally invasively or if an open surgery is necessary. Of course, the priority is to eliminate pain that has resulted from the deformity and restore a better quality of life. Sometimes, when a patient has a mild scoliosis, instead of a large, open surgery to decompress the nerve, I can do a minimally invasive nerve root decompression, he explains, adding that this is accomplished through a small tube. This spares a lot of the midline structures so that the scoliosis curve doesn t get worse, Dr. Meyer elaborates. If a patient needs a bit more than this, there are other minimally invasive ways to correct the deformity, informs Dr. Meyer. For example, he discusses Extreme Lateral Interbody Fusion (XLIF). This procedure entails having the patient lying on his or her side. Dr. Meyer goes behind the abdomen to the lateral part of the spine and inserts an intervertebral device that straightens the spine. This provides improved intervertebral body height and improved neural foraminal height for patients with scoliosis. Dr. Meyer also points out, that with the XLIF, if a subsequent posterior procedure becomes necessary, often there will be less work for him to do. Although most deformities are degenerative, sometimes a patient can develop a deformity as a result of a prior back At times, Dr. Meyer sees patients who were previously treated by other surgeons. Often, they require a revision of a fusion or other procedure to correct a deformity or other resulting problem. I find these cases to be very challenging and also rewarding, Dr. Meyer shares. In fact, he, Dr. Knightly and the other spine surgery specialists at ANS often treat patients who have had unsuccessful procedures elsewhere. It is important for prospective patients and referring physicians to understand the mission that has emerged at ANS over time, in terms of how its patients are treated. It is the philosophy that has become the foundation upon which ANS stands and what truly distinguishes it from other practices. Every one of the 52 people who are employed here is taught that the patient comes first, before any of the business issues, states Maryann F. Gomez, Director of Operations at ANS. In addition to her focus on practice management and development, Ms. Gomez has spent the past 15 years making sure patients know that regardless of which insurance they have or what their financial situation is the priority at ANS is to provide them with whatever treatment is necessary to ensure the best possible outcome. Unfortunately, in order to have the ability to do just that, the physicians of ANS felt compelled to withdraw from some of the insurance networks that were tying their hands by refusing to cover, or substantially reducing coverage for certain crucial clinical services. Especially for the critically ill, such as those with malignant brain tumors, or tumors of the spine, restricting how they could be treated was unacceptable. So that the neurosurgeons at ANS can provide care to those who desperately need it, Ms. Gomez and the expert staff of billers and certified coders at ANS work tirelessly, especially for those out of network patients, to overcome the financial obstacles. While ANS does participate with Medicare, Medicaid, Beech Street, Multiplan and QualCare, Ms. Gomez explains that often patients with other major insurance plans are unaware that their carriers do have arrangements with Beech Street and Multiplan, usually indicated by a small logo on the back of the card that can be implemented. Even when patients are totally out of network, the insurance experts at ANS negotiate extensively with the company in question in an effort to obtain some reimbursement. When a balance remains, ANS sets up individuallydesigned payment plans with their patients that are structured specifically for each person s financial situation. To be able to tell patients to come here because our physicians are the best is not something we take lightly, Ms. Gomez says. You have to live up to that. For more information about Atlantic Neurosurgical Specialists call (973) or visit Dr. Baskin