UB, Kaleida Health neurosurgeons perform first-of-its-kind surgery in Western New York

BUFFALO, N.Y. – The pain was excruciating.

“It got to the point where I couldn’t walk and I was crawling around. I didn’t think I’d ever get any quality of life back,” says Patricia Lipowicz.

But then, earlier this month, neurosurgeons from the University at Buffalo and Kaleida Health performed a groundbreaking procedure, relieving Lipowicz’s intense pain. It is believed to be the first of its kind in Western New York and possibly upstate New York.

“It’s amazing. Considering where I was a month ago, I didn’t think I’d be here today,” she says.

A former nurse, Lipowicz, 58, has advanced cervical cancer that progressed aggressively despite several regimens of chemotherapy. Over the past few months, she had been suffering from intensifying pain in her pelvis and shooting, radiating pain in both legs due to a pelvic tumor involving the sacrum and L5-S1 vertebra encroaching on nerve roots exiting the spine.

“It was unbearable. I was crying all the time, on the floor crawling to get from point A to point B. I never thought I’d walk again,” she says, adding that the pain affected her mood, sleep, social interactions and ability to enjoy life. She even missed part of her oncological treatment sessions due to severe pain.

The team from UB Neurosurgery (UBNS) and Kaleida Health, in collaboration with palliative care colleagues at Buffalo General Medical Center/Gates Vascular Institute, gave her a chance, offering a unique procedure called stereotactic cingulotomy.

“It’s a type of brain surgery that aims to interfere with pain networks, reducing the perception of pain sensations,” says Assaf Berger, MD, who performed the procedure at Kaleida Health’s Buffalo General Medical Center/Gates Vascular Institute. Berger is an assistant professor in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at UB and a neurosurgeon with UB Neurosurgery.

“The surgery can be done while the patient is awake or under general anesthesia, and involves inserting fine radiofrequency electrodes to the dorsal anterior cingulate cortex, a structure located deep within the brain,” Berger adds. “This is done with the precise guidance of a sophisticated neuro-navigation software and stereotactic coordinates frame. After verifying the accurate positioning of each electrode, we perform thermal ablations of the cingulate cortex on each side of the brain.”

There are only a few centers around the country that perform this type of procedure for this patient population, according to Berger.

“I am thrilled about this groundbreaking achievement, which underscores our commitment to pioneering neurosurgical interventions and enhancing our patients’ quality of life,” said Allison Brashear, MD, UB’s vice president for health sciences and dean of the Jacobs School. “My congratulations go to Dr. Assaf Berger from Functional Neurosurgery and Stereotactic Radiosurgery at UB Neurosurgery. This is a significant milestone for UB, the Jacobs School, Kaleida Health and our entire health care community.”

Berger is quite familiar with stereotactic cingulotomy. During his residency at Tel Aviv Medical Center, he was trained by Ido Strauss, MD, who built a center for intractable cancer pain — essentially, pain that is difficult to treat or manage with standard medical care — in collaboration with pain and palliative care physicians.

Berger also co-authored with Strauss a paper in the Journal of Neurosurgery on neurosurgical ablative procedures for intractable cancer pain. He hopes to build a program in Buffalo similar to the one at Tel Aviv Medical Center. Before moving to Buffalo, Berger completed two fellowships in stereotactic radiosurgery and functional neurosurgery at NYU Langone in New York.

“Cingulotomy is just one example among several neurosurgical procedures for cancer pain, and our first patient demonstrates the proof of concept for our abilities to help those who seem to be hopeless,” Berger says.

Berger was a critical recruit to the Jacobs School, bringing novel skillsets and cutting edge clinical advancements to Western New York, says Elad I. Levy, MD, professor and chair of neurosurgery for UBNS and L. Nelson Hopkins Endowed Chair of the Department of Neurosurgery in the Jacobs School.

“UBNS has an  international reputation of excellence and embracing leading edge technologies. We are, therefore, able to recruit neurosurgical luminaries to Western New York, providing our community with care available at only a few select centers around the globe. “With Dr Berger, UBNS continues to enhance patient outcomes with technological innovation,” Levy says.

Lipowicz’s recovery from surgery has been excellent. She plans to do rehab to get back on her feet.

“It’s amazing. I didn’t think this would happen. I honestly didn’t believe it could happen,” she says.

Lipowicz also plans to resume her cancer treatment. She says she has twinges of pain occasionally, “but nothing compared to what it was. I’m blessed. I’m just so grateful.”

Lipowicz’s care was a collaborative effort that included the operating room nursing and anesthesia staffs, as well as John Patti, MD, a Jacobs School alumnus and president and CEO of Infinity Medical of WNY, which provides hospitalist services at both Buffalo General Medical Center/Gates Vascular Institute and Millard Fillmore Suburban Hospital; Jonathan Riley, MD, assistant professor of neurosurgery in the Jacobs School and the director of functional neurosurgery at UBNS; and Jafar Siddiqui, MD, an interventional pain management specialist with UBNS.