Neurology & Neurosurgery

Baylor St. Luke’s Medical Center collaborates with Baylor College of Medicine to revolutionize neurosurgical approaches, find innovative uses for technology, and navigate new frontiers. With some of the best brains in neuroscience, our team manages patient care today while developing new treatments for tomorrow.

Pioneers in deep brain stimulation

A pioneer in deep brain stimulation, Baylor St. Luke’s Medical Center offers the most advanced means of treating Parkinson’s disease and essential tremor. As of 2019, our neurology and neurosurgery program has performed more than 600 DBS implants and manages one of the largest groups of DBS patients.

Our image-guided, robotic DBS implantation system achieves the highest degree of precision available. We offer both conventional, microelectrode recording-guided surgery (during which the patient is awake for part of the procedure) and asleep, image-guided surgery (during which the patient is sound asleep the entire time). We maximize outcomes and minimize side effects by incorporating the latest intraoperative adjuncts and most sophisticated DBS systems, including those with directional steering capability.

In 2016, Baylor St. Luke’s Medical Center was one of the first hospitals in the country to use the Infinity™ Deep Brain Stimulation System, an advanced treatment option for patients with Parkinson’s disease and essential tremor.

And in 2019, we became the first hospital in Texas to use the Vercise™ Gevia™ Deep Brain Stimulation Systems, featuring the Vercise Cartesia™ Directional Lead by Boston Scientific.

“The additional features of this DBS system allow us to better tailor stimulation to each patient’s needs. Because every patient is different, this greater degree of control will be very helpful for individualizing therapy, which translates into better symptom reduction and fewer stimulation-induced side effects for our patients."
Sameer Sheth, MD, PhD

Our team is internationally renowned for employing DBS to treat severe psychiatric illnesses, especially OCD and depression. In fact, Baylor St. Luke’s was the first in the world to use the Medtronic Activa RC+S DBS system in a patient with severe, treatment-resistant OCD as part of an NIH-funded research trial. This system is unique in that it allows the clinician to stream real-time brain recordings from the device in addition to providing stimulation. Dr. Sheth and Dr. Wayne Goodman, Chair in Psychiatry at Baylor College of Medicine, collaborated in the trial.

Sameer Sheth, MD, PhD

Neurosurgeon, Baylor St. Luke’s Medical Center
Associate Professor of Neurosurgery, Baylor College of Medicine

Revolutionizing tumor treatment and removal

As one of the most active pituitary centers in the nation with published superior surgical outcomes, we safely discharge over 90% of our pituitary surgery patients after just one night in the hospital. We utilize a multidisciplinary approach that combines patient management protocol with a less-invasive endonasal surgical technique in which surgeons enter through the nasal passage to remove the pituitary tumor. The patient management protocol emphasizes patient education, early mobilization, and scheduled inpatient and outpatient endocrine assessments that have been shown to decrease hospital stay, complications, and readmission.

The first in Houston to use CyberKnife^® technology to perform stereotactic radiosurgery in a clinical setting for the treatment of intracranial tumors, the Baylor St. Luke’s Medical Center team has built a legacy of advancing the standard of care with pain-free solutions. CyberKnife^® combines intelligent robotics and image guidance to provide a treatment that is so precise that radiation can be sculpted to small complexly shaped lesions near critical structure — including arteriovenous malformations, acoustic neuroma, trigeminal neuralgia, and ocular melanoma.

Benefits include:

Meet our team

The Neurosurgery Service at Baylor St. Luke’s Medical Center provides expert care for all conditions requiring surgical intervention. Our neurosurgeons are subspecialized in their respective specialties.

Ganesh Rao, MD

Marc J. Shapiro Professor and Chairman in the Department of Neurosurgery at Baylor College of Medicine

Dr. Ganesh Rao, Marc J. Shapiro Professor and Chairman in the Department of Neurosurgery at Baylor College of Medicine, focuses on primary and metastatic brain tumors using the latest available technology to treat patients with brain tumors.

Akash J. Patel, MD

Assistant Professor of Neurosurgery at Baylor College of Medicine

Dr. Akash J. Patel, assistant professor of neurosurgery at Baylor College of Medicine, focuses on the treatment of malignant and benign pathologies of the skull base. The skull base tumor program at Baylor St. Luke’s Medical Center provides multi-disciplinary and comprehensive care for patients. Due to their proximity to critical structures of the head, neck, and face, every patient requires meticulous preparation to create a customized plan that will allow for definitive treatment while preserving patient function. Every patient undergoes advanced diagnostic imaging and evaluation by a multidisciplinary team with expertise in treatment and reconstruction

Ali Jalali, MD

Surgical Director of the Pituitary Center at Baylor St. Luke’s Medical Center

Dr. Ali Jalali, surgical director of the Pituitary Center at Baylor St. Luke’s Medical Center, performs pituitary tumor surgeries on a regular basis. He also subspecializes in surgery for primary and metastatic brain tumors using advanced techniques, including robotic guidance and laser interstitial thermal therapy. He is skilled with endoscopy, awake surgery, and speech and motor mapping. To care for his brain tumor patients, Dr. Jalali routinely works with a team of physicians including neuro-oncologists, radiation-oncologists, ENT physicians, and endocrinologists.

Daniel Matthew Sholto Raper, MD

Dr. Daniel Matthew Sholto Raper, assistant professor in the Department of Neurosurgery at Baylor College of Medicine, leads the cerebrovascular and endovascular programs at Baylor St. Luke’s Medical Center. He is dual fellowship-trained in complex open vascular surgery and neuroendovascular surgery and specializes in multimodality treatment of complex aneurysms, arteriovenous malformations, cavernous malformations, and other vascular disorders of the brain and spine. He also specializes in treatment of carotid stenosis via both open and minimally invasive approaches. Dr. Raper uses his dual training and a multidisciplinary approach to provide a comprehensive set of treatment options with a strong focus on the patient’s safety at all times.

AI helps care teams make quicker, more accurate treatment decisions for stroke patients

For people who get to the E.R. after experiencing a stroke, every passing minute is critical in determining the cause, the type of treatment they receive, and their chances of surviving. Now, thanks to a software that uses artificial intelligence (AI) to analyze CAT scan images, stroke care teams can discover much more rapidly the viability of brain tissue in patients with suspected large vessel occlusion (LVO) strokes—ones caused by a blood clot in the brain—and what type of intervention will help them most.

Baylor St. Luke’s Medical Center was the first hospital in the Greater Houston area to adopt the software program, called Viz.ai, after it was approved by the FDA in February 2020. The Viz.ai program integrates with a CT scanner to review images rapidly. It can automatically identify a blocked blood vessel from a perfusion scan (a CT scan with dye) and then send the data about salvageable brain tissue through a massive alert to the smartphones of the patient’s care team. The software saves an average of 37 minutes from picture to alert, allowing the care team to intervene faster. Often, they can know the diagnosis before they are through with the examinations.

Viz.ai’s image analysis facilitates the fast and accurate triage of suspected LVOs in stroke patients, provides better collaboration between clinicians at comprehensive and referral hospitals, and decreases complications for the patients. Viz.ai synchronizes care across the whole care team, enabling a new era of “Synchronized Care” in which the right patient gets to the right doctor at the right time.

“Before, we had to make decisions on the fly or quantify the images from the CAT scan, which can take hours to complete. The Viz.ai software bypasses the guesswork and allows for early intervention, which results in improved outcomes for our patients,” notes Dr. Chethan P Venkatasubba Rao, medical director of the Neuroscience ICU at Baylor St. Luke’s Medical Center.

Brain implant gives epilepsy patients fewer seizures, new lease on life

A small device implanted in the brains of people with epilepsy can help them when other medications fail to reduce seizure frequency or severity.

The device, called the NeuroPace® RNS® System, has been used for the past decade to treat seizures that are not well controlled with antiepileptic drugs. Approved by the FDA in 2010, the device, once implanted, monitors the brain’s electrical activity, detects abnormalities indicative of seizure onset, and emits small electrical pulses to normalize brain activity and prevent the seizure from occurring.

Baylor St. Luke’s Medical Center has treated patients with epilepsy and partial-onset seizures (POS) with the NeuroPace® RNS® System since 2014. Having participated in the NeuroPace clinical trial, St. Luke’s Health is also the most experienced hospital system in the Houston area with this technology. It remains the only device that monitors and responds to brain activity to prevent seizures before they start.

Overall, patients with the implant experience a significant reduction in seizures and an improved quality of life, both physically and mentally, along with improved cognitive functioning. The device works best in someone whose seizures are in one location in the brain. And while patients with the implant may still need medication, they typically need lesser doses.

The longer the device stays in, the better it gets at recognizing and controlling seizures.

“It’s a smart device that’s actually learning about the brain activity, and over time, we are fine-tuning the detection so that it can be very sensitive and also discriminatory from the normal brain activity,” said Dr. Alica Goldman, Baylor College of Medicine associate professor of Neurology-Neurophysiology.

A new method of deep brain stimulation lessens motor impairment in Parkinson’s patients

Researchers at Baylor College of Medicine are investigating the effectiveness of higher-frequency deep brain stimulation (DBS) in controlling tremors and other disabling motor signs in patients with Parkinson’s disease.

Working with University of Houston biomedical engineer Nuri Ince, Ashwin Viswanathan, MD, and Sameer Sheth, MD, Ph.D., at Baylor College of Medicine have found that electrical stimulation of the brain at higher frequencies (>100 Hz) can immediately control the physical symptoms associated with the disease.

DBS has been the most important therapeutic advancement of the last several decades in the treatment of Parkinson’s disease, a progressive nervous system disorder that affects movement in 10 million people worldwide. With DBS, electrodes are surgically implanted in the deep brain to deliver the electrical pulses. However, finding the correct frequency has been time-consuming and imprecise, often requiring months to implant the devices and test them on the patient.

The research team found that higher-frequency stimulation (130-180 Hz), however, induces high-frequency oscillations (~300 Hz, HFO) similar to those observed with pharmacological treatment. Their method may speed up the time it takes to program the devices to the correct frequencies to an almost immediate response. DBS at higher frequencies promises to be an effective alternative to drug therapy and can be personalized to each patient.

Ashwin Viswanathan, MD

Medical Director of Neurosurgery and Director of Functional Neurosurgery
Baylor College of Medicine
Neurosurgery Service Chief
Baylor St. Luke’s Medical Center

Sameer Sheth, MD, PhD

Associate Professor, Cullen Foundation Endowed Chair, McNair Scholar, and Vice Chair of Research
Neurosurgery
Baylor College of Medicine

New research shows promise of DBS as an effective treatment for severe depression

DBS is also being explored as a possible treatment for severe depression. About 30% of the more than 250 million people worldwide with depression have symptoms that are unresponsive to medication or other standard treatments, such as electroconvulsive therapy and transcranial magnetic stimulation. DBS is not yet a federally approved treatment for depression. Previous studies have suggested there are benefits, but results have been inconsistent, and several trials of the devices in the past decade were halted after subjects showed no improvements.

In March 2020, a research team led by Dr. Sameer Sheth, Associate Professor of Neurosurgery at Baylor College of Medicine, began studying a patient’s specific brain activity pattern. Their goal was to identify which of billions of combinations of stimulation characteristics, like frequency and amplitude, would be the right one to disrupt or shift the neural activity to produce a healthier pattern that will ease depressive symptoms. Following that exploratory phase, the patient underwent surgery to implant the battery-operated device—about the size of a matchbook—in his brain. The device was calibrated to detect the neural activity pattern specific to that patient’s feeling of depression and then delivered pulses of electrical stimulation throughout the day to stave off depression.

To test for a placebo effect, researchers gradually stopped stimulation to one brain region without the patient knowing when. The patient’s depression became worse. After stimulation restarted, he improved, suggesting the effect is genuinely stimulation-related. After more than a year of using the device, the patient is now living a productive life and is nearly symptom-free.

Researchers are exploring whether stimulating for a brief period whenever depression begins keeps the brain from becoming accustomed to the treatment or if continuous stimulation is more effective. Researchers are also exploring whether the therapy can prompt lasting brain changes to eventually avert depression with little or no continuing stimulation.

While it may take years to learn if individualized approaches to DBS are effective enough to be approved for treating depression, researchers are hopeful that DBS holds the key to alleviating the symptoms of severe depression and eventually may even be used to treat other psychiatric disorders.

1st to bring applied artificial intelligence to stroke care in Houston

Baylor St. Luke’s Medical Center is the first in the Greater Houston area to partner with Viz.ai to bring its award-winning software that utilizes artificial intelligence to analyze images for suspected large vessel occlusion (LVO) strokes. Viz.ai is the first FDA-cleared computer-aided triage system.

As one of the leaders in stroke care in Houston and surrounding areas, Baylor St. Luke’s Medical Center continues its commitment to leverage the most advanced innovations to improve access to the most optimal treatments for patients who are suffering an acute stroke. Viz.ai solutions will allow Baylor St. Luke’s to further enhance the power of its stroke care team through rapid detection and notification of suspected LVO strokes and allow stroke specialists to securely communicate to synchronize care and determine the optimal patient treatment decision.

Stroke specialists with access to Viz.ai’s technology can potentially save critical minutes, even hours, in the triage, diagnosis, and treatment of strokes. Combining groundbreaking applied artificial intelligence with seamless communication, Viz.ai’s image analysis facilitates the fast and accurate triage of suspected LVOs in stroke patients and better collaboration between clinicians at comprehensive and referral hospitals. Viz.ai synchronizes care across the whole care team, enabling a new era of “Synchronized Care,” where the right patient gets to the right doctor at the right time.

“Viz.ai’s applied artificial intelligence solutions have been developed by top stroke clinicians and technical experts in the world, and we are excited to be able to bring these transformational technologies to Baylor St. Luke’s and our community,” said Dr. Chethan P. Venkatasubba Rao, medical director of the neuroscience ICU at Baylor St. Luke’s. “Before, we had to make decisions on the fly or quantify the images from the CAT scan, which is a laborious process that can take hours to complete. The Viz.ai software bypasses the guesswork and allows for early intervention, which results in improved outcomes for our patients.”

Viz.ai is transforming hospital workflow and synchronizing stroke care with a cloud-based artificial intelligence system that automatically analyzes CT scans for suspected LVOs. It alerts neurovascular specialists of suspected LVOs, enabling earlier imaging review and better collaboration between specialists.

Treating the most complex spine cases

At the forefront of treating backbones, our specially trained team uses the latest in technology to diagnose and conservatively treat spine conditions. When surgery is the best option, our surgeons use the most advanced minimally invasive techniques to alleviate and repair spine injuries and deformities.

Our team has extensive experience treating the most complex conditions, including:

Award-winning comprehensive stroke center

Since 2013, the Neuroscience Institute at Baylor St. Luke’s Medical Center has been home to our State of Texas-designated and DNV-certified Comprehensive Stroke Center (CSC). Our CSC consistently receives the Get with the Guidelines^®–Stroke Gold Plus Quality Achievement Award and the Target: Stroke Honor Roll Elite Achievement Award from the American Heart Association/American Stroke Association.

Equipped to treat even the most complex stroke cases, Baylor St. Luke’s Medical Center’s team of experts deliver safe, high-quality stroke care based on evidence-based protocols and a multidisciplinary approach for the treatment, management, and rehabilitation of stroke patients.

In 2018, Baylor St. Luke’s was the first in Texas to employ the PulseRider, a neurovascular device used to treat patients with wide-neck bifurcation aneurysms.

One year later, Baylor St. Luke’s became one of the first to begin using WEB, the new FDA-approved device to treat complicated aneurysms and avoid the placement of a stent device.

Patient Story

Life-altering treatment for patients with Parkinson’s Disease

Parkinson’s disease is the second most common degenerative neurological disorder after Alzheimer’s disease. Overall, as many as 1 million Americans are living with Parkinson’s disease, and approximately 60,000 Americans are diagnosed with the disease each year.

And while there’s no cure for this disease, a number of lifestyle changes and oral medications can help manage the movement and tremor problems associated with the disease. These medications may increase or substitute for dopamine, which people with Parkinson’s disease have low concentrations of, but over time, the benefits of these drugs frequently diminish, become less consistent, or become a burden in a patient’s life due to the often intolerable side effects, which include nausea, fatigue, among many more.

That was the case for Rudy Hardy whose symptoms became worse over time despite being on various medications to treat the symptoms. “I’d get very self-conscious about the tremoring and the balance issues,” said Rudy, who is also an avid sports photographer. “Last football season, I shot half of the season, but one day my legs were stiffening up on me. I just didn’t feel right on the field, and that was it.”

In a desperate search for answers after the medications made him very sick, he sought out a life-altering treatment at Baylor St. Luke’s Medical Center after hearing about a groundbreaking procedure: Deep Brain Stimulation. One of the most advanced therapies in the field, deep brain stimulation is a surgical treatment that consists of implanting a device that sends electrical signals to a targeted area of the brain responsible for body movement (also called motor symptoms) caused by Parkinson’s disease. The electrical impulses delivered by deep brain stimulation disrupt the abnormal activity that occurs in the brain’s circuitry, which is causing the symptoms.

There are three areas in the brain that can be targets for deep brain stimulation in patients with Parkinson’s disease. They are the subthalamic nucleus, the globus pallidus internus, and the ventral intermediate nucleus of the thalamus. Each of these areas plays a role in the brain’s circuitry that is responsible for the control of movement.

Dr. Sameer Sheth was the neurosurgeon who performed the procedure on Rudy over the course of two weeks. The goal of the first surgery was to implant the probes into the brain, and the second procedure consists of running the wires from the probes to the implanted battery in the patient’s chest.

“The results have been amazing. As soon as they turned it on, my right hand stopped tremoring. It’s unbelievable,” said Rudy of his experience with the DBS treatment.

Rudy is now retired from his career in law enforcement, but continues to be active in his professional career. He plans to return to Houston Community College in the spring of 2020 to teach Criminal Justice. He’s even considering reconnecting with his passion for sports photography since this activity has always given him so much joy.

Dr. Sheth and Dr. Ashwin Viswanathan, who also are associate professors of Neurosurgery at Baylor College of Medicine, were among the first group of doctors in Texas to use this most advanced version of deep brain stimulation, which includes extremely precise robotic surgery and the latest generation of DBS devices. By bringing these advances to their patients, they seek to make the treatment of Parkinson’s more effective for more patients.