AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord

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1 Preliminary Program AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Westin Bellevue Bellevue, Washington Directly Provided by

2 Welcome Welcome to AONeuro! In AO North America s continued commitment to surgeon education: It is our distinct pleasure to announce a special educational offering for Neurotrauma which represents a collaborative effort between AOSpine North America and AONeuro North America. This unique course will provide participants with an outstanding opportunity to advance their knowledge and surgical skills in brain, spine and spinal cord trauma through didactic lectures and case-based discussions. Faculty selection includes recognized Neurotrauma leaders who are eager to share their knowledge and experience with you. We hope that you will consider registering for this course and sharing this opportunity with your colleagues. Course Chairs Randall M. Chesnut, MD, FCCM, FACS Richard G. Ellenbogen, MD, FACS Table of Contents CME Mission 4 Statement Course Overview 5 Target Audience 5 Learner Objectives 6 Accreditation 6 Designation 6 Statement Faculty 7 8 Preliminary 9 13 Program Presentation 14 Information Course Tuition 15 and Registration Hotel and Travel 16 17

3 Message from the Program Coordinator On behalf of AO Foundation and your local and international faculty, I would like to welcome you to this AONeuro educational event. AONeuro is a unique worldwide multi-specialty community that includes cranial Neurosurgeons, Neurologists, Neurointensivists, Neuro anesthesiologists, Neuro Traumatologists and Neurological professionals who are involved in cranial neurological trauma, cranial oncologic and cerebrovascular surgery, cranial reconstruction and cranial congenital anomalies surgery. Our organization creates a forum for specialists from all over the world who have common interests and enthusiasm in these fields. It is our goal to encourage and inspire residents, fellows, and experienced practitioners by means of education, academic stimulation instruction and international communication to pursue more fulfilling, rewarding and productive careers in these fields. Education has always been a major pillar in the AO Foundation. Currently, more than 46,000 surgeons participate in over 750 AO educational events worldwide per year. AONeuro is committed to communicating the latest advances, treatment information, protocols in education, equipment and new developments as we strive to improve your educational experience by providing you education at the forefront of your specialty. Your cranial neurological colleagues are working diligently to bring you the latest in cranial neurological education, and most specifically have initiated programs in the area of traumatic brain injury. Cranial AO Neurosurgeons collaborate with their AOSpine colleagues to bring you the latest developments in combined brain and spinal cord trauma. For years, cranial neurological surgeons have cooperated with craniomaxillofacial colleagues in the areas of facial and cranial trauma, congenital craniofacial anomalies, and skull base trauma and surgery to provide the multidisciplinary perspective necessary to manage these areas. AONeuro is a project of the AO Foundation, established to learn the needs and educational structure which cranial neurologists require to improve their worldwide educational efforts. AONeuro cooperates with AOSpine and AOCMF (Craniomaxillofacial) to provide multidisciplinary course education, and seeks to add a cranial dimension to existing AO Education in the present specialty areas of Orthopedics, Spine, Craniomaxillofacial and Veterinary surgery. We hope that your experience with us over the next few days will result in the acquisition of new knowledge, skills and understanding that can directly translate into improved care for your patients. We also hope that, as a result of this educational event, you will develop a longer term relationship with AOSpine and AONeuro, become a member of our communities, take advantage of our website explore our comprehensive online medical reference tool and phone app AO Surgery Reference ( take up AO Membership, and participate in AONeuro and AOSpine courses and educational opportunities. You may also even wish to acquaint yourself with AOCMF educational events in the areas of congential anomalies surgery, craniofacial trauma and skull base surgery. Make these organizations yours by bringing your opinions, ideas and contributions. Enjoy the camaraderie of our unique network, and help us maintain and expand the preeminent educational position that the AO Foundation enjoys worldwide. Yours sincerely, Paul Manson, MD Coordinator, AONeuro Pilot Program

4 4 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord CME Mission Statement The Continuing Medical Education (CME) mission of AO North America (AONA ) is to provide comprehensive multidisciplinary needs based education to surgeons, fellows, and residents in the specialties of orthopedic, hand, craniomaxillofacial, spine, neurosurgery, and veterinary surgery in the areas of trauma (i.e.), operative reduction and fixation), degenerative disorders, deformities, tumors, and reconstruction. Expected results of AONA s CME activities for surgeons, fellows, and residents are to: Increase their knowledge base and surgical skill level Improve competence by applying advances of knowledge in patient care in the areas of trauma, degenerative disorders, deformities, tumors, and reconstructive surgical techniques Address practice performance gaps by improving management of all aspects of musculoskeletal injuries and disorders (i.e., pre-operative planning to post-operative care)

AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 5 Course Overview Managing neurotrauma patients in an evidence-based manner is challenging for even the most experienced clinician.

Formulating optimized, cooperative treatment plans requires understanding of the complex underlying pathophysiology, limitations of current monitoring systems, evolution of the injury over time and

5 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 5 Course Overview Managing neurotrauma patients in an evidence-based manner is challenging for even the most experienced clinician. Choosing the best available operative and nonoperative treatment options requires balancing numerous parameters and coordinating care between multiple disciplines. Formulating optimized, cooperative treatment plans requires understanding of the complex underlying pathophysiology, limitations of current monitoring systems, evolution of the injury over time and with treatment, and limitations in the available literature. This course is designed to provide participants with a unique opportunity to advance their evidence-based knowledge and surgical skills in brain and spinal cord trauma through didactic lectures and case-based discussions with renowned neurotrauma thought leaders. Systematic, surgical, and critical care considerations in managing patients with traumatic brain and spinal cord injuries will be addressed. Target Audience Neurological Surgeons, Neurointensivists, Neurologists, Orthopedic Spine Surgeons, Registered Nurses, Physician Assistants, Nurse Practioners, and specialists involved in the care of the neurotrauma patient will benefit from attending this course. Residents and Fellows will especially find this course to be of interest as this will be geared towards their education, as well.

6 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Learner Objectives At the conclusion of this Course, the participant should be able to: Apply evidence-based decision making to

6 6 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Learner Objectives At the conclusion of this Course, the participant should be able to: Apply evidence-based decision making to the management of the neurotrauma patient Recognize the clinically relevant pathophysiology underlying traumatic brain and spinal cord injuries Discuss the utility and limitations of currently available neurological monitoring systems and their interactions Recognize indications and opportunities for individualizing and fine tuning treatment of traumatic brain and spinal cord injuries Describe the utility and limitations of current guidelines in directing neurotrauma management Coordinate the acute management of neurological trauma with the overall care of the polytrauma patient. Outline the available methods and distinguish the advantages, and disadvantages of various methods of managing traumatic cerebrospinal fluid leaks Identify the priorities and techniques that influence coordination of the surgical management of cranial neurological and maxillofacial injuries Accreditation AO North America is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Designation Statement AO North America designates this live educational activity for a maximum of AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. For Canadian Based Physicians Attending AONA Courses All live conferences or live courses held outside of Canada can be reported as accredited group learning activities under Section 1 of the MOC Program if they are developed by a university, academy, college, academic institution or physician organization. Courses sponsored by AO North America meet the criteria of the Royal College of Physicians and Surgeons for accredited group learning activities. This course meets the CME external trauma-related requirements of the American College of Surgeons, Committee on Trauma (ACS COT). This course meets the requirements of the American Board of Neurological Surgery (ABNS) for Part II of Maintenance of Certification: Lifelong Learning and Self-Assessment.

7 Faculty Course Chairs AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 7 Randall M. Chesnut, MD, FCCM, FACS Integra Endowed Professor of Neurotrauma Department of Neurological Surgery Department of Orthopaedic Surgery Professor, School of Global Health Harborview Medical Centre University of Washington Seattle, Washington Richard G. Ellenbogen, MD, FACS Professor and Chairman Department of Neurological Surgery University of Washington School of Medicine Harborview Medical Center University of Washington Medical Center Seattle Children s Hospital Seattle, Washington Education Advisor Carlo Bellabarba, MD Professor, Departments of Orthopaedic & Neurological Surgery University of Washington School of Medicine Acting Chief of Orthopaedics Harborview Medical Center Seattle, Washington Faculty Rocco A. Armonda, MD Director, Neurointerventional Surgery Department of Neurosurgery MedStar Georgetown University and Washington Hospital Center Washington, District of Columbia Neeraj Badjatia, MD, MS Associate Professor Chief of Neurocritical Care, Program in Trauma Departments of Neurology, Neurosurgery, Anesthesiology University of Maryland School of Medicine Baltimore, Maryland Eileen M. Bulger, MD, FACS Professor of Surgery and Chief of Trauma Harborview Medical Center Seattle, Washington Jefferson Chen, MD, PhD, FAANS, FACS, FCCM Neurological Surgeon Director of NeuroTrauma Department of Neurological Surgery University of California, Irvine Orange, California

8 8 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Faculty (continued) Joseph Gruss, MD, FRCSC Marlys C. Larson Professor Craniofacial Surgery Division of Plastic and Craniofacial Surgery Childrens Hospital & Medical Center Seattle, Washington Richard Hopper, MD, MS Chief, Division of Pediatric Plastic Surgery Surgical Director The Craniofacial Center Professor Department of Surgery University of Washington Seattle, Washington Peter Le Roux, MD, MBBCh, FACS Professor Department of Neurosurgery Thomas Jefferson University Philadelphia, Pennsylvania Geoffrey T. Manley, MD, PhD Professor and Vice-Chairman of Neurological Surgery Chief of Neurosurgery, San Francisco General Hospital Co-Director, UCSF Brain & Spinal Injury Center San Francisco, California Kris S. Moe, MD, FACS Professor and Chief, Division of Facial Plastic Surgery Department of Otolaryngology Head & Neck University of Washington Seattle, Washington David O. Okonkwo, MD, PhD Professor and Executive Vice Chair Department of Neurological Surgery University of Pittsburgh Pittsburgh, Pennsylvania Nino Stocchetti, MD Milan University Neuro Intensive Care Milan, Italy Shelly D. Timmons, MD, PhD, FACS, FAANS Director of Neurotrauma, Geisinger Health System Neurosurgery Residency Program Director, Geisinger Health System Associate Director for Neurosciences Adult ICU Geisinger Medical Center Clinical Associate Professor, Temple University Department of Neurosurgery Danville, Pennsylvania Miriam Treggiari, MD, PhD, MPH Portland, Oregon Jennifer M. Zumsteg, MD Assistant Professor Medical Director, TBI Rehabilitation Fellowship Director, Brain Injury Medicine Investigator, TBI Model System University of Washington Department of Rehabilitation Medicine Seattle, Washington Faculty list subject to change.

AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 9 Preliminary Program Thursday, September 3, 2015 Time Agenda Item 1700 1800

Management 18:40 18:50 Discussion 18:50 19:05 Concussion/Return to Play 19:05 19:15 Discussion 19:15 19:30 Practical Multimodality Monitoring 19:30

9 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 9 Preliminary Program Thursday, September 3, 2015 Time Agenda Item Registration / Buffet Dinner 18:00 18:15 Classification of Traumatic Brain Injury (TBI) 18:15 18:25 Discussion 18:25 18:40 What s Wrong with Current Management 18:40 18:50 Discussion 18:50 19:05 Concussion/Return to Play 19:05 19:15 Discussion 19:15 19:30 Practical Multimodality Monitoring 19:30 19:40 Discussion 19:40 19:55 Guidelines 19:55 20:05 Discussion 20:05 20:15 Neurotrauma Practice in the Real World 20:15 20:25 Discussion 20:25 21:30 Case Discussions

10 10 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Preliminary Program Friday, September 4, 2015 Time Agenda Item 08:00 08:10 Introduction 08:10 08:25 What is AONeuro 08:25 08:40 TBI Pathophysiologic Mechanisms 08:40 08:55 Intracranial Pressure (ICP) and Cerebral Compliance 08:55 09:10 Cerebral Blood Flow (CBF) and Autoregulation 09:10 09:25 Measuring and Treating Cerebral Ischemia 09:25 10:00 General Discussion 10:00 10:15 Coffee Break 10:15 10:30 Resuscitating the Polytrauma Patient with TBI 10:30 11:15 Principle Discussion Based on Patient Cases: Case 1 TBI Patient Direct to Operating Room (OR) with General Surgery Case 2 Herniating Patient Needing Direct Transport to OR Case 3 Timing of Non-emergent Surgery in TBI 11:15 11:30 Penetrating TBI 11:30 11:40 Discussion 11:40 11:55 Pediatric TBI 11:55 12:05 Discussion 12:05 12:20 TBI Rehabilitation 12:20 12:30 Discussion 12:30 13:15 Lunch 13:15 13:30 Decompressive Craniectomy 13:30 13:40 Discussion 13:40 13:55 Difficult Cranioplasty Management

11 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 11 Preliminary Program Friday, September 4, 2015 (continued) Time Agenda Item 13:55 14:05 Discussion 14:05 14:25 Bifrontal Injury But High Glasgow Coma Score (GCS) 14:25 14:45 Normal ICP, No PbrO2 Desaturations, DI III CT 14:45 15:05 Difficult ICP Control, No PbrO2 Desaturations 15:05 15:25 Difficult ICP Control With PbrO2 Desaturations 15:25 15:45 Normal ICP But PbrO2 Desaturations 15:45 16:05 Refractory ICP 16:05 16:25 Coffee Break 16:25 16:45 Principle Discussion Based on Patient Cases: Case 1 Subdural Hematoma (SDH) Case 2 No Subarachnoid Hematoma (SAH) Case 3 Minimal Mass Effect Case 4 Good GCS 16:45 17:05 SDH, Moderate Swelling at End of Evacuation 17:05 17:25 Gun Shot Wound with Bifrontal Injury, Alert, CSF Leak 17:25 17:45 Diffuse Swelling High ICP Needs Decompression 17:45 18:05 Pediatric Patient with High ICP 18:05 18:25 Severe TBI with Unstable Spine 18:25 18:45 Devastating TBI, Family Wants Everything Done 18:45 19:00 General Discussion

12 12 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Preliminary Program Saturday, September 5, 2015 Time Agenda Item 08:00 08:20 Principle Discussion Based on Patient Cases: Case 1 14 Year Old Football Player with Concussion Loss of Consciousness (LOC) on Field 08:20 08:40 Principle Discussion Based on Patient Cases: Case 1 24 Year Old NFL Player with > 1 Concussions in One Season 08:40 09:00 Status Post Discharge with Hydrocephalus 09:00 09:20 Status Post Cranioplasty with Large Hygroma Under Flap 09:20 09:40 Status Post Discharge, Ready for Rehabilitation at 3 Weeks 09:40 10:00 General Discussion 10:00 10:15 Coffee Break 10:15 10:25 Anticoagulants 10:25 10:35 Cerebral Spinal Fluid (CSF) Leak Management 10:35 10:45 Endoscopic Options for CSF Rhinorrhea 10:45 10:55 Cranioplasty Following Decompressive Craniectomy (DC) 10:55 11:15 Principles of Craniofacial Reconstruction 11:15 11:30 Principle Discussion Based on Patient Cases: Case 1 CSF Rhinorrhea 11:30 11:45 Post DC Needing Cranioplasty Scalp Problems 11:45 12:00 Patient with Combined Facial and Frontal Skull Defects Requiring Surgery 12:00 12:10 Pick up Boxed Lunch 12:10 12:25 Pathophysiology of Spinal Cord Injury 12:25 12:35 Blood Pressure Management 12:35 12:40 Emergent Decompression Always 12:40 12:45 Emergent Decompression Conditional 12:45 12:55 Discussion

13 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 13 Preliminary Program Saturday, September 5, 2015 (continued) Time Agenda Item 12:55 13:00 Steroids Pro 13:00 13:10 Steroids Con 13:10 13:20 Discussion 13:20 13:50 Principle Discussion Based on Patient Cases: Case 1 Incomplete Spinal Cord Injury (SCI) with Jumped Facets 13:50 14:00 Course Evaluations and Adjourn Preliminary program subject to modification.

14 14 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Presentation Information Faculty Disclosure It is the policy of AO North America to abide by the Accreditation Council for Continuing Medical Education Standards for Commercial Support. Standard 2: Disclosures Relevant to Potential Commercial Bias and Relevant Financial Relationships of Those with Control over CME Content, requires all planners, including course directors, chairs, and faculty, involved in the development of CME content to disclose their relevant financial relationships prior to participating in the activity. Relevant financial relationships will be disclosed to the activity audience. The intent of the disclosure is not to prevent a faculty with a relevant financial or other relationship from teaching, but to provide participants with information that might be of importance to their evaluation of content. All potential conflicts of interest have been resolved prior to the commencement of this activity. Conflict of Interest Resolution Statement When individuals in a position to control or influence the development of the content have reported financial relationships with one or more commercial interests, AO North America utilizes a process to identify and resolve potential conflicts to ensure that the content presented is free of commercial bias. Off-Label / Experimental Discussions Some medical devices used for teaching purposes and/or discussed in AO North America s educational activities may have been cleared by the FDA for specific uses only or may not yet be approved for any purpose. Faculty may discuss off-label, investigational, or experimental uses of products/devices in CME certified educational activities. Faculty have been advised that all recommendations involving clinical medicine in this CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported or used in this CME activity in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection and analysis. Liability Statement AO North America faculty and staff assume no personal liability for the techniques or the use of any equipment and accessories used for teaching purposes in the laboratory. The certificate provided pertains only to the participants completion of the course and does not, in any way, attest to the proficiency of the participants clinical experience. Disclaimer The opinions or views expressed in this live continuing medical education activity are those of the faculty and do not necessarily reflect the opinions or recommendations of AO North America or any commercial supporter. The certificate provided pertains only to the participants completion of the course.

15 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 15 Course Tuition and Registration Tuition: $ U.S.D. Course, breakfasts, coffee breaks and lunch will be provided. Registration is available online only at We encourage early registration, as seating is limited. Upon receipt of your online registration you will be sent via a confirmation of your registration in the Course, along with hotel and travel information to assist you in making your arrangements. PLEASE NOTE: Registration deadline is August 13, ADA Statement AO North America fully intends to comply with the legal requirements of the Americans with Disabilities Act. If any registrant is in need of accommodation, please do not hesitate to submit a written request at least one month prior to this activity. Until an confirmation is received, please do not consider yourself registered in this Course. For Information: Contact AONA Customer Service Department Phone: (800) (610) Fax: (610) customerservice@aona.org

16 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Hotel and Travel Hotel Information: Westin Bellevue 600 Bellevue Way, Bellevue, WA.

16 16 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord Hotel and Travel Hotel Information: Westin Bellevue 600 Bellevue Way, Bellevue, WA Hotel Concessions: Complimentary internet in guestrooms. Complimentary local calls and toll calls from guestrooms. Complimentary 2 bottles of water in each guestroom. Travel We recommend flying into Seattle-Tacoma International Airport (SEA). SeaTac Airport is the gateway to Bellevue, Seattle and the Pacific Northwest. The Westin Bellevue is just an 18 mile drive north of SeaTac on Interstate 405, roughly a 25 minute drive. There are several ways to reach the hotel from the airport. You can catch a cab, rent a car, arrange for a private car service, or take the airport shuttle. To travel throughout the Bellevue area and beyond, we recommend hailing a taxi outside the hotel. If you re heading to Seattle, take advantage of public transit at the city bus station, just three blocks from the hotel. Port of Seattle Travel Distance: Approximately km/13.0 miles Options for getting to and from the hotel include: By Taxi Fee: 40 USD Hours: hours By Shuttle Fee: 61 USD Hours: 24 hours Airport Seattle/Tacoma International Airport (SEA) Travel Distance: Approximately km/18.0 miles Hertz Car Rental Travel Time: 25 minutes Contact: (425) ; Reservation Required Budget Car Rental Travel Time: 25 minutes Contact: (425) Enterprise Rent A Car Travel Time: 25 minutes Contact: (425) ; Reservation Required Green Cab Fee: 45 USD; One way, additional passenger fees apply Hours: 24 hours Travel Time: 25 minutes Contact: (206) ; Reservation Required About: Green Cab taxis are readily available outside of the airport. Green Cab offers the only all-hybrid fleet of enviromentally friendly taxi cabs in Puget Sound. Learn more at Alamo Rent A Car Hours: 24 hours Travel Time: 25 minutes Contact: (800) ; Reservation Required Thrifty Car Rental Travel Time: 25 minutes Contact: (425) ; Reservation Required Avis Rent A Car Travel Time: 25 minutes Contact: (425)

AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 17 Hotel and Travel (continued) Options for getting to and from the hotel include: National Car Rental Travel Time: 25 minutes

17 AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord 17 Hotel and Travel (continued) Options for getting to and from the hotel include: National Car Rental Travel Time: 25 minutes Contact: (800) ; Reservation Required Shuttle Express Fee: 19 USD; Fee is one way, per person Hours: 24 hours Travel Time: 25 minutes Contact: (206) ; Reservation Required About: Shuttle Express buses depart regularly from the airport. Call in advance for airport pickup reservations, or book online. For more information visit Bayview Transportation Fee: Varies by vehicle type Hours: 24 hours Travel Time: 25 minutes Contact: (206) ; Reservation Required About: Bayview Transportation offers a fleet of private cars that can be reserved for aiport pick-up. For more information or to make a reservation visit Complimentary Self-Parking on Friday and Saturday nights $25 per night for Self-Parking on Sunday Thursday nights $29 per night for overnight Valet Parking Rates do not include taxes. Valet Parking is available at the front door of The Westin Bellevue Hotel. Should you choose Self-Parking, you will be directed to the Lincoln Square parking garage by the doorman. Please park on level P4 or P5 near the south elevators and take the elevator up to the hotel lobby. Directional signage is posted. Covered, lit parking is directly connected to hotel via elevators and indoor walkways. This is not a hotel-owned parking facility although parking fees can be added to your hotel bill. Rates are subject to change. Please visit our website: to register for this Course and for other course offerings.

20 Preliminary Program AONeuro Course Controversies in Neurotrauma: Brain and Spinal Cord AO North America Department of Continuing Medical Education 1700 Russell Road Paoli, PA Registration is available only online: Hotel and Registration deadline: August 13, by AO North America. All rights reserved. 1981A 5/15

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