Chapters Transcript Video Neurosurgical innovation and incremental wins in an unforgiving field Take GBM, you know, glioblastoma, for example. It's not a curable disease. We've been working on for 100 years and we still don't have a solution, right? Um, but the survival went from 9 months to 20 months, you know, in the last 20 years. And it's not because of only one thing, uh, we did better surgery. No, it's surgery plus Radiation plus chemotherapy, plus all the clinical trials that we're doing. A lot of bright minds are studying the basic science of this. So, that's how I envision we kind of move the needle. Hi, I'm Lindsay Carrillo, director of business development at UCI Health. Hi, I'm Doctor Sunil Verma, Associate Chief Medical Officer for ambulatory and a laryngologist here at UCI Health. Welcome to Physician Huddle by UCI Health. Today we are joined by Doctor Frank Sue, the Denny and Bettyai Endowed Chair in Neurological Surgery. Welcome to the podcast, Frank. Thank you for having me. Doctor Sue, tell us a little bit about yourself. How did you come to UCI, but also I want you to talk about your unique educational background because I think you're probably one of the few neurosurgeons that has degrees in electrical engineering. Uh, that's right. Well, I kind of made a big circle, so I started out in Florida, went to high school there, and, uh, spent 11 years in Baltimore, uh, went to college in medical graduate school there, and then I moved to Oregon to do my residency training, and then after that, um, I did a fellowship in Phoenix. I was supposed to go back to Oregon, but the Phoenix sun kind of spoiled me, so I decided not to go back to the Pacific Northwest. Um, California seemed like a fascinating place, so I started my first job at Loma Linda University. I spent 9 years there before I was recruited to come to UCI. So how does the electrical engineering play into this? Was this sort of, you wanted to merge these fields, or was it you kind of chose that first and then found your way into medicine? Uh, I, I actually never thought about medicine, uh, in the beginning, um, but one lecture that I went to kind of changed my mind. I was punching cards. Most people now don't know what that means, uh, punching cards, programming computers, and one lecture I went to this professor, pretty famous person said, The brain is like a computer. You can do things to it, fix it up. That kind of got me into medicine and then eventually neurosurgery. Hm Um, tell us a little bit about the department. So you came here as a faculty member and then, um, how many years ago did you become chair and what's that journey been like? So I came in 2012, uh, I, I was recruited as the vice chair and program director. And about a year later, um, my predecessor left, uh, and then I was asked to kind of stabilize the program as a temporary chair, interim chair, and after 6 months, uh, then I became the chair. And at the time, you know, um, first order was to stabilize the program, uh, and drum up the clinical productivity, and, and we did that. And then over the next few years, we got into the development, uh, the growth of the department. Tell us a little bit about your clinical role. What it, what drives you and what makes you excited? You have a wide variety of tools and tricks you have, tiny tools. So tell us, yeah, like tell us how you collaborate with other departments. I, I mean, obviously I have a little bit of a bias as an ENT, but I just think it's amazing that the work that you do. Well, I, I am actually part of the ENT department as well. Uh, I have an adjunct position and uh also in biomedical engineering. Um, so, um, my interest lies in, um, skull base, um, brain tumor, and functional neurosurgery. Uh, and all those fields overlap with mostly ENT and a lot with neurology, neuroscience. So personally, I love collaborating with my colleagues, which makes it fun. Yeah, Half of my work is done with ENT and that's transnasal approaches or transmastoid. How are you accessing these tumors or areas that you need to manage? Yeah, any way we can get to, uh, mostly for skull base, it's a transition zone between ENT and neurosurgery. So we kind of respect each other's boundary and we work together to access those areas. Transnasal is just one way that it's minimally invasive. We don't make any incisions, put a camera in the nose, and we can remove difficult tumors like that. And a lateral skull base is also a big part of my practice and, and obviously that's Near the ear, so we work a lot and also the neck too, yeah, you know, it's Lindsay, it's crazy when I was in residency I remember walking in it was, uh, uh, to Doctor Marty Weiss's OR and, and watching him. This was uh over at where I trained, but watching them. Put a camera in the nose and they said, OK, watch this, we're gonna drill this bone down and I, I had, I was like, I don't even know where we are anymore, right? Like there's no cadaver dissection we were doing back then to really understand it. And then they're like, there's dura and there's brain and, uh, I'm still amazed by it. Like I love walking whenever I can. I get to walk into that operating room and, and watch the way that you folks work. I mean, using, I mean, essentially just where you stick your finger up your nose. That's, that's the, it's just amazing. That's how you do this amazing work and the morbidity for these patients is really decreased. Yes, and, and, yeah, the shorter length of stay and the shorter recovery time, and, and, you know, when, whenever you have to open the head, uh, it, it makes it more difficult for the patient. So anytime you can access with a different minimally invasive route, patients do a lot better. So now as a chair, then your job too is to find folks who are doing equally as creative things in other areas of neurosurgery. So tell us a little bit about your approach to doing that. Yeah, so we wanted to make sure we have a comprehensive team, you know, just like any sports team, you want to have different talents on the, on the team that can perform different tasks to the highest degree of uh their capability, you know. So we try to recruit experts in that sub-specialty. And I, I think initially when, uh when I got here, the program was small, um, we did not have the luxury of having experts in each field. And that's one of the big goal that we wanted to accomplish, which was to really refine the subspecialty areas. Uh, for example, trauma, you know, most, most hospitals will treat trauma like OK, well, somebody get injured pretty badly. All you want to do is make them survive and move on, you know, or, or not. Um, but our trauma program, uh, we really Uh, get into the research, monitoring, multi-modality monitoring, uh, which only a few places in the country that do that. Um, really, we gather a lot of data to improve the outcome. So that's one area The other area is spine. I mean, 75% of neurosurgery is spine. And our unique program here is really a collaboration uh among the orthopedic. Neurosurgery, neurology, and the pain service and rehab. So, it's a very comprehensive program uh led by both ortho and neuro. And, you know, when I got here, it wasn't like that. Uh, uh, it was a little bit more competitive versus collaborative. Um, but I can tell you, this is the most uh collaborative program that I've ever seen. In spying. Um, functional is a big thing. Uh, functional is a very important part of neurosurgery and probably huge part going into the future, you know, with movement disorder program, epilepsy, psychosurgery, pain surgery. A lot of patients need help. Um, and we utilize the latest technology, minimal invasive technique, uh, to, to improve these patients' life. Um. Our marquee program is skull-based program. Um, and we have a very strong neuro-oncology program that have multiple clinical trials, and we take care of the sickest patients, uh, around the region. Sometimes, uh, people seek us out from all over the country. Uh, uh, as a team combination of surgery, radiation, uh, chemotherapy, uh, we have the latest trial that's possible. So you mentioned collaboration, not only, you know, between neurosurgery department and other departments, but you also mentioned that that was the culture you wanted to instill as you built the department and started to recruit people. I don't know if neurosurgeons have a Uh, reputation for having large egos. What do you mean? No, I mean, not you, not you, but actually you are one of the most chill, low-key neurosurgeons I've ever met. So, but tell us about that because it seems deliberate, like something you really wanted to make sure was a, a specific culture in your group. Yeah, I mean, neurosurgery is a very serious field, so the people who are drawn into it have a certain type of personality, and you're right, you know, there's, there are people with big egos and And prima donnas, and it, it, it is difficult to manage a group of very smart. Competent people who have big egos. Um, but I, I, I think we take a different approach. We kind of look at this like, you know, we have a very common goal. I it's a family. We started out small, but with growth, a lot of programs run into uh this program, uh problem where you become so big, you lose that mom and pop. Shoplike vibe. Um, so from the beginning, we, um, value our colleagues and when we recruit people, it's very important that they understand our culture and um have the common goal. You know, we don't have to agree on everything, but I think we do have to have a common goal. Um, and this starts with the faculty member, the office staff, you know, um, the residents, the fellows. So we try to maintain this harmonious culture. You know, first order was stability. Let's stabilize the program and let's make it harmonious. People need to get along. Uh, and then we can prosper. You, you've mentioned stabilizing, but I really think you're on the growth aspect and, and the addition of the community network hospitals, I think is really important for your program. Uh, your program is relied on as a, as highly trans I mean just the number of acute cases that come in for transfer it's just not enough beds here. Uh, to take care of all the patients. So how do you envision growing at the other sites both with your skull-base cases or, or, or brain case, but then also with the vascular cases because that's a big part of your program as well. Yeah, the vascular, um, that I didn't uh mention enough, um, stroke is a huge problem. Orange County, population aging. Uh, we are one of the largest stroke center here. Um, Orange is traditionally known to be the level one trauma center, the comprehensive stroke center, the sickest patient get here, but as everybody knows, we've been so congested that we're not able to take care of the sickest patient that need to be here. Uh, so with the new Irvine Hospital, we already offloaded 1/3 of our elective cases there to free up space in Orange. And the 4 community hospitals that we acquired now under the UCI brand. Allowed us to have more flexibility in kind of distributing the patient, the, the workflow, uh, that will maximize the efficiency. It's not an easy project, obviously, it's gonna take years, but, uh, we, we, we're really working hard on that. Yeah, I think of, especially with the expansion and you mentioned the new hospital, neurosurgery is absolutely one of the leaders in, in making this a multi-site program, you know, um, that's, that's a big step, especially for a, a new building. Yeah, it's a beautiful building. Um, I personally enjoy working there and I, you know, it's been a month and a half and it's been wonderful. The people are very eager to make it work and they really go bend backwards for us to make sure we can do our work and take care of the patients. And with that, we also accomplished um expansion of our residency program, you know, we pretty much doubled its size since I've been here. Uh, we have 4 fellowships right now, uh, in endovascular, skull-based, open vascular, functional, and spine. So, the program really has grown and, and, and grown, grown in a way that's, uh, uh, refined, uh, and, and, and trying to elevate the level of the program. So you have some really stellar faculty in your group. Um, we've mentioned some of the subspecialties that you represent, but tell us a little bit about some of the innovations or who's kind of doing exciting stuff in that sphere and, you know, what are the cool things that are coming out of your team. Yeah, so I, I did mention the, the trauma program, uh, with our monitoring system. Uh, the spine, um, program. Now, we're kind of catching the waves of robotics, um, uh, uh, minimally invasive endoscopic approaches. So, again, the Comprehensive Spine Program are kind of embarking on all the latest, the best technology we have and Um, the field is kind of blowing up with robotics, so we're trying different system to see what, what, yeah, what that sticks, right? Yeah, yeah, a lot of this will come and go, right? That's the tough part about innovation is that everything seems sexy, especially in a field like spying where there's so much innovation and so much focus of industry, but your faculty or the physicians also have to be, you know, cognizant that, that, you know, the first thing isn't always gonna be the greatest thing, right. And, and, and then we, we go based on research and evidence, you know, we don't just try everything, right, uh, functional. So for example, the latest thing we have, uh, going is the focus ultrasound. Tell us about that. So that's a machine that uh use high frequency ultrasound to make lesions in the brain. Um, they selectively, very precisely make small lesions to alter people's functions. So, for example, essential tremor, Parkinson's disease, those are very commonly treated with deep brain stimulation, which has been around for a long time. But for some patient population, they don't want to have open surgery. Uh, so focused ultrasound is very useful. So our, um, first case is coming up February. Uh, uh, this requires again, a big team of MRI physicists, radiologists, because the procedure is done in the MRI machine. So they're in the patient's in the machine and you deliver energy. Is that the right word to use? Yes, it's ultrasound energy that's focused beam and through the skull. They have to work out some mathematics, but uh they can deliver a pinpoint accuracy, high dose energy. Uh, to take care of the Problem. And when, when does the patient start to see effect from that right away, right away, yeah, yeah, uh, the most typical patient will be a patient with essential tremor, uh, and they can shake and then you make that lesion and it stops shaking. It's kind of a miracle. Yeah, yeah. So those, that's a pretty good technology, I would say so, yeah. And we have, um, you know, collaboration with the depression Center, which we have a big center, you know, um, on campus, uh, and, and our psychiatry department is very well known for a lot of these works. So we're trying to work with a lot of different departments, um, and, and also engineering departments, uh, to refine our tools. Amazing. Uh, you touched on the residency program a little bit. I know that that's a passion of yours to train the, these leaders of tomorrow, and you took a really specific approach to growing that and honing it and making sure that you were attracting like the best of the best. So how has that kind of changed throughout your time as chair? Yeah, so, um, Again, 2012, you know, when I got here, there were a lot of work to be done, you know, um, again, um, at that time, we did not have a full complement of residents, um, and the residency was pretty good, you know, it's reputable, um, but over time, I think. We started with medical students and, and some of the big programs around the country that we really respect, uh, the medical students are very interested in neurosurgery. And in the beginning, we didn't have anybody interested in neurosurgery. And then something happened, the medical students got really involved. They even created an AANS, which is American, uh. Association of Neurological Surgeons, which is a national organization. They have a chapter in there. They were so proactive. Lots of MSTP, the MD PhD program students. They were super eager to learn about neurosurgery, and that started. A wave. And, and from then on, uh, every year we have at least 1 to 3 people who were interested in neurosurgery and they all match either here or other great places. And the resident quality increased as well as, as we start recruiting new residents. And at this point, I have to say this is the best group of residents I've ever seen and I'm very proud of that. Uh, the big reason we kind of stay in academia is we're training and, and that's why we're here. Uh, and, and also the fellowship that, you know, we get postgraduates, uh, they bring their value and skill set from other places that we learn from them, they learn, learn from us and they teach our residents as well. That's really exciting, you know, we've been doing this pod for a bit and we haven't really talked about the importance of medical students and really how it helps to grow a faculty department, but that's gotta be really special because when these medical students, frankly, if they're coming here they've got choices. So to know that somebody would intentionally choose here just be to know that they can have that inroads with the faculty. To be able to make a difference and do to perform meaningful research and then to set themselves up for residency how and where they want I think is amazing. I we've definitely noticed that in otolaryngology as well the caliber of the medical students is just skyrocketed and the amount of work they do and their desire to learn is uh very stimulating for us as physicians here. Yes, yes. So we touched on the acquisition of 4 hospitals, which was a couple of years ago. We've now opened our hospital in Irvine. We're also set to open a 7th hospital, a rehab hospital this year. This is tremendous growth, but from your perspective, um, you know, what would be the right way to grow? Where are you excited to grow? Like what would be your vision for UCI health neurosurgery in 5 years? Well, I, I think as the only academic center in Orange County, um, UCI should be the leader for healthcare. Obviously, you know, there are different systems and we coexist and we collaborate actually. Um, but from the missions, you know, we, we need to be the leader in research, in education, in the, the hardest, you know, the tertiary care aspect of uh the Orange County and, and even beyond. Um, so, having such rapid expansion also created a lot of task and, you know. Kind of nights that I stay awake to kind of try to figure things out. Um, and I think our administration has clear vision and uh we, um, obviously follow their lead. Uh, we also kind of suggest certain way to grow and the way we, we think we should grow is um have a real Solid team that uh it may be academicians, maybe hybrid uh practitioners out there, um, but really treat this as a community that, um, you know, we, we share the vision, like I'm talking about the vision. And it's not the easiest to convince a private practice doctor in a community hospital to jump on board right away. But um through the quality, you know, um, and the referral and the discussion, uh we're making progress with the community physicians. And to see how they wanna work together. I, I'd like that you mentioned that this isn't a problem your employed physicians are gonna tackle on their own, especially with our community network hospitals and there's just too many patients. So how do you collaborate and determine where care should be delivered and trust each other that we're doing things right and we are being collaborative? I think that's really important for the system to grow and succeed, yeah. And we're trying to figure out. I mean, it's still kind of early and, and I, I've seen other really big systems, you know, on the East Coast fail by just diving in without thinking too much. And I think our, our um CEO administration really um studied this and, and, and real cautiously doing things. So I, I think that's the right thing to do. Um, we talked a little bit about research and, you know, maybe there's new gadgets or robots or things that you could get, but just kind of in the meetings that you attend, where do you think neurosurgery is headed? What are some of the cool innovations that are coming down the pipeline that you hope to be able to bring to UCI? So I think all surgery specialties we're trying to focus on. Being less invasive, you know, I, I think that's across the board, whether it's a da Vinci robot in, you know, or, or, or laser or, or radiation, radiosurgery, um, or different delivery route, you know, through the brain, spine. Uh, so the The kind of the order will be to minimize the damage to the patient. While we treat the patient and surgery is very invasive, no way around that. Um, maybe one day we don't need surgeons, you know, maybe like maybe a little ways from now. Come on. Well, I mean, Elon Musk said 3 years, right, and he got kind of criticized for, um, but I, and I think people say 25 years, but even with the robots. They're not gonna have the judgment, uh, the, the, the, the kind of the emotion we have. Maybe sometimes it's good, uh, but But I think it, you're right. I think we, our job security, so, well, you know, my job security is to be a podcast host. So if they, if the robot and their laser eliminate me in airway surgery and laryngeal surgery, I have a, have a great career going. Yeah, we can just interview the robot. No problem. Yeah, you're diversifying your risk, which is, yeah, once I heard that Elon comment, I knew I had to pivot. Well, are you envisioning like a drive-through surgery like a car wash? Uh, there's a cartoon. There's Frank's brain surgery and the guy sticks his head in there. It's actually a real cartoon. You must have seen that. Yeah, yeah, that's funny. But, but we do have a few, um, kind of tool that we don't have, um, and that we, we would like to get, uh, you know, focused ultrasound was a a big deal, uh, even though it's not like brand brand new right now, but to get it in UCI, which a lot of our patients will benefit, um, just different ways of, uh. Improving the safety. I mean, at the end of the day, it's about risk and benefit, how we can help people. And these are just tools, right? Um, they've been doing neurosurgery for 100 years and uh it's only the incremental um progress that we made. Like, there's really not like huge breakthrough in neurosurgery, but um this disease, we've been working on for 100 years and we still don't have a solution, right? Um, but the survival went from 9 months to 20 months, you know, in the last 20 years. And it's not because of only one thing, uh, we did better surgery. No, it's surgery plus radiation plus chemotherapy, plus all the clinical trials that we're doing. A lot of bright minds are studying the basic science of this. So that's how I envision we kind of move the needle over time. It's nothing is gonna be like revolutionary, maybe, maybe, you know, but uh, no, but it's little, it's incremental. So day by day or year by year, it doesn't seem different, but you look back 1015 years and things are different and that's a, that's the interesting thing about medicine. There's gonna be some moves that like you said, very few that are gonna snap and change things overnight, but that's also the fun of being in academics is being. Flexible enough to follow that wave and to jump on the wave when it's a little unstable and be able to ride it through. I mean, we've come a little ways. You're no longer just like cracking someone's skull open with a rock, or maybe you are. Tree Foundation, um, yeah, we don't do that. We use tiny, tiny tools with tiny, tiny openings to make patient better. Love it. Great. Well, we really appreciate your time. We know you're busy. Thank you. This has been Physician Huddle by UCI Health. Thank you for joining us. This was an episode of the Physician Huddle podcast by UCI Health, produced by Brett Shahen, Angelica Yagubi, and Victor Ting. For more episodes, information on clinical trials at UCI Health, or to refer a patient, view the show notes or visit clinical connection. UCIhealth.org. Created by
