On this episode of Advances in Care, Erin Welsh and Dr. Jeffrey Greenfield, pediatric neurosurgeon at NewYork-Presbyterian and director of the Chiari CARE program at Weill Cornell Medicine, discuss a rare condition called Chiari malformation.

Typically diagnosed by MRI, Chiari malformation is classified when part of the cerebellum descends into the upper spinal canal. Though some of the most severe types of Chiari malformation can be diagnosed during pregnancy, the most common type may present asymptomatically until adolescence or adulthood, with symptoms that are often misdiagnosed as other disorders. To address the unmet need for proper diagnosis and management of this condition, Dr. Greenfield created the Chiari CARE program–a multidisciplinary approach involving neurology, pain management, neuropsychology, radiology, and more–to help provide full-spectrum care to patients. A key factor of the Chiari CARE program is its emphasis on transitional care, which includes both treating patients who come in as pediatrics throughout their adulthood as well as those who are diagnosed later in life.

But Dr. Greenfield’s vision extends to the future. Having just treated the program’s thousandth surgical patient, his team is amassing and analyzing outcomes data and using machine learning to refine predictions for which future patients would be good candidates for surgery or require other treatment methods that will enhance overall quality of life.

Chapters:

[00:00 - 4:12] Chiari CARE

Dr. Greenfield and Erin discuss a rare congenital brain condition called Chiari malformation, and highlight Dr. Greenfield’s Chiari CARE program at NewYork-Presbyterian and Weill Cornell Medicine.

[4:12 - 8:35] The Importance of Transitional Care

Dr. Greenfield expands on the importance of transitional care for patients with congenital neurological conditions like Chiari malformation.

[8:35 - 11:51] Determining the Right Approach

Dr. Greenfield explains how he and his team determine whether their patients need surgery or not, and the challenges of diagnosing and treating Chiari malformation in adults.

[11:51 - 14:31] Harnessing Data to Advance Research

Dr. Greenfield describes how his team is utilizing the MRI scans from over a thousand patients to develop models that could predict who may be a good candidate for surgery or other treatment avenues.

[14:31 - 18:35] Advancing Diagnostics

Dr. Greenfield shares his vision for an improved coordinated care model for patients newly diagnosed with Chiari malformation.

[18:35 - 19:20] Credits

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Jeffrey Greenfield, MD, PhD is a board-certified neurosurgeon who specializes in pediatric neurosurgery. In addition he sees certain adult patients with congenital neurosurgical conditions. Compassionate clinical care, research, and education are all central to his philosophy as a neurosurgeon and physician. His clinical expertise includes Chiari malformation, all forms of tethered spinal cord, pediatric brain tumors and congenital neurosurgery into adulthood.

As creator and director of the Chiari CARE program, Dr. Greenfield has developed an international reputation caring for children and adults with Chiari malformation, tethered cord, syringomyelia, and other associated conditions such as craniocervical instability, CSF leaks, and hydrocephalus as part of a large multidisciplinary team.

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Erin Welsh is joined by Dr. Jeffrey Port, a thoracic surgeon at NewYork-Presbyterian and Weill Cornell Medicine, and a leader in thoracic surgical oncology, to discuss advances in minimally invasive robotic surgery and the unique collaborative care model that his program employs to operate on complex chest tumors.

When Dr. Port first started his career, the surgical techniques used to operate on lung cancer patients were akin to open heart surgery. But in recent years, his team has pioneered new techniques in thoracic surgery, specifically a minimally invasive single port robotic approach, which utilizes a multi-finger robotic hand to operate through one incision. Weill Cornell Medicine is currently one of only 10 centers nationwide using this technology for thoracic surgery, and the highest-volume center in the country that is performing these advanced procedures. Dr. Port also discusses the unique collaborative model his team utilizes to perform complex chest tumor surgeries which oftentimes require cardiopulmonary bypass. This combination of cutting edge surgical techniques, high case volume, and a multidisciplinary approach, is meaningfully expanding treatment options for patients who cannot be treated elsewhere.

Chapters:

[00:00 - 04:39] Introduction to Thoracic Surgery

Dr. Port and Erin discuss the standard of care for thoracic surgery as it stood a few years ago and his pioneering use of robotics in single port thoracic surgery today.

[04:39 - 09:06] Recovery Benefits of Single-Port Robotic Surgery

Dr. Port expands on how the technology differs from standard robotics and the recovery benefits of single-port robotic thoracic surgery.

[09:06 - 13:20] NewYork-Presbyterian/Weill Cornell Medicine as Early Adopter of Innovative Technology

Dr. Port details his department’s efforts as a training facility, teaching surgeons and health care professionals from across the world the techniques and workflows that contribute to their success.

[13:20 - 16:16] Multidisciplinary Approach as a Key to Cardiopulmonary Care

Dr. Port outlines how multi-specialty care allows his team to undertake very complex cases with success.

[16:16 - 17:01] Credits

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Dr. Jeffrey L. Port is a Professor of Thoracic Surgery at Weill Cornell Medicine and a leader in thoracic surgical oncology. For more than two decades, he has helped shape Weill Cornell’s robotic thoracic surgery program and played a central role in advancing both minimally invasive and complex, high-risk chest surgery. His clinical focus spans lung cancer and other thoracic malignancies, with particular expertise in robotic approaches and coordinated cardiac–thoracic procedures for patients with advanced disease.

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh is joined by Dr. Mirella Mourad, maternal-fetal medicine specialist at NewYork-Presbyterian and co-director of the Preterm Birth Prevention Center at Columbia, to explore a groundbreaking new technology aimed at improving the diagnosis and treatment of preterm birth.

Preterm birth impacts approximately 1 in 10 pregnancies in the United States, making it a leading cause of neonatal complications and long-term health challenges. But despite its prevalence and associated risks, innovative solutions to address the condition have lagged behind. To address this gap, Dr. Mourad and her collaborator, Dr. Kristin Meyers, a professor of mechanical engineering at Columbia’s School of Engineering, are developing a new tool: a patient-specific “digital twin” of the cervix. This advanced technology has the potential to revolutionize obstetric care for patients, by allowing clinicians to test new treatment methods, collect data to better understand why certain people are at risk for preterm birth, and overall, catalyze innovation in the historically under-researched field of maternal-fetal medicine, ultimately helping to drive better outcomes and successful pregnancies. Dr. Mourad also discusses how this digital twin can potentially assist with identifying women with placenta accreta spectrum disorder, and inform more precise and proactive treatment plans for patients with this high-risk condition.

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Mirella Mourad, MD is the Co-Director of the Preterm Birth Prevention Center and a Maternal-Fetal Medicine specialist at Columbia University Irving Medical Center. She is particularly interested in the medical diseases that affect pregnancy, focusing on maternal cardiac conditions, autoimmune diseases, and surgical complications involving abnormal placentation. Dr. Mourad is a fellow of the American College of Obstetricians and Gynecologists and a member of the Society of Maternal-Fetal Medicine.

For more information visit nyp.org/Advances