Duke Hospital is a tertiary care teaching hospital licensed for 1124 beds and is consistently ranked by the U.S. News & World Report as one of the top 10 Best Hospitals in America. The main hospital campus includes Duke North Pavilion for inpatient care, Duke South Pavilion for outpatient care, and the Children's Health Clinic. The North Pavilion includes an entire floor devoted to neurosurgery and neurology patients as well as a dedicated 16-bed neuro ICU. Duke is the largest hospital in the South and has been named as a center of excellence for stroke. Durham Regional Hospital, a 369-bed community hospital, and the Durham VA Medical Center also provide exposure to neurosurgical care in non-academic settings.

 

The operating rooms at Duke University Medical Center include the most up-to-date technology for neurosurgery including the use of intraoperative microscopes for microscopic dissection, brain and spinal cord monitoring including evoked potentials and intraoperative EEG. The operating rooms are also equipped for intraoperative angiography for treatment of complex aneurysms or vascular malformations. We have the use of 3-dimensional Stealth stereotactic guidance for framed biopsies and functional neurosurgery as well as the frameless Brain Lab stereotactic guidance system to assist in navigating the brain 3-dimensionally for the treatment of brain tumors and vascular lesions. Of the 30 operating suites at Duke University Medical Center, three are dedicated to the neurosurgical service and three more are shared with other surgical services throughout the week for a total of up to six operating rooms available at any given time.

 

 

The Duke University Medical Center endovascular facilities include a state of the art Phillips Integris 3-dimensional rotational angiography unit. This equipment allows the physicians to visualize the arteries of the neck and brain in 3-dimensions and allows them to, with computer assistance, rotate the arteries to visualize aneurysms and other problems that might not be seen on conventional angiography. This unit also allows the neurointerventionalist to treat complex vascular problems in the brain such as aneurysms, arterial venous malformations, and fistula with maximum efficacy. The interventional suite is supplied with both standard and innovative materials to treat these problems such as GDC platinum coils to treat cerebral aneurysms and arteriovenous fistula, endovascular stents to treat narrowed arteries and some cerebral aneurysms, and liquid embolic agents to treat arterial venous malformations.

 

The Departments of Radiation Oncology and Neurosurgery at Duke University offer stereotactic radiosurgery. This procedure allows the radiation oncologist and neurosurgeon to work together to focus the radiation beam precisely on a small target within the brain. This technology has been used at Duke since 1991. The stereotactic unit is a LINAC (Linear Accelerator) System which enables precise focusing of radiation on lesions in the brain such as aterial venous malformations or tumors to attempt to treat these lesions non-invasively. Specifically, this treatment is reserved for patients with small vascular lesions or tumors that may not be accessible surgically. Radiosurgery requires a highly skilled, multi-disciplinary team of doctors and is only available at select tertiary care hospitals. Duke University Medical Center has a large referral base for radiosurgery and is also recently the first in the world to begin using the Novalis Tx radiosurgery system.

 

The NICU is a 16-bed intensive care unit dedicated to the neurosurgical and neurological services at Duke. A highly trained team of neurointensivists, nurse practitioners, pharmacists, respiratory therapists, and intensive care nurses round daily with the neurosurgical team on all critical care patients. The neurosurgical team works closely with these dedicated practitioners to make daily plans and minute-to-minute decisions on critical care issues that arise throughout the day. Each of the sixteen rooms are equipped with state of the art and centralized monitoring equipment to facilitate patient care. Invasive neurological monitoring includes both standard ICP monitors and ventriculostomies as well as the newer Licox multi-modal monitors for the management of patients with head trauma, tumor, hemorrhage, and stroke.

Funded by the generosity of Dr. Takanori Fukushima, the microanatomy dissection lab was created to provide neurosurgical residents with a resource to perfect their microsurgical skills outside of the operating room. The lab includes eight complete stations, each with a microscope, drill, suction, and microdissection instruments. International research fellows are always available for assistance and the lab always has cadaver specimens available for resident use. Duke residents frequently utilize the lab to improve their anatomic knowledge base, microsurgical techniques, and spinal instrumentation methodology. Throughout the academic year, practical teaching conferences utilize the microanatomy dissection lab or the Research Tissue Skills Lab to supplement the standard didactic conferences.

 

 

 

Built adjacent to the Microanatomy Dissection Lab, the Wilkins Library houses an impressive collection of the classic and current literature that shapes the practice of Neurosurgery. Donated largely by Dr. Wilkins from his personal library, it includes the entire Classics in Medicine series as well as original texts. The library also has current and past issues of Neurosurgery, Journal of Neurosurgery, and other current literature vital to our field of study. The library serves as an invaluable resource for texts, atlases, and journals. Educational conferences are held in the library on a weekly basis and the library is available to residents at all times. Dr. Wilkins served as the Neurosurgery division chief at Duke prior to Dr. Friedman and founded Neurosurgery, among many other achievements within the field.

 

 

 

Situated between Duke Hospital North and South Pavilions, the Medical Center Library is a state-of-the-art multimedia resource. The library houses 285,190 volumes including 1,503 current print subscriptions and an outstanding Trent Collection in the History of Medicine. In 2003, The Nashold Exhibit on the history of stereotactic neurosurgery was dedicated as a permanent display in the library. In addition, 2,421 electronic journal titles are available on-line to all Duke employees. Information technology is changing the way medicine is practiced at Duke and improvements are constantly being made. The Office of Information Technology (OIT) has an excellent website with free software and is integrating the medical record system at Duke for the electronic age. Radiology and medical records are now available to Duke physicians on the web for browsing while away from the hospital. In addition, each neurosurgery resident is provided with both an HP iPAQ PDA and a laptop computer to enable patient record keeping, medical record tracking, and transfer of care.

 

 

Duke University is an international leader in basic science research with cutting edge facilities to lead the way. Of note, is the Duke Comprehensive Cancer Center, the recently developed Center for Genomic Technology and the Duke Microarray Facility. The division of Neurosurgery has dedicated laboratory space in Duke South, the Sands Building, and in the Medical Science Research Building, in addition to space in numerous animal facilities.  Residents and faculty in the division of Neurosurgery often collaborate with researchers throughout the graduate school, thus gaining access to any of the facilities available at Duke.

 

Duke University consistently ranks among the top programs to receive NIH research funding. In 2002, Duke's School of Medicine received 598 awards for a total of $245.5 million, placing eighth in the nation overall. The majority of the awards funded research grants, with the remainder going toward training grants, fellowships, research and development contracts and other awards. The division of general internal medicine received $79.9 million, making it the top Duke NIH grantee. Duke's department of surgery received $35 million - more funding than any other surgery department in the country. Other Duke research areas among the nation's top 10 for NIH funding include biology, biostatistics, radiation and diagnostic oncology, psychology and pharmacology.

 

The Preston Robert Tisch Brain Tumor Center at Duke  is one of its strongest assets. Co-directors Henry Friedman, MD, and Allan Friedman, MD, combine administrative talents with clinical expertise and research endeavors to lead a team of over 100 professionals in their quest to provide state-of-the-art treatment and improved quality of life for patients with brain tumors and their families. The Brain Tumor Center currently cares for more than 1,000 patients with brain tumors who have come to Duke from all over the world. Duke has one of three brain tumor research programs recognized by the National Institutes of Health and offers more active clinical trials than any other known treatment center. The nationally acclaimed Brain Tumor Family Support Center is the model for hospital based support programs throughout the United States.