By Marshall Grode, MD, Charles Carton, MD and Scot Macdonald, PhD

Cedars-Sinai Medical Center traces its roots back to 1902 when Kaspare Cohen Hospital, which later became Cedars of Lebanon Hospital was founded in East Los Angeles. In 1921 Mount Sinai Hospital was founded in Boyle Heights with six beds to treat victims of the influenza epidemic that had struck Los Angeles. In 1955 Mount Sinai Hospital moved to a new building on Beverly Boulevard on the site of the present medical center. Cedars of Lebanon and Mount Sinai Hospitals merged in 1961 to form what would become Cedars-Sinai Medical Center. The complex of buildings between Beverly Boulevard, San Vicente Boulevard and Third Street grew through the early 1970s and is today one of the premier medical facilities in the country. Although missing records from Kaspare Cohen Hospital make it difficult to trace the evolution of neurosurgery at that hospital, pathology records from Cedars of Lebanon show that Carl Rand, MD and Mark A. Glaser, MD performed neurosurgery in the 1930s and 1940s at the hospital. Dr. Rand had been a resident in Boston at Peter Bent Brigham Hospital under the pioneering neurosurgeon, Harvey Cushing, MD.

Innovation has always been a part of Cedars-Sinai Medical Center and many of its neurosurgeons invented or developed new instruments and techniques. Emil Seletz, MD, who between 1936 and 1937 worked with Walter Dandy, MD, an innovative neurosurgeon at the Johns Hopkins Medical Center. Dr. Seletz became Chief of Neurosurgery at Cedars of Lebanon in 1958. He also designed a non-rigid brain cannula for ventriculography, a universal Kerrison Punch handle and set, a lighted guillotine hook for sympathectomy, and other surgical devices.

Tracy Putnam, MD joined Cedars of Lebanon in 1947 as Chief of Neurosurgery and co-discovered dilantin with H. Houston Merritt, MD. Dr. Putnam also held a professorship at the New York Neurological Institute, part of the Columbia Presbyterian Medical Center in New York City. In the 1960s, Charles A. Carton, MD helped develop a rapid non-suture ring anastomotic method. Dr. Carton also conducted research on baboons in collaboration with John Kennedy, MD at Harbor Hospital.

In the early years at Cedars of Lebanon, few neurosurgical procedures were performed. In 1946, for example, Dr. Rand performed only four neurosurgical procedures, and the following year Dr. Seletz performed eight neurosurgical procedures. Sanford F. Rothenberg, MD became Dr. Putnam's only resident from 1948 to 1952. Dr. Rothenberg later continued Cedars of Lebanon's pioneering work, with Dr. Louis Conway, describing laboratory work in which a stent was passed through an arteriotomy to the orifice of a presumed aneurysm. This procedure foreshadowed some of the endovascular work done today. Dr. Rothenberg also published a paper on the use of labeled red blood cells to determine whether the finding of red blood cells on lumbar puncture was traumatic or due to a leaking aneurysm. He was also active outside the laboratory and the operating room, being President of the Los Angeles County Medical Association from 1974 to 1975 and helping establish SCIPIE, a doctor-owned insurance company that helped in the malpractice insurance crisis of that time.

Neurosurgical patients were seen at the Mount Sinai Out-Patient Clinic at 207 North Breed Street by Maxwell Andler, Jr., MD until Mount Sinai Hospital opened in 1955, leading to Dr. Andler and Milton Heifetz, MD joining Cedars of Lebanon but doing much of their work at Mount Sinai. Dr. Andler had won a Bronze Star for his service as a physician while he was a prisoner of war of the Japanese between 1942 and 1945. He was Chief of Neurosurgery at Mount Sinai Hospital from 1963 until 1967. Dr. Heifetz was Chief of Neurosurgery from 1983 until 1986. Dr. Heifetz invented and designed many neurosurgical instruments, including the Heifetz aneurysm clip.

Over the years there have been many neurosurgeons on staff at Cedars, including Drs. Heifetz, Carton, Andler, Rothenberg, Ernest Penka, Elliot Blindeman, Richard Lewin, Seth Weingarten, Marshall Grode, Seletz, Martin Cooper, Todd Lanman, Myles Saunders, Ian Armstrong, Jeff Rush, Martin Krell, David Ditsworth, Earl Crandall, and Robert Bray. Their commitment to Cedars-Sinai Medical Center as clinical attendings and divisional leaders has been recognized, with several serving as chairmen of the Division of Neurosurgery.

A major turning point in the history of neurosurgery at Cedars-Sinai Medical Center was the founding of the Maxine Dunitz Neurosurgical Institute in 1997. The Institute is dedicated to advancing the field of neurosurgery, providing leading-edge clinical care and conducting research for the full range of intracranial conditions. Keith L. Black, MD has been director of the Institute since its founding and now leads a team of eight neurosurgeons and two neuro-oncologists. The Institute performed over 1,000 major neurosurgical procedures last year ranging from craniotomies for tumor resections to surgical resection of vascular malformations. Dr. John Yu co-directs the Comprehensive Brain Tumor Program and is the lead investigator on several innovative protocols for brain tumors, including the use of a dendritic cell vaccine for malignant glioma. He is also actively researching adult neural stem cells. Dr. Wouter Schievink directs the Neurovascular Program, Dr. Moise Danielpour is director of Pediatric Neurosurgery, Dr. Brian Pikul directs Neurosurgical Trauma and Dr. Asha Das is Director of the Neuro-Oncology Program. Dr. Ajay Ananda, Dr. Ali Mesiwala, Dr. Ray Chu, Dr. Gabriel Hunt and Dr. Michael Badruddoja add expertise in areas of skull base surgery, epilepsy, facial pain, neurovascular malformation, and neuro-oncology.

The Institute's multifaceted programs address and treat brain tumors, neurovascular diseases, functional disorders, trauma and other complex conditions requiring neurosurgical intervention for both pediatric and adult patients. The Institute offers the full spectrum of diagnostic and treatment options, including an Outside Scan Review. Cedars-Sinai Medical Center has dedicated neurosurgical operating rooms equipped with intraoperative MRI, image-guided surgery, operating microscopes, CUSAs, lasers and intraoperative angiography. CSMC also has the capability to perform stereotactic biopsy and radiotherapy of tumors.

A unique strength of the Maxine Dunitz Neurosurgical Institute is the ability to rapidly translate research findings from the laboratory into clinical practice, which gives patients direct access to the latest treatment alternatives.

Robert Bray, MD and Ted Goldstein, MD started the Cedars-Sinai Institute for Spinal Disorders in 1998, which is a comprehensive and advanced spine center dedicated to the evaluation, diagnosis and treatment of all spinal disorders. The Institute is now led by co-directors J. Patrick Johnson, MD with Neel Anand, MD, Mch Orth, Director of Spine Trauma, and Robert Pashman, MD, Director of Scoliosis and Spinal Deformity. The Institute has a multidisciplinary team of surgeons, surgical fellows, specialized spine nurses and educators, and conservative care and diagnostic specialists. The Institute offers expert spine care with state-of-the-art X-rays and MRI imaging, physical therapy, postoperative rehabilitation and surgery. The Institute treats the full range of adult and pediatric spinal disorders.

The Institute offers pain management therapy ranging from conventional therapy to surgical interventions, including minimally invasive surgical techniques and state-of-the-art artificial disc replacement. The Institute's spine physicians and specialists are also dedicated to developing new techniques and instrumentation for spine surgery, including several clinical trials. This research is the future for more effective approaches to treat spinal disorders.

The conservative discipline focuses on physical therapy, rehabilitation, pain management, diagnostic assessment and alternative medicine. When surgery is necessary, board-certified neurosurgeons and orthopedic surgeons lead the patient's care. All surgical facilities feature spine-specific, technically advanced operating rooms, allowing physicians to provide state-of-the-art care with the latest equipment and the best possible outcomes.

In addition to the Cedars-Sinai Institute for Spinal Disorders and the Maxine Dunitz Neurosurgical Institute, Cedars-Sinai has continued to encourage the participation of private attendings in neurosurgery. These fine physicians have access to all the advanced diagnostic and therapeutic techniques that have kept Cedars-Sinai Medical Center's Division of Neurosurgery at the forefront of neurosurgical patient care.

For 102 years Cedars-Sinai Medical Center has gathered together expert teams to provide compassionate, state-of-the-art care for the full range of neurological and spinal disorders, even while conducting research to improve treatments for patients. With better imaging systems, ground-breaking research on everything from delivering anti-cancer drugs to the brain to using genetic analysis for diagnosis, as well as advances in artificial spine prostheses, Cedars-Sinai continues to be a leader in the field of neurosurgery, both in the clinic and in the laboratory.

Marshall Grode, MD is a neurosurgeon in private practice at Cedars-Sinai Medical Center.

Scot Macdonald, PhD is the staff editor at the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles.