The vision for the future of Barrow Neurological Institute
The seizure crumpled University of San Diego student Colby Bishop, leaving him unconscious on the ground. A professor found him and called for medical help.
Doctors quickly determined that Colby had a rare arteriovenous malformation (AVM), an abnormal tangle of arteries and veins, the size of a tangerine. Because it was attached to his brain’s motor strip, removing it would be a high-risk surgery. Leaving it in place was even riskier, as a rupture could cause paralysis or death.
Because of the complexity of the surgery, Colby’s doctors knew there was only one thing to do. They recommended he see Dr. Michael Lawton at Barrow Neurological Institute, where more brain surgeries are performed compared to any other American hospital.
Dr. Lawton, among the world’s top brain surgeons, specializes in difficult AVM and aneurysm cases. He’s written groundbreaking reference books on both.
Within days, Colby was undergoing a nine-hour surgery, during which a section of the AVM ruptured and he suffered a stroke. Anywhere else, that could have been deadly. But Dr. Lawton and his team handled the rupture and removed the AVM.
Despite the complication, Colby left the hospital a few days later. After a week of neurorehabilitation at Barrow, he headed home to Idaho, and started classes on time that fall for his last semester of college.
“I was relieved to be able to start school and focus on my future without ever again having to worry about a ticking time bomb in my brain,” he says. “I am incredibly thankful.”
Colby feels 100 percent healed, has graduated from college and is completing an internship, with a bright future ahead.
Centers of excellence
Colby’s experience fits Dr. Lawton’s vision for Barrow’s future, as he continues to build on the foundation left by founder Dr. John Green (1962-86) and Green’s successor as president, Dr. Robert Spetzler (1986-2017).
Dr. Lawton, nearing his first anniversary as Barrow’s third president and CEO, is charting ways to further enhance the institute’s global reputation for innovation. Barrow 3.0 will “push the boundaries of neuroscience even further and strive to solve the unsolvable with new techniques, new technologies, and in ways we never thought possible,” he says.
Toward that end, he sees Barrow not as a collection of neuro-centered programs, but as home to centers of excellence in treatment and research.
The Barrow Aneurysm and Arteriovenous Malformation Research Center, or BAARC, is one example.
While AVMs are rare, they are often deadly – half of all hemorrhages are fatal, and they occur most frequently in teens and young adults, like Colby.
Brain aneurysms are more common – 10 burst in the United States every three hours. Of those 10 people, four don’t make it. Another four suffer permanent neurological defects.
There is little research into aneurysms and AVMs – the federal government invests just 83 cents per year for each person affected. Yet this is a field that offers a great potential to improve quality of life for so many people. That’s why Dr. Lawton is leading BAARC to be the place where critical research takes place.
Dr. Lawton, for instance, found two common gene mutations responsible for what was thought to be hereditary hemorrhagic telangiectasia, a rare disorder that leads to the development of multiple abnormalities in the blood vessels. That research indicated the condition may not be hereditary after all. Understanding the genetics helps doctors find ways to better treat or prevent complications.
Some AVMs are small and easily removed. Some are so large they’re impossible to deal with. Unraveling the biology behind these large AVMs can lead to the development of new, noninvasive, effective treatments.
Similarly, the consensus on aneurysms has changed. Once, surgery was scheduled for all aneurysms regardless of their size. About a decade ago, researchers determined that smaller ones generally don’t rupture if they’re left alone. As neurosurgeons become more conservative in their approach, medications to further reduce the risk of a ruptured aneurysm become more valuable. If doctors can determine the biology that makes an aneurysm grow, they can develop drugs to counter it.
Other medical fields have done this with great results. Arteriosclerosis used to be highly fatal. Once the biology of the disease was better understood, statin medications were developed. People lived longer. As Dr. Lawton and his team unravel the biology of aneurysms and AVMs, they expect to see the same results.
Barrow’s reputation for medical excellence attracts patients, who provide tissues for research, which in turn provides better options for treatment, and attracts more patients. This is translational genetics at its best. And it’s why Barrow is uniquely situated to lead the world in improving the treatment of aneurysms and AVMs.
Fundamental transformation in medicine
Dr. Lawton encourages this same sense of discovery, innovation and research to improve patient outcomes throughout Barrow. He’s identified key programs for particular emphasis.
Barrow 3.0 will make great use of artificial intelligence, which is poised to fundamentally transform medicine by truly delivering personalized care.
Diagnostics and treatment are, at their core, data analysis problems. Doctors collect data to determine what’s wrong and find a solution. Some data, such as lab results, flow into a spreadsheet. Other data are “unstructured,” to use computer speak for information not organized in a pre-defined manner. This data includes X-rays, MRIs, CT scans, genome sequences or a doctor’s clinical notes.
The human brain understands how to sort through this data, just as it knows how to find a route on a map, tell the difference between pictures of a dog and a muffin or turn on the lights. Until recently, any of these tasks were beyond a computer’s ability. But now Siri finds a coffee shop for you, Google sorts through photos and finds the one you need and Alexa keeps your electric bill low. This is rudimentary artificial intelligence, or AI.
What does this have to do with medicine?
Today, your family doctor might send you to a specialist, who will visit with you, collect your medical history, run tests and review radiology. Weeks later the doctor will have results and can reach a diagnosis.
In the future, a supercomputer using deep learning and artificial intelligence will help the doctor and speed diagnosis. Within minutes, this computer will gather your entire medical history from multiple doctors’ offices, examine your lab results, radiology, doctors’ notes and genetic data, and compare it with the 25,000 petabytes of collected medical data worldwide, looking for patterns and predictions to inform a personalized diagnosis before you leave the office. You could quickly receive treatment that is far more likely to improve your health than a one-size-fits-all plan.
The technology to do this doesn’t exist – yet. This is the disruptive future of medicine. One of Dr. Lawton’s first Barrow 3.0 recruits, Dr. Igor Barani, is at the forefront of developing the AI accuracy necessary for medical applications.
Working in the private sector, Dr. Barani made breakthroughs in using AI to read and diagnose medical imaging such as X-rays. He came to Barrow, with its huge medical data repository and a powerful supercomputer, because he believed he could make a larger impact here.
Dr. Barani is thinking big. Other researchers tackle discrete pieces in medicine, such as reading an X-ray or comparing doctors’ notes to the latest literature. Dr. Barani instead has set an audaciously big goal: working toward a holistic approach that will use Barrow’s supercomputer to interpret both images and text, which no one else is attempting. It will then apply deep learning and assimilate this big data to create efficiencies and personalize treatment.
A place to reject the status quo
Dr. Lawton and Dr. Barani are not alone in pursuing ground-breaking research. A refusal to accept the status quo runs deep in Barrow’s DNA and is the guiding principle of Barrow 3.0.
The world’s top neuroscience researchers come here to study brain and spine disorders in hopes of discovering new treatments and cures for conditions such as Alzheimer’s, Parkinson’s, ALS, brain tumors and cerebrovascular disorders. Last year, Barrow scientists conducted more than 300 clinical trials and nearly 1,000 studies.
But these leading scientists are stymied because lab space is at a premium. The manner in which Barrow’s clinics, research labs, rehabilitation facilities, operating rooms and offices are scattered across an eight-block radius makes collaboration more difficult.
At a minimum, this arrangement forces patients to navigate a maze of offices to find their doctor. Over the longer term, it limits ground-breaking research and innovations that would benefit patients. Barrow’s doctors brim with ideas on how to improve medical care, but a lack of lab space often delays their development.
The solution: The Barrow Neuroplex. The new five-story building will serve as the heart of Barrow, centralizing and integrating clinical research, neurology and neurosurgery for enhanced patient care. The new centers of excellence – including the Barrow Aneurysm and AVM Research Center and the Barrow Artificial Intelligence Center – will find a home here. The larger research space will be a gathering area for disparate neurologic specialties, fostering dynamic synergies and collaboration.
This new home for Barrow began as a project of Dr. Spetzler and carries on today under Dr. Lawton. The building project was formerly known as the
Spetzler Legacy Project, because Dr. Spetzler dedicated philanthropic gifts made in his name for his retirement to address the space constraints that limited Barrow’s growth. He says, “This project is dear to my heart and carries with it the promise of future neurological progress.” Today, the building project, called The Barrow Neuroplex in the spirit of a Google Campus of Neuroscience, continues Dr. Spetzler’s legacy and will allow Dr. Lawton to take Barrow to new heights.
Ultimately, the Neuroplex will transform the way modern neurosurgery is practiced by utilizing advanced virtual reality and augmented reality technology to combine a patient’s MRI, CT and angiographic images. In a virtual reality studio, the surgical team will prepare for an operation, plan its strategy and anticipate complications. Then during surgery the team will use a computer-guided system.
“This state-of-the-art facility is critical to helping Barrow become the world’s leading neuroscience center, because it will change the environment in which our team works, create a portal for destination patients, and expand our space for research,” Dr. Lawton says.
That’s Barrow 3.0, creating fresh variations on the theme that Dr. Green and Dr. Spetzler instilled in this neurological institute. Under Dr. Lawton, Barrow will find new ways and new technologies to solve the unsolvable, with many initiatives already underway that have the potential to change the protocol for treating neurological conditions.
Why we give: Lysi and Scott Bishop
“Barrow gave us our son Colby’s life back. We are so grateful, and it was very important to us to do what we could to support the place that saved our son. By giving to Barrow, we hope that our gift will help provide that same care for someone else in need and offer funding for research into AVMs. For people from all over the world who are diagnosed with AVMs, having that resource in Barrow is incredible. There is no one better or more experienced in performing those surgeries than Dr. Lawton. No one else has his skill set. We wanted to help others who are in those same shoes, who get the call that their loved one has an AVM and needs high risk surgery. Having someone like Dr. Lawton, with that vast experience in how to save them, truly makes all the difference in life.”