Funding the Future of Neurosurgery

The Peter Black Neurosurgical Fund

at Brigham and Women's Hospital Boston, Massachusetts

Why and how do brain tumors grow?

How can we control or even stop the growth of tumors?

How can our ability to locate and surgically remove brain tumors be refined?

A team of world-class neurosurgeons, scientists and radiologists at one of Boston's most prestigious medical centers is committed, day-in and day-out, to pursuing the illusive answers to these difficult questions. Their insights and research findings in the laboratory must continue to be applied in monitored clinical trials at the bedside of thousands of children and adults, bringing us one step closer to a cure.

A Century of Progress

Neurosurgery is the subspecialty of surgery in which operative procedures are focused on diseases and malfunctions of the human brain and nervous system. The development of neurosurgery as a surgical subspecialty had its genesis in Boston, Massachusetts at the turn of the twentieth century thanks to one man, Dr. Harvey Cushing, a widely acclaimed scientist, clinician, and teacher. Trained as a surgeon, Dr. Cushing's innovative surgical procedures on the brain yielded remarkable advances over the course of his thirty-year tenure as a physician at the former Peter Bent Brigham Hospital, now the Brigham & Women's Hospital.

His breakthroughs in the field of neurosurgery were best illustrated in the dramatic decline in the mortality rate for brain surgery patients. At the beginning of his career, patients with brain tumors had only a 20% chance of survival. By the time Dr. Cushing retired in the mid-1930's, the survival rate for his patients rose to nearly 92%.

The decade of the forties saw growth in the burgeoning field of neurosurgery when Dr. Franc D. Ingraham, a student of Dr. Cushing, established a pediatric neurosurgical service at Boston's Children's Hospital. Under the direction of Dr. Ingraham and his successor, Dr. Donald Matson, pediatric neurosurgery flourished.

Opportunities for scientific discovery in the Neurosurgical Service reached new momentum in the late 1980's with the appointment of Dr. Peter Black as Neurosurgeon-in-Chief at both the Brigham & Women's Hospital and Children's Hospital. It was at this significant juncture that the Neurosurgical Service reestablished its commitment to develop the Brigham & Women's Hospital as a leading center for adult neurosurgery.

Neurosurgery Today

The Neurosurgical Service at Brigham and Women's Hospital is distinguished by a skilled and talented team of surgeons, scientists, trainees, and staff all committed to achieving excellence in patient care, teaching, and research. Today, the clinical service is functioning at high capacity with more than 1400 operative cases completed in 1998.

The basic science and clinical research efforts in tumor biology, neuroscience, and imaging technology have rapidly built an international reputation for the Service in innovation and scientific excellence and the physician training program has become one of the best and most sought-after in the world for residents, students, and fellows.

Throughout ten years of working to reinvigorate the Neurosurgical Service, it has been Dr. Black's passion to nurture and sustain vital links between basic science research in the laboratory and the care of patients at the bedside. This can be a difficult connection to maintain. It takes unique talent and inexhaustible determination to combine the painstaking attention to detail that is required in the laboratory with the compassion and urgency required in patient care. Dr. Black has demonstrated a unique gift as one of the few surgeons in the world who is as respected for his achievements in basic science research as he is for his clinical care.

Brain Tumor Research & Imaging Technology

Dr. Black's most notable accomplishments as a clinician-scientist focus on his research in brain tumor biology and the imaging of the brain. In the basic science laboratory, Dr. Black probes the mysteries of tumor cells, searching for ways to control their growth. In the imaging laboratory, he collaborates with radiologists from the Brigham, to develop new methods for surgeons to see inside the brain - before, during, and after surgery. Thanks to increasingly precise visualization technologies which reveal the details of what's going on within the brain, surgeons can be far more effective at removing tumors safely, as well as performing other technologically demanding neurosurgical procedures.

Probing the Causes of Brain Tumor Growth

In the study of brain tumor biology, Dr. Black and his colleagues in the laboratory are searching to uncover the events that cause brain tumor growth and discover ways to stop their development. A wide variety of scientific approaches are utilized, from examining the abnormalities in chromosomes and human genes, to identifying the factors in a cell that encourages growth. Studies such as these are often inspired by clinical experience.

For example, physicians in the clinical setting were the first to notice that tumors called meningiomas were more common in women than in men. Researchers in Dr. Blackšs laboratory have shown that increased levels of female hormones likely contribute to the increased incidence of these tumors in women compared to men. This kind of information provides critical clues needed to develop drugs which prevent the growth of these and other tumors.

Arresting Tumor Growth

Another laboratory research project that holds promise for the development of new treatments for brain tumors involves limiting the blood supply to the tumor to control its growth. A colleague of Dr. Black's at Children's Hospital, Dr. Judah Folkman, first investigated the idea that one may be able to control tumor growth by preventing the development of new blood vessels, a process known as angiogenesis. Tumors require tremendous amounts of nutrition and oxygen in order to grow. As a tumor gets larger, new blood vessels must form around and through it in order to meet these ever-increasing needs. The result is an intense concentration of new blood vessels at the site of the tumor. It is thought that if one can either arrest or altogether prevent the proliferation of the cells that form the new blood vessels, the tumor may be starved of the nutrients it needs to grow.

Dr. Folkman has identified a substance that can effectively prevent the formation of new blood vessels and thus stop the growth of several tumor types such as colon and breast tumors. Researchers in Dr. Black's lab have now shown that this compound inhibits the growth of brain tumors in animal models and they are developing methods for delivering this drug to the site of a brain tumor using gene therapy. Once this work is completed, this method will be ready for testing on human patients.

Programmed Cell Death Research

Neurobiologists are finding the answers to how and why cells grow and die during the development of the brain. Members of Dr. Black's research team are currently applying these discoveries and insights to tumor cells. They have identified substances found naturally in the brain that instruct normal cells to grow, or signal them to die. Researchers in the lab have shown that if you introduce a high concentration of one of these naturally occurring substances to the site of a brain tumor, it will quickly die, leaving the surrounding normal cell around it intact. This approach is now being brought to clinical trials where it will be tested on patients with incurable, aggressive brain tumors.

Surgical Imaging Research

When planning and performing surgery, the most modern technology is used by surgeons to produce better images of the brain. Commonly referred to as "virtual reality," three-dimensional imaging has been refined and incorporated into surgical planning procedures. It produces precise pictures of both the location and size of a tumor and its relationship to other critical brain structures. Using a three-dimensional picture of the brain rather than the traditional two-dimensional image, Dr. Black and his colleagues can accurately identify the best way to remove a tumor with a minimum of disruption and damage to the healthy parts of the brain. This technology becomes particularly powerful when used in conjunction with magnetic resonance imaging (MRI) to guide the surgeon's work during surgery.

Dr. Black is one of the principal investigators using a new and experimental "intra-operative MRI" system, which he helped to develop in collaboration with scientists at General Electric and Dr. Ferenc Jolesz, the radiologist at the Brigham and Women's Hospital who invented this remarkable technology. This revolutionary technology provides surgeons with real-time MRI images as surgery is performed, enabling them to use the highly sensitive MRI as their "eyes" during the operation. Patients whose brain tumors would previously have been considered inoperable are now being treated with these exciting advances in surgical imaging technology.

Upholding the Tradition of Excellence

In the last ten years, Dr. Black has followed closely in the footsteps of Dr. Harvey Cushing, providing patient care that is as compassionate as it is revolutionary. On April 15, 1931, Dr. Harvey Cushing performed his 2,000th confirmed brain tumor surgery at the former Peter Bent Brigham Hospital. Sixty-six years later, on December 15, 1997, Dr. Black performed his 2,000th confirmed brain tumor surgery at the Brigham & Women's Hospital in the intra-operative MRI facility. These two men, so far apart in time and technology, remain connected by their intense drive to improve the lives of thousands of their patients afflicted with brain tumors.

The Need for Philanthropy

The remarkable achievements in neurosurgical research and teaching at Brigham & Women's Hospital during the past decade are a credit to Dr. Peter Black and his colleagues. However, their ability to sustain the clinical and scientific momentum which has gained them the acclaim of their peers in medicine and the gratitude of patients and their families is threatened by limited research dollars and a changing healthcare reimbursement environment.

Today's rapidly changing medical arena affects the life of an academic physician. There is intensifying pressure to commit more and more time to direct patient care activities, which produce revenue, over non-revenue producing activities such as research, writing and mentoring young physician trainees. Neurosurgeons have fewer opportunities to mentor and advise medical students and residents or to participate in the creative brainstorming that occurs in the laboratory.

The future holds endless possibilities but new sources of financial support are needed. An infusion of charitable gift dollars will enable the Neurosurgical Service at Brigham & Women's Hospital to continue flourishing as a highly productive teaching and research entity and continue its tradition of excellence in patient care.

The Dr. Peter Black Neurosurgical Fund

To insure that scientific advances in neurosurgery and the training of young physicians are perpetuated, the Dr. Peter Black Neurosurgical Fund will be established at Brigham and Women's Hospital. Charitable gifts from Dr. Black's patients and their families, colleagues and friends are needed to achieve the challenging goal of five million dollars to establish this fund.

It is Dr. Black's intention that 20% of new gift commitments to The Dr. Peter Black Neurosurgical Fund will be used, at his discretion, to support current activities of the brain tumor research laboratories. The remaining 80% will be directed to endow a fund at Brigham & Women's, income from which will support the ongoing needs of the Neurosurgical Service, in perpetuity, at the discretion of Dr. Black.

Upon Dr. Black's retirement, a portion of the contributed funds will then be re-directed to the Harvard Medical School to endow a Chair in Neurosurgery, in honor of his lifetime achievements and dedication to patient care, research and medical education.

Endowing a chair at Harvard Medical School fulfills Dr. Black's vision of providing adequate income to fund a Professorship which will allow more opportunities for those critically important non-revenue producing teaching and investigating activities. This endowed chair will provide the next generation of neurosurgeons with the opportunity to study, reflect, and publish; to mentor future neurosurgeons; and to care for patients with neurosurgical diseases.

Gift Opportunities

Individuals, corporations and foundations are invited to consider supporting this major philanthropic initiative with an outright gift from current income, a planned gift from assets, or a combination of both. Donors may restrict their gift to current use, endowment or to a combination, as envisioned by Dr. Black.

Contributions to The Dr. Peter Black Neurosurgical Fund may also be made in honor or in memory of an individual. Gifts in excess of $100,000 will be recognized with a designation as a permanent fund, bearing the name of the donor or an honoree.

We welcome the chance to discuss gift and pledge options, as well as appropriate recognition opportunities. For additional information, please contact:

The Boston Neurosurgical Foundation

300 Longwood Avenue Boston, MA 02115

617-355-6558