We met with Dr Jenny Kienzler – who recently won the first prize from the Swiss Neurosurgical Society – to talk about some hot topics in neurosurgery. Dr Kienzler is a Swiss neurosurgeon based at the Kantonsspital Aarau. She was selected as research fellow at the Brain Tumor Center at the Department of Neurosurgery, University of California, Los Angeles, USA.
Brainwork: You recently won an award from the Swiss Neurosurgical Society (congratulations!). Could you tell us a little bit about the project that won you the prize?
Dr Kienzler: We were awarded this prize for developing and validating a non-invasive technique to measure intracranial pressure (ICP). Currently, ICP measurements are performed in the intensive care units only, and the procedure involves surgical insertion of a probe into the brain parenchyma or ventricle. There is an evident risk of bleeding and infection, as with any open surgery. Therefore, the current technique for measuring ICP is not applicable to all patients and carries risks associated with open brain surgery.
Our novel technique – developed in collaboration with colleagues from Kaunas University of Technology (Lithuania) – measures ICP non-invasively using Doppler ultrasound. Essentially, this technique measures blood flow in the segments of the ophthalmic artery, and the ICP value can be derived mathematically from a comparison of intracranial and extracranial blood flow values. The required equipment includes a head frame that fixes the Doppler device on the eye, meaning that head size can sometimes be a problem. While no surgical procedure is necessary, the measurements must to be performed by a technician skilled in the Doppler technique. We are still improving the technique to make it faster, but the important advance that we have already made is that the technique is pain-free and non-invasive, and can be performed on all patients, including ones who are awake.
Brainwork: How are you planning to apply this technique to patient care?
Dr Kienzler: We have validated this technique in patients with traumatic brain injuries and found that it is accurate, robust and reliable. The differences in ICP values obtained through this technique compared to probe-based ICP measurements were very small indeed, meaning that we can begin to explore the use of our new technique in other patient populations.
We are planning to apply this technique to measuring ICP in patients with brain tumours before and after surgical resection of the tumour. Furthermore, we are also planning to use this technique to measure ICP in patients presenting with malignant stroke of the middle cerebral artery. For these patients, ICP measurements were so far not performed because the patients are initially awake but can then deteriorate very fast. Accurate ICP measurements can be particularly useful in this patient population, as it could help to determine the right timing for decompression surgery, and thereby improve patient outcomes.
Brainwork: We hear you’re planning to move to LA in the near future! Will you be continuing this work there? What other research plans have you got?
Dr Kienzler: My project at UCLA is a 2-year fellowship with the broad aim of improving treatment of brain metastases, so it is not related to the ICP measurement device.
In essence, the clinical part of my work will involve the delineation of the best possible timepoint to perform radiosurgery, and how the timing of radiosurgery should be matched with the timing of immunotherapy. There is evidence that radiosurgery can activate the immune system, resulting in favourable outcomes after combining it with immunotherapy, so we would like to investigate this phenomenon. The laboratory-based part of my work will complement the clinical findings, as we will extract the immune and genetic profiles of various types of brain metastases and their primary tumours.
Brainwork: Are you moving to LA specifically for this work? What motivates you to move across the Atlantic?
Dr Kienzler: I will move specifically for this work – and I have done a lot of background research in deciding to go for this project. I wanted to work in an internationally renowned centre to specialize in Neuro-oncology and Stereotactic Radiosurgery. Meeting Dr. Linda Liau – the Chair of Neurosurgery at the David Geffen School of Medicine at UCLA – last year at the American Association of Neurological Surgeons (AANS) annual meeting was key to my decision. I was inspired by her and wanted to work with her, and the scope of her research matched very well with my interests.
My plan is to ultimately build my own research group in Switzerland whilst continuing to perform surgery. With respect to this goal, it is important to completely immerse myself in research for a time, to learn further techniques, and to broaden my horizons with new research questions. At UCLA, there are vast opportunities for collaboration between departments, so it is in many ways the right place for this type of project.
Brainwork: What advice would you give to someone else considering a similar move?
Dr Kienzler: I would say prepare yourself well in advance, and do plenty of background research on the type of project you are undertaking and the place you are going to. I have been preparing for this move for about three years.
I would say your research background and the hospital you come from are not essential factors in determining your success at securing and completing a research project in the USA. Drive and passion for research – as well as being proactive at making connections with people – are much more important.
A big thank you to Dr Kienzler for taking the time to sit down with us. We wish her the best of luck with her future research and move to LA!