Solving the Puzzle
Jefferson Neuroscience Leads the Way in “the House that Rosenwasser Built”
Robert Rosenwasser, MD, MBA, is part neurosurgeon, part historian. He revels in telling the tale of how Jefferson vaulted into medical history in the late 19th century by performing the first-ever brain tumor surgery in the country. With just a mere mention of “The Gross Clinic,” he launches into a TED-like talk full of trivia nuggets about the painting—including how artist Thomas Eakins inserted himself into the piece. And he can spout every detail of a little-known, but medically pioneering, Civil War-era hospital in Philadelphia.
Rosenwasser, the Jewell L. Osterholm, MD, Professor and Chair of the Department of Neurological Surgery, is the president of the Vickie and Jack Farber Institute for Neuroscience at Jefferson Health. He is also the architect of the institute, stacking the building blocks to create the world-class program recently named “best in the region”—and number 21 in the country—for neurology and neurosurgery in U.S. News & World Report’s 2019–2020 “Best Hospitals” listing.
Sporting a gleaming gold brain lapel pin that boasts membership in the W.W. Keen Society—named for the pride of Jefferson, pioneering surgeon William Williams Keen—Rosenwasser is quick to enthusiastically tick off fun and fascinating facts from more than a century and a half of Jefferson’s history, leading up to today’s litany of “firsts”: first in the region to perform stereotactic radiosurgery for brain tumors and vascular malformation; first to offer the Gamma Knife; first in Philadelphia to perform asleep deep brain stimulation surgery for Parkinson’s disease; first dedicated stroke center in Philadelphia; first in the region to establish a university-based mobile robotic healthcare teleconsulting system; and first academic medical center-based mobile stroke unit in the region, just to name a few.
It is that enthusiasm that has transformed the neurosciences from individual departments to the all-encompassing, nationally renowned Vickie and Jack Farber Institute for Neuroscience. Dubbed “the House that Rosenwasser Built,” it is an institution where all departments in the neurosciences have a seat at the table, and a place that encourages a cohesive, collaborative atmosphere to foster great ideas.
“When I got here [in 2008], the hospital and university leadership made the commitment to invest in structured, formal clinical service lines—one of them was the neurosciences,” says Mark L. Tykocinski, MD, provost and executive vice president for academic affairs at Thomas Jefferson University, and the Anthony F. and Gertrude M. DePalma Dean of Sidney Kimmel Medical College.
“The logical place to start was with neurosurgery because we had this incredible and unique chair in Robert Rosenwasser,” Tykocinski says. “Robert got it right from the beginning. He hit the ground running, and as he ran, we ran with him. Robert catapulted us forward, and continues to do so today.”
A Distinguished History
Jefferson’s rise to the top of the field of neurosurgery began in the 19th century when Jefferson Medical College (now Sidney Kimmel Medical College) professor of surgery Samuel Gross, MD 1828, penned his pioneering textbook, System of Surgery, which focused on disorders of the nervous system. His work paved the way for William Williams Keen, an 1862 alumnus who earned the sobriquet “America’s first brain surgeon” when, in 1887, he became the first surgeon in the country to successfully remove a primary brain tumor. Adding to his celebrity, Keen also secretly operated on President Grover Cleveland on the presidential yacht, The Oneida, to remove verrucous carcinoma from the roof of his mouth, and later served as a consultant to President Franklin Delano Roosevelt after he contracted poliomyelitis.
During the Civil War, Keen joined fellow surgeons George Read Morehouse and S. Weir Mitchell at the Turner’s Lane Hospital in Philadelphia (located on a then-country estate between Girard College and Eastern State Penitentiary), where they cared for soldiers with peripheral nerve injuries. Keen and his colleagues authored several papers, including Gunshot Wounds and Other Injuries of the Nerves, which introduced medical concepts such as causalgic pain, reflex dystrophy, and paralysis. The authors’ groundbreaking work effectively led to the founding of American neurology.
Keen served as the chairman of the division of surgery at Jefferson from 1889 until 1907. Despite its reputation for excellence in neurosurgery, an official division within the Department of Surgery wasn’t established until 1943, and didn’t become a separate department until 1969. The next five years saw tremendous growth, with a move to larger facilities that incorporated research laboratories, an overhaul of the residency program that included collaboration with the neurology department, and the addition of its own residency program.
In 1974, Jewell L. Osterholm, MD, became the first chairman of neurosurgery at Jefferson, and the growth continued. Osterholm instituted changes that improved medical education, residency, and research programs, and increased the number and types of surgery performed. He also oversaw the addition of a neurosurgical intensive care unit and dedicated operating room, and the establishment of the Regional Spinal Cord Injury Center of Delaware Valley.
Osterholm left the chairmanship in 1994, but remained active in academic and research areas for years afterward. In 2010, Jefferson established the first endowed chair in neurosurgery in his name. Osterholm passed away in 2017.
Throughout the next decade, the department continued to grow clinically and academically. A spine fellowship was created to allow orthopaedic and neurological surgeons to train collaboratively, and the endovascular and cerebrovascular divisions expanded.
“We had first-mover advantage not only in technology, but in skill set,” Rosenwasser says. “There were specialized types of neurovascular procedures only offered here at Jefferson.”
While neurosurgery was flourishing, the rest of the neurosciences were making great strides in research, clinical care, and education. There was no organized neuroscience department at the time, but work was being done in the areas of biochemistry, pathology, and others affiliated with the specialty. The department of psychiatry was small, but active in both patient care and physician and researcher training. Each department had its own strengths, but operated separately with no cross-interaction.
Neuroscience got a boost in 2001 when longtime Jefferson benefactors Vickie and Jack Farber made a $10 million gift to establish the Vickie and Jack Farber Institute for Neuroscience. The institute opened its doors in early 2002, supporting basic, translational, and clinical research for treatments of neurodegenerative disorders, including Parkinson’s disease, amyotrophic lateral sclerosis (ALS), Alzheimer’s, multiple sclerosis (MS), and more.
In 2004, Rosenwasser, who was serving as professor of neurosurgery and division chief for Jefferson’s cerebrovascular division, was awarded chairmanship of the Department of Neurological Surgery. One of the first dual-trained vascular neurosurgeons in the country, Rosenwasser took the helm of the section just as its staff and faculty numbers started to dwindle.
Unfortunately, Rosenwasser explains, what made Jefferson a top-in-the-country organization also made it a target for other universities and healthcare systems.
“Jefferson did a very good job of training people, and that made them very attractive to prestigious institutions throughout the country,” Rosenwasser says. “They became valuable assets, and other institutions began recruiting them away for division chief and chair positions.”
Several faculty members left for leadership positions at other distinguished universities, including Stanford, Duke, Tulane, and University of Pennsylvania.
Tykocinski recounts the story of a chair of neurosurgery at another institution taunting him about raiding Jefferson’s best and brightest: “He said, ‘Lots of luck, because we decimated your neurosurgery department,’” he recalls. “But I’m a pretty competitive guy, and took that as throwing down the gauntlet. I decided to take up the challenge.”
That challenge was not only to bolster the neurosurgery division, but to take it one step further and create an all-encompassing neuroscience service line at Jefferson that would elevate every division and subspecialty. Luckily, he says, Jefferson’s reputation for excellence made it possible to attract other talented people to replace those who had left.
In 2014, Tykocinski and Stephen K. Klasko, MD, MBA, president of Thomas Jefferson University and CEO of Jefferson Health, decided that a “CRISP” approach was necessary. CRISP—Clinical and Research Integrated Strategic Program—is an innovative method of organizing healthcare based on disease focus rather than by departments or specialties.
“We set out to create a true institute in the model of having basic science, hardwiring in the clinical side as well, and also bringing together the four lead departments—neurosurgery, neurology, neuroscience, and psychiatry,” Tykocinski says. It was time to start putting into place the building blocks of what would become a nationally renowned program.
The keystone was neurosurgery. Tykocinski says Rosenwasser was already known for his skill as a surgeon, but a unique talent for entrepreneurialism—he has an MBA from Villanova University—and dedication to his field made his department a good place to start.
The initial goal, Tykocinksi notes, was to see the department doubled in size; instead, it more than tripled.
Aside from recruiting topflight surgeons, physicians, and researchers, Rosenwasser put his business acumen to work. He began reaching out to smaller hospitals in the region that didn’t have neurosurgery practices, offering to cover their needs either on-site or through telepresence support. Through this, he created Jefferson Expert Teleconsulting (JET), the region’s first university-based mobile robotic teleconsulting system. It allows community hospital physicians to remotely consult with a Jefferson Health neurologist or neurosurgeon to medically evaluate neurovascular events, such as stroke or aneurysm, in real time to determine whether to continue treatment at the community hospital or to transfer the patient to a facility that could provide more advanced care. The JET network has grown to include 37 hospitals in Pennsylvania, New Jersey, and Delaware.
This technology made the region’s first academic medical center–based mobile stroke unit (MSU) possible. The specially outfitted ambulance is fully equipped with a CAT scan machine to bring diagnosis and care right to the patient’s door, expediting treatment for a time-sensitive disease. The goal is to eventually add more mobile stroke units to serve the Philadelphia region and South Jersey.
With Rosenwasser’s expertise in both clinical care and entrepreneurialism, neurosurgery was thriving, says Tykocinski. “But neurosurgery doesn’t exist in a vacuum. It’s highly dependent on having strong neurology and neuroscience programs.”
Jefferson’s department of neurology has a long and storied history in the United States. Established in 1824, it was the first division of neurology in the country, and S. Weir Mitchell, MD, 1852, a Jefferson graduate, is considered “the father of American neurology,” says Abdolmohamad M. Rostami, MD, PhD, professor and chair of the Department of Neurology and director of neuroimmunology and the multiple sclerosis laboratory.
In 2003, Rostami took the leap from the University of Pennsylvania to Jefferson because he “saw an opportunity to build a department.” And build it he did.
When he arrived, there were only eight faculty members, nine residents, and seven clinical and research fellows. With the backing of hospital and university leadership, he began recruiting. The department is now more than 70 faculty strong, and consists of some of the best-funded research laboratories in the institute. More than 70 clinical trials are ongoing to find the answers to Alzheimer’s disease, epilepsy, stroke, Parkinson’s disease, headache, and neuromuscular diseases.
In addition, the department enjoys a robust and well-respected training program for the next generation of physicians and researchers. The department has 27 residents and 25 postdoctoral clinical and research fellows. Each year, it receives more than 750 applications for residency slots from students at the country’s top medical schools.
“Residents and fellows who graduate from Jefferson’s program are highly sought after by institutions such as the National Institutes of Health, Harvard, Columbia, Johns Hopkins, and of course, some stay at Jefferson,” Rostami says.
He also began a mandatory neuroscience/neurology rotation for medical students at Sidney Kimmel Medical College because “they are such important aspects of medicine that even those who do not want to go into neurology should have good knowledge of the nervous system,” Rostami says. There are also specialized academic programs for nurses and physician assistants.
“My goal was to create a state-of-the-art department that would include all the subspecialties of neurology, and also create an educational environment for all residents, fellows, and junior faculty,” he says. He credits his success to his talented faculty and staff—and to the hospital and university leadership for “understanding the value of neuroscience.”
Rostami says the bench-to-bedside achievements can be directly attributed to the four departments being brought together at the Vickie and Jack Farber Institute for Neuroscience to work as partners in promoting science, furthering education, and improving lives.
“We try to not only help our patients, but also to move the boundaries of research—to understand the neurological diseases, and find the therapies for these diseases,” he says. “And although we have achieved a lot, we know we need to do even more. And we will.”
In January 2010, the Department of Neuroscience was officially established, bringing together neuroscientists who previously had primary appointments in other departments, including neurological surgery, neurology, pathology, and biochemistry. Internationally renowned researcher Irwin Levitan, PhD, was recruited to become the new department’s founding chair.
Levitan, who holds the title of Paul C. Bucker Professor and Chair of Neuroscience, had built the neuroscience department at the University of Pennsylvania and served as its chair for a decade. He was looking for a new challenge, and “starting a new department from scratch sounded like fun,” he says.
“Before about 2001, there was no organized neuroscience research community at Jefferson. There were neuroscientists, but their faculty appointments were in biochemistry or pathology or neurology or neurosurgery,” Levitan explains. “The original establishment of the Farber Institute (for research) in 2001 provided some structure for the neuroscience research community. By the time the department of neuroscience was founded, the Farber Institute had a brand for working on neurodegenerative diseases, and so my goal was to build on that strength.”
He set about the task of recruiting scientists for his department to complement Jefferson’s existing and established core group of neuroscience researchers. Their goal was to do “basic research” that would have implications for fundamental understanding of the brain in health and disease. Currently, the department has 14 faculty members, and between 30 and 50 basic science projects running at any given time with a principal investigator and postdoctoral or graduate student workers. In addition, two academic psychiatrists have recently joined the research team; although their primary appointments are in the psychiatry department, they conduct research in the neuroscience laboratories.
Levitan says the neurosciences at Jefferson are on a “very positive trajectory” due to an atmosphere that allows for the sharing of ideas and working toward common goals. Along with the executive committee, consisting of the chairs of neurosurgery, neurology, neuroscience, and psychiatry meeting weekly, faculty members are free to reach out to other departments at any time.
“Jefferson is an extremely collegial and cooperative place to work,” Levitan says. “People here are really eager to pitch in and participate and be part of a community.”
In order to create a complete institute that focused on mind-brain disorders, psychiatry had to be part of the plan, Tykocinksi says.
Established in 1942, the Department of Psychiatry at Jefferson had experienced more than 50 years of growth and innovation when Michael Vergare, MD, was recruited to become chair of the Department of Psychiatry and Human Behavior in 1998.
“We were smaller then, and the focus was more on education and clinical care,” he says. However, because of insurance company reimbursement rules, there were severe limits on the services the department could provide.
That changed with the integration into the Vickie and Jack Farber Institute for Neuroscience. Being brought under the umbrella of the institute in 2016 transformed the way Jefferson viewed psychiatry services, allowing for wider access to care. It also provided new resources for research and recruitment.
In addition, the department recently added two researchers whose work is anchored in psychiatry and neuroscience, exploring the genetic and protein metabolism associated with psychosis and depression.
Vergare says becoming part of the institute “encouraged collaboration among departments and around all programs so we could support each other and share faculty and ideas,” and he credits Rosenwasser’s vision for the advances in the psychiatry department.
“Through Robert’s leadership we coalesced,” Vergare says. “His emphasis has always been on advancing excellent patient care through strong teams that draw on the best of science. His style is to roll up his sleeves and work hard in the background to strengthen those around him.”
In September 2019, Vergare became chair emeritus and passed the baton to John Lauriello, MD, now professor and chair of the Jefferson Department of Psychiatry and Human Behavior, and senior vice president of behavioral health.
Lauriello says that psychiatry has an important place with the other three departments.
“Psychiatry bridges both issues of the brain and the mind, and offers a complementary perspective on the underlying pathology and clinical care,” Lauriello says, adding that he hopes to help the already well-respected department grow even further. “I want to help rationalize and standardize the delivery of clinical psychiatric/behavioral care across the entire enterprise [so that we can become] a national leader in this endeavor.”
Under One Roof—The House that Rosenwasser Built
With the four departments securely under one roof and working as a cohesive entity, the blueprint for an all-encompassing program came together.
In 2015, the mission of the Vickie and Jack Farber Institute for Neuroscience was expanded beyond research to include clinical care and training for the next generation of physicians and scientists. In 2016, the founding benefactors made another transformational $20 million gift, and Rosenwasser was named president and CEO of the institute.
“Research into devastating neurologic diseases was gaining momentum at Jefferson for years. Vickie and I chose to make the investment because we want to be part of the transformation we know is in process,” says Jack Farber, who has served as a member of Jefferson’s board since 1984, including five years as chairman.
“Our hope is that no family has to watch a loved one disappear into the darkness of Alzheimer’s or ALS or Parkinson’s or any brain disease,” adds Vickie Farber, whose father succumbed to amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), and whose mother suffered from Alzheimer’s disease.
Also in 2016, the Jefferson Weinberg ALS Center was established through a merger between the Farber Institute for Neuroscience and the Frances and Joseph Weinberg Unit for ALS Research. In July 2018, the center was named an ALS Association Certified Treatment Center of Excellence.
But there is more to the neurosciences than the Farber Institute, Tykocinski says. In addition to the work at the institute, there is much being done across a multitude of departments at Jefferson, including biochemistry, radiology, anatomy and cell biology, neuroradiology, neuropathology, and neuro-oncology.
“There are a lot of moving parts to the neurosciences,” Tykocinski says. “And all the moving parts and cross-department teamwork have culminated in great achievements in education, research, and patient care.”
For example, combining the strengths of the neurosciences and the Sidney Kimmel Cancer Center (SKCC) has resulted in a possible vaccine for glioblastoma, the most aggressive type of primary brain cancer.
The Farber Institute also partners with Wills Eye Hospital in research. The collaboration has resulted in a breakthrough eye-saving treatment for children with retinoblastoma.
Further collaboration with Wills Eye was established in May 2019, when the two institutions opened the William H. Annesley, Jr., MD ’48 EyeBrain Center. It is the world’s first facility focused on exploring the visual signatures of neurological diseases—specifically, the connections between the retina and the optic nerve and disorders of the brain.
Add to that its 15 specialty centers, including epilepsy, spine, sleep medicine, and the Jefferson Headache Center, and the neurosciences at Jefferson are opening up new frontiers in research, education, and patient care.
With all the parts moving in unison, Tykocinski predicts advancements in the neurosciences will progress at a dizzying rate—including novel technologies for brain imagining, a greater understanding of molecular defects at the gene and protein levels, futuristic surgical and ultrasound therapies, and new immunotherapies.
“The momentum is there,” he says. “And we’re going to keep that momentum by continuing to do unique, world-class, cutting-edge kind of things that you’re just not going to find anywhere else.