D E Brackmann

House Research Institute, Los Angeles, California, United States

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Publications (181)251.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Translabyrinthine resection of intracranial tumors results in single-sided deafness, which can be treated by surgical and nonsurgical means. Here we describe the first series examining complication and device usage rates among patients receiving a surgically implanted bone-anchored hearing device (BAHD) at the time of translabyrinthine tumor removal. Case series with chart review. Private tertiary neurotologic referral center. Patients (N = 154) undergoing concurrent BAHD placement and translabyrinthine tumor resection. Concurrent BAHD placement and translabyrinthine tumor removal. Postoperative complication rates and BAHD usage. Of the 154 patients, 121 (78.6%) had no device-related complications. The most common device-related complications were skin overgrowth (8.4%), acute infection (5.2%), and chronic infection (3.2%). The overall and specific complication rates did not differ from published BAHD complication rates. One patient (0.6%) developed a cerebrospinal leak through the surgical site for the device. At the time of last follow-up (mean, 39.8 months), 151 patients (95.0%) were still using their devices. Patients undergoing concurrent translabyrinthine tumor removal and BAHD placement exhibit similar device-related complication profiles as patients undergoing standard device placement. Based on these outcomes and the high long-term usage rates, BAHD insertion at the time of translabyrinthine intracranial surgery can be considered a safe and useful procedure. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 11/2014;
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    ABSTRACT: To describe the clinical and radiographic characteristics in a series of patients with non-vestibular schwannoma cerebellopontine angle (CPA) and intracanalicular (IAC) masses, who underwent microsurgery for presumed vestibular schwannoma (VS).
    09/2014;
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    ABSTRACT: Evaluate long-term prevalence of tumor growth and need for further treatment in patients with a vestibular schwannoma treated with conservative management.
    06/2014;
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    ABSTRACT: We present video of gross-total resection of a large cerebellopontine angle tumor consisting of both vestibular and facial schwannoma components via the translabyrinthine route in a patient with neurofibromatosis type 2. The facial nerve is reconstructed using a greater auricular nerve graft, and an auditory brainstem implant is placed. Prior to surgery the patient had no facial nerve function on the operative side and had lost useful hearing. He also had usable vision only on the ipsilateral side and had contralateral vocal cord paralysis. The video can be found here: http://youtu.be/IOkEND-0vhI .
    Neurosurgical FOCUS 01/2014; 36(V1Supplement):1. · 2.49 Impact Factor
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    ABSTRACT: Patients with Neurofibromatosis 2 (NF2) present complex and challenging management dilemmas. Surgical removal of vestibular schwannomas (VS) often result in total hearing loss. Early diagnosis using gadolinium-enhanced magnetic resonance imaging and refinements in hearing preservation surgery have improved our ability to prevent total hearing loss while achieving complete tumor removal in smaller tumors, but for patients with larger tumors or patients with no useful hearing in that ear, the auditory brainstem implant (ABI) allows restoration of some auditory function when the tumor is removed. Additionally, children with cochlear aplasia and cochlear nerve deficiency have begun to be implanted with auditory brainstem implants, with varied results. This article discusses surgical placement of the ABI.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 01/2014;
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    ABSTRACT: Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone. Retrospective chart review. Tertiary referral neurotologic private practice. Patients undergoing total ossicular replacement with a titanium prosthesis (total ossicular reconstruction prosthesis [TORP]); 74 with a TORP + footplate shoe and 62 with TORP alone. Ossicular chain reconstruction with a titanium TORP. Short- and long-term air-bone gap (ABG), change in ABG from preoperative to postoperative and from postoperative to last recorded follow-up, sensorineural hearing loss. The shoe group had a smaller mean postoperative ABG (17.7 dB versus 21.6 dB, p ≤ 0.048) and a greater average amount of closure in ABG (21.9 dB versus 13.2 dB, p ≤ 0.004), but there was no significant difference in percentage of patients achieving a postoperative ABG of 20 dB or lesser (57.4% versus 61.6%). There were no differences between groups at long-term follow-up or in amount of change in ABG from postoperative to last audiogram or in amount of change in sensorineural hearing from preoperative to postoperative. Although surgical factors (number of previous surgeries, and presence of a cavity) impacted outcomes, there were no interactions with prosthesis group and no differences in complications between groups. Ossicular reconstruction still presents challenges. A titanium prosthesis with a "shoe" for stabilization may offer advantages. Results in this study consistently favored the TORP + shoe group,although not all differences achieved statistical significance. A larger study might better define possible advantages of the shoe prosthesis for specific subgroups of patients.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 11/2013; · 1.44 Impact Factor
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    ABSTRACT: To determine whether partial tumor removal in large vestibular schwannoma improves facial nerve outcomes while maintaining a low risk of tumor regrowth/recurrence. Retrospective chart review and prospective database. Tertiary neurotologic referral center. Four hundred patients with a vestibular schwannoma of 2.5 cm or greater in maximum diameter undergoing translabyrinthine microsurgical resection from 2001 to 2011. There were 325 gross total resections (GTR), 44 near total resections (NTR), and 31 subtotal resections (STR), with an overall mean tumor size of 3.2 cm (standard deviation, 0.7). Translabyrinthine surgical tumor resection. House-Brackmann (H-B) facial nerve grade postoperatively and at 1 year, tumor regrowth/recurrence (≥2 mm), additional treatment, and complications. Higher rates of H-B facial nerve Grades I and II were achieved at both the postoperative and 1-year follow-ups in the NTR (78%, 97%) and STR (71%, 96%) groups compared with GTR (53%, 77%) (p ≤ 0.001). Eye treatment, medical or surgical, was required more often in GTR (28.0%) than NTR and STR (8% and 21%, respectively, p ≤ 0.04), with no other differences in complications. The NTR and STR groups had a significantly higher rate of regrowth than GTR resection (21% and 22% versus 3%) (p ≤ 0.001) at average follow-up times of 3.7, 3.7, and 5.1 years, respectively, and need for further treatment occurred at a higher rate, although infrequently, in NTR and STR (2% and 10% versus 0%) (p ≤ 0.001). Near total and subtotal removal in large tumors are viable treatment options to maintain facial nerve function. During the follow-up period examined in this study, there was a low risk of need for further treatment. Longer-term follow-up is needed to better assess the need for retreatment in patients treated with NTR and STR.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 08/2013; · 1.44 Impact Factor
  • Rick A Friedman, Michael Hoa, Derald E Brackmann
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    ABSTRACT: Objective To review the cumulative experience of surgical management of endolymphatic sac tumors (ELSTs) in the literature. To review the experience with ELST management at a tertiary referral-based otology-neurotology practice and present our approach to management. Study Design Retrospective patient review at a referral-based otology-neurotology practice. Methods A review of all available records from the House Clinic of patients with ELSTs was performed. Presentation, diagnostic workup, microsurgical approach, and outcomes were reviewed. Literature review using MEDLINE of studies reporting surgical outcomes of patients with ELSTs was also performed. Results Retrospective chart review revealed 18 patients with ELSTs who underwent surgical management. Grouping of these patients provides surgical outcomes on the largest group of mostly non-von Hippel-Lindau patients with ELSTs in the literature. Patients most commonly presented with sensorineural hearing loss, tinnitus, and dizziness. A majority of patients presented with large tumors exhibiting significant destruction of surrounding structures including the cochlea, vestibule, and internal auditory canal. Patients underwent microsurgical resection with the intent of complete resection. Conclusions Although the extensive nature of ELSTs at time of diagnosis often precludes hearing preservation, complete microsurgical resection can be achieved safely with preservation of facial function in the majority of cases.
    Journal of neurological surgery. Part B, Skull base. 02/2013; 74(1):12-9.
  • Joseph A Ursick, Derald E Brackmann
    Ear, nose, & throat journal 10/2012; 91(10):E31. · 1.03 Impact Factor
  • Joseph A Ursick, Derald E Brackmann
    Ear, nose, & throat journal 07/2012; 91(7):270. · 1.03 Impact Factor
  • Derald E Brackmann
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    ABSTRACT: Vestibular schwannomas (VS) or acoustic neuromas are benign tumors arising from Schwann cells of the vestibular branch of the eighth cranial nerve. The tumor was first described 1910 by Henschen, who provided evidence that it originates from the Schwann cells. Nevertheless, the term acoustic neuroma was commonly used. The National Institute of Health decided in 1992 in a Consensus Development Conference: “The term vestibular schannoma is preferred over acoustic neuroma as these tumors are composed of Schwann cells and typically involve the vestibular rather than the acoustic division of the eighth cranial nerve.” Therefore, we will use the term of VS, although acoustic neuroma is still more common in the literature.
    Otolaryngologic Clinics of North America 04/2012; 45(2):xiii-xv. · 1.46 Impact Factor
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    ABSTRACT: Auditory brainstem implants (ABIs) can provide highly beneficial hearing sensations to individuals deafened by bilateral vestibular schwannomas (neurofibromatosis type 2). Relatively little is known about the status of stimulated neurons after long-term ABI use. Direct examination of the cochlear nuclear complex (CN) of one 5-year ABI user indicated no deleterious effect. Recently, we examined the brainstem of a patient who used his ABI daily for 15 years with excellent performance. There was good preservation of CN cell size, morphology, and packing density, a very favorable sign considering that a number of infants are now receiving ABIs.
    The Laryngoscope 03/2012; 122(3):645-8. · 1.98 Impact Factor
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    ABSTRACT: Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome characterized by bilateral vestibular schwannomas (VS) which often result in deafness despite aggressive management. Meningiomas, ependymomas, and other cranial nerve and peripheral schwannomas are also commonly found in NF2 and collectively lead to major neurologic morbidity and mortality. Traditionally, the overall survival rate in patients with NF2 is estimated to be 38% at 20 years from diagnosis. Hence, there is a desperate need for new, effective therapies. Recent progress in understanding the molecular basis of NF2 related tumors has aided in the identification of potential therapeutic targets and emerging clinical therapies. In June 2010, representatives of the international NF2 research and clinical community convened under the leadership of Drs. D. Gareth Evans (University of Manchester) and Marco Giovannini (House Research Institute) to review the state of NF2 treatment and clinical trials. This manuscript summarizes the expert opinions about current treatments for NF2 associated tumors and recommendations for advancing therapies emerging from that meeting. The development of effective therapies for NF2 associated tumors has the potential for significant clinical advancement not only for patients with NF2 but for thousands of neuro-oncology patients afflicted with these tumors. © 2011 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part A 12/2011; · 2.30 Impact Factor
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    ABSTRACT: To examine hearing preservation rates, facial nerve outcomes, and tumor recurrence rates in patients with neurofibromatosis Type 2 undergoing a primary middle cranial fossa approach for vestibular schwannoma removal. Retrospective chart review. Private practice tertiary neurotology referral center. All patients with neurofibromatosis Type 2 undergoing attempted hearing preservation via a middle cranial fossa approach for removal of vestibular schwannoma from January 1, 2000, to June 1, 2010. Primary middle cranial fossa approach for removal of vestibular schwannoma. Preoperative, postoperative, and change in hearing thresholds, word recognition scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class, House-Brackmann facial nerve grade, and tumor recurrence. Class A or B hearing according to the American Academy of Otolaryngology-Head and Neck Surgery was maintained in 50% of cases, whereas 63.6% had Class A, B, or C hearing, with an average word recognition score of 93.8% at an average follow-up period of 32.5 months. Facial nerve outcomes were excellent; 75% of cases maintained House-Brackmann Grade 1, whereas 94.3% had Grade 1 or 2 at an average of 25 months after surgery. Tumor growth within the surgical field was observed radiographically in 59% of cases. In patients with neurofibromatosis Type 2, proactive treatment of smaller tumors provides a chance to maintain serviceable hearing and obtain tumor control for extended periods. When examining hearing outcomes, it is important to use word recognition scores, in addition to American Academy of Otolaryngology-Head and Neck Surgery hearing class, to better assess functionality. Although facial nerve outcomes tend to be favorable, the growth of new tumors, including facial schwannomas, may occur within the surgical field. Continued surveillance with serial magnetic resonance scans after surgery is mandatory.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 12/2011; 32(9):1530-7. · 1.44 Impact Factor
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    ABSTRACT: To design a treatment algorithm based on experience with facial nerve schwannomas (FNS) over a 30-year period. Retrospective chart review. Seventy-nine patients with facial nerve schwannomas seen from 1979 through 2009 at a tertiary referral private otologic practice were categorized by treatment modality. Interventions included surgical resection with grafting, bony decompression, observation, or stereotactic radiation. Outcome measures included House-Brackmann facial nerve grade before and after intervention as well as change in facial nerve grade, tumor size, involved segments of nerve, time to intervention. Thirty-seven patients (46.8%) ultimately underwent surgical excision with grafting or primary anastomosis, 21 (26.6%) underwent bony decompression alone, 15 (19.0%) were managed with observation only, and 6 (7.6%) had stereotactic radiation. Through 1995, 85% of cases had surgical resection and none had observation only. Of the 52 patients seen after 1995, 27% had surgical resection and grafting, 33% had bony decompression, 29% were managed with observation alone, and 11% had radiotherapy. Facial nerve grade was maintained or improved over the follow-up period (mean time = 3.9 years) in 78.9% of the decompression group and 100% of the observation and radiation groups compared to 54.8% of the resection group (P ≤ .012). Surgical resection and grafting, once widely accepted and practiced, has in many cases given way to observation, bony decompression, or stereotactic radiation. A wide armamentarium of options is available to the neurotologist treating facial nerve schwannomas with the ability to preserve facial function for a longer period of time.
    The Laryngoscope 09/2011; 121(10):2065-74. · 1.98 Impact Factor
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    ABSTRACT: Determine whether more conservative management for surgical salvage after failed radiation leads to better facial nerve outcomes. "Retrospective" review using prospectively planned database. Private practice, tertiary neurotology/neurosurgery referral center. A series of 73 patients with vestibular schwannoma, who underwent primary radiosurgery with no other intervention and then surgical salvage tumor removal using the translabyrinthine approach. Translabyrinthine craniotomy for vestibular schwannoma salvage surgery after failed radiation, with either gross total or partial tumor removal. Long-term (1 yr) House-Brackmann (H-B) facial nerve grade and change in facial nerve grade from before to after surgery. Of the 73 patients, 79.5% had gross total removal, 5.5% had planned partial resection (subtotal or near total), and 15.1% had intraoperatively elected partial removal with most of these being near total removal. At 1 year of follow-up, good facial nerve function (H-B I/II) was found in 50% of patients with gross total removal and 85.7% of those with partial removal (p ≤ 0.03). The H-B grade was maintained postoperatively in 45.8% and 78.6% of the 2 groups, respectively (p ≤ 0.037), with 21.7% of the total removal group having unsatisfactory outcomes (H-B V or VI) compared with 7.1% of patients with partial removal. To date, no patient has required additional treatment. Failed radiosurgery is an increasing indication for salvage surgery in patients with posterior fossa tumors. A conservative approach with a willingness to perform partial and near-total tumor removals leads to better facial nerve outcomes with no current evidence of treatment compromise.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 09/2011; 32(8):1322-8. · 1.44 Impact Factor
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    ABSTRACT: To assess the duration of hearing preservation from time of vestibular schwannoma middle fossa decompression with short-term and 1-year hearing preservation rates. Retrospective case review. Tertiary referral center. Patients with and without neurofibromatosis type 2 who underwent middle fossa decompression. We excluded patients without tumor size or audiograms at initial diagnosis or follow-up less than 3 months. Middle cranial fossa decompression, audiometry, and magnetic resonance imaging. Period of hearing maintenance (from surgery to longest time point that preoperative American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] hearing class maintained or improved), short-term hearing preservation (within 3 mo of surgery), and 1-year hearing preservation. A total of 49 patients underwent middle fossa decompression of vestibular schwannoma. Approximately 90% of patients had documented hearing loss before surgery, and more than 50% of patients exhibited significant tumor growth before surgery. Of these surgeries, more than 90% were performed in patients with hearing loss in an only hearing ear, and more than 90% were patients with neurofibromatosis type 2. The mean period of hearing maintenance was 2.1 years. The short-term hearing preservation rate as measured by the change from preoperative AAO-HNS hearing class was approximately 90%. The 1-year hearing preservation rate as measured by change from preoperative AAO-HNS hearing class was 63%. Middle fossa decompression for vestibular schwannoma can prolong hearing in patients with hearing changes in an only hearing ear. Understanding the duration of hearing preservation can enable more effective counseling of patients considering middle cranial fossa decompression for vestibular schwannoma.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 06/2011; 32(6):1017-24. · 1.44 Impact Factor
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    ABSTRACT: The authors report a case of neurofibromatosis Type 2 presenting with symptoms of trigeminal neuralgia refractory to medical management following placement of an auditory brainstem implant (ABI). Physical examination and history revealed trigeminal neuralgia. A 3D FIESTA (fast imaging employing steady-state acquisition) MR imaging study demonstrated compression of the trigeminal nerve by an ABI cable. After maximal medical therapy, a retrosigmoid microscopic decompression of the trigeminal nerve achieved complete symptom resolution. This is the first report of an ABI cable becoming displaced, resulting in neurovascular compression. This case demonstrates that trigeminal neuralgia can result from nonvascular compression of the trigeminal nerve.
    Journal of Neurosurgery 01/2011; 114(1):186-8. · 3.15 Impact Factor
  • Jose N. Fayad, Marc K. Bassim, Derald E. Brackmann
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    ABSTRACT: With the advances in diagnostic abilities and the refinement of surgical techniques, the focus of vestibular schwannoma surgery has shifted from tumor removal and facial nerve preservation to also include hearing preservation when possible. Many authors have reported on hearing preservation surgery, with rates approaching 70% in some series. Proper patient selection and expectations are critical, and a number of factors have been analyzed for their prognostic significance. The 2 main approaches used are the middle cranial fossa approach and the retrosigmoid approach. For patients who lose their hearing as a result of either the tumor or the treatment, several rehabilitative options exist with good results. This paper will review the history of hearing preservation for vestiblar schwannoma, prognostic factors, and patient selection, different techniques, and the rehabilitation of patients with hearing loss from these tumors.
    Neurosurgery Quarterly 05/2010; 20(2):53-59. · 0.09 Impact Factor
  • Maroun T Semaan, William H Slattery, Derald E Brackmann
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    ABSTRACT: To review the clinical presentation, evaluation, and management of 18 patients with geniculate ganglion hemangiomas seen at the House Clinic. Retrospective case review. Private neurotological tertiary referral center. Eighteen patients with geniculate ganglion hemangiomas treated at the House Clinic between 1986 and 2008. Observation or surgical intervention using the middle fossa or translabyrinthine craniotomy for decompression or excision of the hemangioma with or without facial nerve resection and grafting. Postoperative facial function using the House-Brackmann grading system, postoperative audiograms and postoperative follow-up magnetic resonance imaging or computed tomographic scan of the temporal bone. Approximately 13 patients (72%) were female subjects, and 5 (28%) were male subjects. Mean age was 54 years, and follow-up was 73 months. 17 (94%) of 18 patients presented with facial paresis or paralysis. Facial twitching was present in 10 (56%) of 18 cases. Four patients (22%) presented with hearing loss. Facial nerve function was House-Brackmann grade I/II in 7(38%), III/IV in 5 (28%), and V/VI in 6 (34%) patients, respectively. Approximately 13 patients (72%) underwent middle fossa craniotomy for excision or decompression of their hemangiomas, and 2 (11%) underwent translabyrinthine removal. The facial nerve was preserved in 11 (73%) of 15 patients and was excised and grafted in 4 (27%) of 15. Recovery to a House-Brackmann grade I/II was seen in 8 (72%) of 11 patients in whom the integrity of the facial nerve was preserved. In the surgical group, hearing remained stable in 64% of hearing preservation cases and worsened in 38%. Facial function remained stable in the nonsurgical group. Geniculate ganglion hemangiomas are rare vascular malformations that produce facial paralysis despite their relative small size at presentation. When possible, excision with neural preservation yields better long-term facial function. Recurrences are rare.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 03/2010; 31(4):665-70. · 1.44 Impact Factor

Publication Stats

3k Citations
251.38 Total Impact Points

Institutions

  • 1997–2013
    • House Research Institute
      Los Angeles, California, United States
    • Mayfield Clinic
      Cincinnati, Ohio, United States
  • 1990–2012
    • University of California, Los Angeles
      Los Angeles, California, United States
  • 1978–2012
    • University of Southern California
      • Department of Otolaryngology-Head and Neck Surgery
      Los Angeles, CA, United States
  • 2010
    • American University of Beirut
      • Department of Otolaryngology - Head and Neck Surgery
      Beirut, Mohafazat Beyrouth, Lebanon
  • 2007
    • CSU Mentor
      Long Beach, California, United States
  • 2004
    • University of Cologne
      • Department of Neurosurgery
      Köln, North Rhine-Westphalia, Germany
  • 2003
    • St. Vincent Medical Center
      Bridgeport, Connecticut, United States
  • 2001
    • Ear, Nose and Throat Institute
      Alabama, United States
  • 2000
    • Inonu University
      Malatia, Malatya, Turkey
  • 1997–2000
    • University of California, San Francisco
      • Department of Otolaryngology - Head and Neck Surgery
      San Francisco, California, United States
  • 1998
    • Hospital San Juan de Dios Pamplona
      Quilichao, Cauca, Colombia
  • 1991–1997
    • Wilford Hall Ambulatory Surgery Center
      Lackland Air Force Base, Texas, United States
  • 1995
    • University of California, Irvine
      Irvine, California, United States
    • St. Vincent's Hospital Melbourne
      Melbourne, Victoria, Australia
  • 1994
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 1987
    • Shea Ear Clinic
      Memphis, Tennessee, United States
    • Duke University Medical Center
      • Department of Surgery
      Durham, NC, United States