Inside Scoop: Joshua P. Aronson, MD
In our staff profile series highlighting the roles of individuals and their departments across the organization, D-H Today visits with neurosurgeon Joshua P. Aronson, MD, who came to Dartmouth-Hitchcock (D-H) in June 2016 and is also an assistant professor of surgery (neurosurgery) at the Geisel School of Medicine at Dartmouth. He received his bachelor’s degree from Massachusetts Institute of Technology (MIT), and attended Harvard Medical School in the Health Sciences and Technology program, a joint MD program with MIT. He then completed neurosurgery residency at the Massachusetts General Hospital in Boston, and also completed a fellowship there in stereotactic and functional neurosurgery and epilepsy surgery under the direction of Dr. Emad Eskandar.
Why did you choose to come to D-H?
I chose to join D-H for multiple reasons. I was looking for an academic position that would allow me to focus my clinical interests in functional and epilepsy neurosurgery, but also run a translational neuroscience laboratory. My research focus is studying brain circuitry involved in learning and memory, particularly after traumatic brain injury. Over the years, I held multiple conversations with D-H’s now emeritus neurosurgery chief, Dr. David Roberts. He is a national leader in stereotactic and functional neurosurgery and when he decided to retire, he was instrumental in recruiting me here. In addition, my wife, Leila Agha, is a health economist and was also recruited to join Dartmouth College’s Department of Economics faculty. We have two young children and the Upper Valley provides wonderful schools and recreational opportunities.
What made you want to specialize in this area of medicine and what are your areas of expertise?
During my undergraduate time at MIT, I worked in a lab investigating tissue engineering, growing replacements for the body’s tissues to restore function. This idea stayed with me and in the second year at Harvard Medical School, an MGH resident taught neuroanatomy. What fascinated me was the microscopic connectivity that underlie the brain’s function. The idea of operating on such a delicate and elegant structure drew me to neurosurgery. In residency at MGH, I returned to the principle of restoring function, which led me to my subspecialty interests within neurosurgery. Both clinically and in the lab, I focus on deep brain stimulation as a treatment for Parkinson’s disease, essential tremor, and obsessive compulsive disorder, as well as epilepsy surgery to reduce or eliminate seizures. My other surgical interests are facial pain (trigeminal neuralgia) and brain tumors.
What brings you joy in your work?
Deep brain stimulation surgeries are done awake, and we test stimulation in the operating room. That means there is a moment in surgery when the patients first experience their tremor stopping and rigidity alleviating. My goal is to give patients the opportunity to live their fullest lives. For patients with epilepsy, that means placing electrodes in the brain to localize where seizures are starting, and then removing that spot or placing a device that can lead to a meaningful reduction or elimination of their seizures. When I see patients back in the clinic after surgery, the greatest joy comes from their stories of what they can do now that they were unable to do before we operated.
What's the greatest frustration in your work?
There are two areas. One is that there are many patients who could potentially benefit from deep brain stimulation or epilepsy surgery but are not aware of these options. One of my goals is to raise awareness.
My other frustration is that as much as we know about the brain, there are still so many disorders where we don’t know the best target for intervention. For example, there have been multiple trials of deep brain stimulation for major depressive disorder. Unfortunately, none so far have been successful, revealing how much we still need to learn about circuitry within the brain. Thus, I lead a laboratory at D-H where we focus on the brain networks underlying learning and memory. Our current projects investigate using deep brain stimulation to improve recovery from traumatic brain injury.
I understand that D-H has some innovative, new approaches to surgery for epilepsy and Parkinson’s disease. Can you tell me a little about these?
All of these surgeries rely on extremely accurate targeting of small wires deep in the brain. We also often need patients to be awake and interact with us during surgery. The traditional method uses metal stereotactic frames which, while accurate, are very uncomfortable for patients during awake brain surgery. The new approach is frameless and uses custom 3D printed frames for each patient that let patients move their heads during surgery, and is faster and much better tolerated.
For epilepsy-seizure-localization surgeries, we favor a minimally invasive approach, again using a custom 3-D printed frame to place up to 16 depth electrodes. First, we have a collaborative meeting between neurosurgery, neurology, neuropsychology, neuroradiology and, based on that multidisciplinary conference; I design a plan on where the electrodes will be placed and create a draft frame. I meet again with the patient’s neurologist to confirm the plan, and then the final, approved 3-D frame design is printed. Using the 3-D frame leads to shorter surgery time, with less anesthesia, and it is less invasive, extremely accurate, and better tolerated by patients than traditional open grids and strips for epilepsy.
We also take advantage of the Center for Surgical Innovation (CSI) operating room at Dartmouth-Hitchcock Medical Center (DHMC) that lets us obtain MRI (magnetic resonance imaging) and CT (computed tomography) scans during surgery without the patient leaving the operating room. This means we can confirm the accuracy and safety of the surgery and make adjustments if needed. We are one of the few hospitals in the country with these intraoperative technologies and we use them at a higher volume than any other center in New England. Combining these minimally invasive approaches with the CSI facility is a unique benefit for D-H patients considering deep brain stimulation for Parkinson’s disease, essential tremor, or epilepsy surgery.
What's your favorite non-work activity?
My time out of work is spent with my family, my wife and our two children, who are now four and two years old. We love to travel and most recently explored Germany and the Czech Republic. We discovered our kids are big fans of trdelník, a rolled dough with sugar and cinnamon and roasted over charcoal.
What about you would surprise most people?
I enjoy doing home improvement projects with my four-year-old daughter. As we have been settling into our new home, she and I have worked on rewiring light switches, installing speakers, and assembling furniture. She always reminds me to start by reading the instructions.
What's the best piece of advice you’ve been given?
I have been so fortunate to have had amazing mentors who supported and advised me on my path. When I thanked my MIT premedical advisor, Dr. Michael Bailin, an MGH anesthesiologist, for his help, he replied with JFK’s (former President John F. Kennedy) words, “For of those to whom much is given, much is required.” I try to remember this responsibility to the broader community and serve as a mentor to undergraduate, medical students and residents.
How do you strive to make a difference in the lives of our patients and your colleagues?
When I meet new patients, I first listen to how they experience their disease. They have lived with their conditions for years; every patient responds to Parkinson’s disease or epilepsy in their own way. It is so important for me to understand what are the most bothersome symptoms to them and what aspects of their lives they are hoping to improve. It is only then that I can provide the best advice on whether surgery can help them achieve their goals.
Neurosurgery is a small division of six neurosurgeons and seven residents. We have a shared goal to provide excellent, comprehensive care to our patients. This relies on a cohesive group, and we are often called on to help each other. As a teaching hospital, we are also responsible for training the next generation of neurosurgeons to ensure our future patients receive the highest quality care. It is with these goals in mind that I enter this hospital every day.