25 Years of Advances in Neurosurgery
Henry Brem reflects on his time leading the Johns Hopkins Department of Neurosurgery.
In 1971, Henry Brem had just finished his freshman year at New York University. He was still a teenager, and already assisting with surgeries. The precocious student was working in a Columbia University microbiology lab that summer, and asked surgical residents if he could join them in the operating room. Before long, he was scrubbing in and helping.
That experience inspired a passion for surgery, leading to an extraordinary career that includes 25 years as director of the Johns Hopkins Department of Neurosurgery. Brem, who stepped down in May, reflected on the many accomplishments of the department under his direction.
“I benefited from an environment that really supports innovation and maximizing your potential,” he says. “I feel very proud that over these 25 years, by every metric, the department has fulfilled the promise of building an environment of creativity, great clinician-scientists, and being sure that we attracted the best of the best.”
He came to the position with lofty goals — to expand the department through adding clinical trials and research, and building the department’s expertise in spinal tumors, brain tumors, and pediatric and vascular neurosurgery. By 2007, Brem had grown the neurosurgery department to one of the largest academic programs of its kind in the country — both in number of faculty members and patient volume — which it remains to this day. In 2010, U.S. News & World Report named it the top neurosurgery program in the nation, and it consistently remains in the top 5.
Brem will remain on the faculty that he first joined in 1984, and will lead a new neurosurgery translational research center. Brem says his work at the center will take him back to the excitement and enthusiasm of the lab and allow him to do what he loves: research, mentor and teach. He says he has heard too many stories about research that didn’t make it out of the lab into clinical practice for various reasons — and hopes his new center can push new discoveries through that process to directly benefit patients.
He is succeeded by Chetan Bettegowda, an internationally renowned neurosurgeon and expert on the treatment of brain and spinal tumors. Bettegowda started in Brem’s lab as a first-year Johns Hopkins medical student, and went on to complete a doctorate with world-renowned researcher Bert Vogelstein.
Bettegowda has changed the understanding and treatment of brain and spine tumors, Brem says, and now leads his own impactful laboratory. His discoveries led to innovative cancer liquid biopsy approaches that can act as personalized biomarkers.
“He does earth-shattering, great research. He’s an incredible gentleman. Everybody loves him, he’s respectful of everybody, and he enhances other people,” Brem says. “So I’m thrilled that he will bring the department to even higher levels.”
Bettegowda describes Brem as a visionary leader and inspirational mentor and teacher.
“His contributions as a skilled surgeon have touched the lives of thousands of patients and families, and his discoveries in the lab have and will continue to improve the outcomes of individuals with brain cancer around the globe,” Bettegowda says. “It’s with a tremendous sense of honor and responsibility that I assume the role as director of neurosurgery.”
Progress and Discovery
When he succeeded Donlin Long as director of the Department of Neurosurgery in 2000, Brem had already founded and built the Comprehensive Brain Tumor Center, making it an international referral center, bastion of clinical excellence, and hub for research and clinical trials. In his new role, he continued his passion for brain tumors, recruiting many neurosurgeons who made major discoveries that changed neuro-oncology as well as spine, vascular, functional and pediatric neurosurgery. Many of these Johns Hopkins students, trainees and faculty members have not only made revolutionary discoveries, but have also gone on to lead neurosurgery programs around the world.
Nicholas Theodore, director of the Johns Hopkins Neurosurgical Spinal Center, performed the world’s first real-time, image-guided robotic surgery to insert screws into a patient’s spine, which is now used worldwide. Timothy Witham, director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory and Johns Hopkins Bayview Medical Center’s spine program, is a leader in using virtual reality as an adjunct to spine surgery. Daniel Lubelski, director of spine tumor surgery, routinely and safely removes spinal tumors that were previously considered inoperable.
Pivotal studies in imaging led to a revolution in navigation, allowing physicians to use MRI and CT scans for surgical visualization. The spine division at Johns Hopkins Bayview, under the direction of neurosurgeon Ali Bydon, was one of the first in the country to adopt intraoperative CT in late 2009. The technology could be integrated with other imaging modalities during surgery, and it allowed for immediate scans after procedures in the operating room.
Researchers in the department are now looking at ways to treat brain tumors with MR-guided focused ultrasound. “We may be able to take another quantum leap, and treat tumors without doing open surgery,” Brem says.
Over the past 25 years, endovascular surgery became the dominant, less-invasive way to treat a number of vascular diseases, aneurysms, arteriovenous malformations and even stroke. And functional neurosurgery, a newer field, is a routine treatment for essential tremor that is being explored for other uses, including converting brain signals to movement of artificial limbs.
“It’s sort of like science fiction, and yet it’s happening in the operating rooms,” Brem says. “The advances in neurosurgery and in medicine have been breathtaking over the time that I’ve been privileged to be the chair of the department.”
Support and Balance
Brem’s path to Johns Hopkins included stops at some of the country’s most reputable institutions. After graduating from NYU in 1973, he studied biological chemistry at Harvard University and graduated from Harvard Medical School in 1978. He first came to The Johns Hopkins Hospital in 1979 for fellowships in neurosurgery and ophthalmology, followed by a neurosurgery residency at the Columbia College of Physicians and Surgeons’ Neurological Institute of New York.
He joined the Johns Hopkins faculty in 1984, with the research goals of developing a new form of cancer treatment, anti-angiogenesis, and developing polymers for direct delivery of chemotherapy to brain tumors — and he did just that.
In 1996, the Food and Drug Administration approved a dime-sized biodegradable polymer wafer he co-developed — the Gliadel Wafer — that can be implanted in the brain to deliver chemotherapy directly to tumors. With the combination of the wafer and other cancer-fighting drugs, the average overall survival rate for glioblastoma multiforme tumor patients who have had their malignancies removed at Johns Hopkins has more than doubled.
In 2009, the American Association of Neurological Surgeons and Congress of Neurological Surgeons would count this among the 38 top achievements in glioma treatment in the preceding 160 years. Brem’s department has continued to build on this innovation, as have other researchers around the world, to determine how it can be used with immunotherapy and other targeted therapies.
Brem’s imprint and mentorship in the field of neurosurgery can be felt far beyond Johns Hopkins. There are 21 chairs of neurosurgery departments throughout the country and the world — from the Mayo Clinic to Agostino Gemelli University Policlinic in Rome — who spent significant years of their careers in Brem’s department.
There are also 20 endowed chairs within the department, and two newly created rising professorships — a program designed to support promising early-career physician-scientists — with two more in the pipeline.
“Those we should really be supporting are the young people, because they’re starting their clinical careers, their research careers, and balancing their family needs,” Brem says. “It’s a very stressful time, the early years, yet the most critically important time.”
Brem and his wife, Rachel, a renowned breast imaging specialist and researcher at the George Washington Cancer Center, have three daughters and three sons-in-law, as well as 10 grandchildren, all in the Baltimore-Washington area.
“Life balance has been a very big part of the department as well as my own life,” Brem says. “You can achieve great things in medicine and in research and still be a balanced, whole person.”
He believes this type of balance makes better clinicians.
“You understand other people better because you know how much you care about your own family,” Brem says. “I think it makes you feel the angst that people have facing disease with their family and their loved ones. You understand how much it means to make people whole again, and it motivates you to find better solutions to clinical challenges.”
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