Seventy years ago, Dr. Irving Cooper was performing a subtemporal approach for a cerebral pedunculotomy to try and correct a Parkinson’s tremor when he accidentally damaged the patient’s anterior choroidal artery. Forced to occlude the artery, Copper feared the worst. However, when the patient gained consciousness the tremor was gone. This discovery (on the back of the work of Russel Meyers) led to focused surgical efforts on targets within the basal ganglia to correct movement disorders. Thus innovation in the field of functional neurosurgery was born. In 2021, Dr. Joseph Neimat is one of the neurosurgeons who have gladly picked up that torch of innovation and is carrying the field forward.
Groundbreaking research
Dr. Neimat’s passion for his field is evident in the sheer volume of his work. From identifying cells coded for specific emotions in the vestibular gyrus while researching depression to developing patented novel devices for deep brain stimulation, it seems Neimat has had his hand in every area of functional neurosurgery. One of his most fascinating projects was a novel, physiologically based atlas that normalized the anatomy of different patients and allowed his team to make target predictions based on the last 100 or so patients they had operated on. Each team member took turns going up against the targeting AI they created to see if anyone could select a better surgical target. They couldn’t. “I was pretty silently beaten by computer targeting, which was astonishing,” Neimat said with a wry grin on his face.
Another incredible innovation Dr. Neimat is working on is the Merlin robot with engineer Eric Barth. Together, they developed novel pneumatic robots to assist with epilepsy surgical procedures. The Merlin robot is a combination of small plastic bellows that inflate under high pressure while moving a probe in and out of the brain and Nitinol needles that can be inserted into tissue and steered precisely. Because Merlin contains zero metal, it can be used in MRI environments and can perform epilepsy surgery, not by drilling through the skull but by entering through the foraminal valley. Neimat and Barth just received additional NIH funding for Merlin and are excited to continue their research.
Innovating for today while shaping tomorrow
It’s clear that Dr. Neimat is on the bleeding edge of functional neurosurgery research, but one thing that stands out about him is his humility. He has every right to revel in his accomplishments, yet when asked about all the patents he’s working on, Neimat takes a moment to shine the spotlight on those he’s working with. He also has a strong desire to support the next generation of neuro-innovators. Upon becoming the Chair of Neurosurgery at Louisville, Dr. Neimat developed a curriculum for students around innovation. “You can’t force innovation,” Neimat remarks as he reflects on the process of shaping this program. “You can’t sit down and say ‘Ok, I’m going to be creative now’…but you can educate people on what it looks like to take a product from an idea, to a prototype, to a trial, to FDA acceptance, to creating a company.”
As our conversation came to a close I asked Dr. Neimat what he would do for the field of functional neurosurgery if he had a magic wand. Light-filled his eyes as he talked about being able to gain a nuanced understanding of how the human brain works. He dreamed of a day when we’ll be able to use that knowledge to superimpose sensory phenomenon onto the brain with an electrical device to restore sight or sensation in patients that are paralyzed. He hoped for a day when our brains can be decoded like a language in Rosetta Stone. And while magic wands don’t exist, I know we are that much closer to these possibilities with people like Dr. Joseph Neimat leading the charge.