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Winter 2008

Neurosurgeon Brings Clinical and Research Experience

Within months of arriving at UCSF Medical Center, Manish Aghi, M.D., Ph.D., confronted a particularly difficult case.

A left-handed patient arrived from out of state with a malignant glioma on the right side of his brain. In a procedure a few years earlier, the tumor had not been completely removed because studies of the patient in his home state indicated it was dangerously close to his language center.

At UCSF, however, Aghi and his colleagues used a functional MRI to more precisely map out the speech center. They found it was actually on the left side of the patient's brain. Aghi then performed a more thorough resection of the tumor, which enhanced the patient's expected disease-free survival time.

Cases like this — and the ability to do both clinical work and research at one of the largest adult brain tumor centers in the country — are what drew Aghi to UCSF in January 2008. He arrived after having spent seven years as a resident at Massachusetts General Hospital. (His M.D. and Ph.D. are from Harvard.)

"At Harvard, I became interested in 'wiring,' what makes us different and unique," Aghi says. "Brain tumors had both an intellectual and personal appeal: I wanted to try to at least improve the outcomes of an untreatable disease."

Surgeon and Researcher

At UCSF, Aghi is both neurosurgeon and researcher, part of a busy team that in addition to their work on malignant tumors, will remove more than 200 benign pituitary tumors this year. Since his arrival, Aghi is especially appreciative of the collaborative approach he has found here.

"One example is that there is always an endocrinologist available to manage hormonal issues for the pituitary tumors," Aghi says. "Patients can often see both surgeon and endocrinologist in the same day."

There are also the daily interactions with senior surgeons. "It's important to have colleagues you can discuss cases with," he says. "It helps me build knowledge and integrate new information with what I've learned elsewhere. The more points of view you have, the better the finished product."

In his research lab, Aghi is exploring both how malignant tumors form in blood vessels and the pharmacological options to inhibit their growth. In one study, he is following up on studies from other labs indicating that the chemotherapy drug Avastin can improve survival times.

"When tumors grow back after treatment with Avastin, they're either nodular or 'sneaky,' snake-like growths," Aghi says. When the regrowth is nodular, there is still a surgical option; for the snake-like regrowth, there is none.

"So we're doing a molecular analysis to understand what factors the tumors are expressing that causes both types of regrowth. If we can identify the pathways, we hope to develop an appropriate regimen to block them."

For more information, contact Dr. Aghi at (415) 353-7500.

MRI-based speech mapping shows in blue the areas on the left side of the brain that control picture naming and verb generation tasks performed by the patient.

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