Incisionless brain surgery a career milestone for Dr. Nizam Razack

Nizam Razack, MD, JD, FACS, a neurosurgeon at UCF Lake Nona Medical Center, which opened to the public in March, is among the first neurosurgeons in the country to perform incisionless brain surgery using focused ultrasound for the treatment of essential tremors. This pioneering procedure is new to the Orlando market, and UCF Lake Nona Medical Center is the first hospital to offer it in Central Florida.

Getting Started

Born in a small village in India and raised in Buffalo, NY, Dr. Razack attended undergraduate school at the University of Michigan, where he took many science classes and volunteered at a hospital. While he had every intention of becoming a radiologist, his plans changed after observing a single neurosurgical procedure which, in his words, “blew me away.” He went on to complete medical school at the State University of New York at Buffalo and a residency in neurological surgery at University of Miami’s Jackson Memorial Hospital, as well as fellowships at the Mayo Clinic and the University of Texas MD Anderson Cancer Center.

Dr. Razack moved to Orlando in 2001 to start a neurosurgery practice with three fellow physicians whom he had met throughout his education and early career. In the beginning, their team covered many trauma calls, routinely performing stressful emergency surgeries. Today, he still answers the occasional trauma call, but concentrates his practice on elective spine and brain procedures.

“In my 20s and 30s, I was immersed in trauma emergencies, where nothing is planned and everything you do is reactive,” said Dr. Razack. “Elective procedures, however, are very controlled and technical, which is critical given the level of technology we’re using today – particularly with something like the focused ultrasound.”

A Cutting-Edge Procedure

In an MRI-guided focused ultrasound, a metal frame is placed around a patient’s skull, creating a fixed point of reference. The patient is then put into an MRI scanner, where sound wave energy is administered directly to the thalamus – an area of brain tissue believed to be the source of tremor. No surgical incision or anesthesia is involved, and many patients report immediate or significant reduction in hand tremors, markedly improving their ability to perform previously challenging daily activities.  
“Tremor is the most common movement disorder, affecting 3 percent of Americans or 10 million people in the U.S.,” said Dr. Razack. “This non-invasive therapy is a game changer for individuals who live with tremor and for whom medication alone will not work and surgery is not an option. There are no incisions or holes made to the skull, meaning a reduced risk of infection and clot formation – which can be associated with traditional neurosurgical procedures.” 

Increased Access to Lifechanging Therapy

While MRI-guided focused ultrasound became FDA-approved in the summer of 2016, it was only approved for reimbursement by the Centers for Medicare and Medicaid Services (CMS) in all 50 states in July of last year. With that critical approval, UCF Lake Nona Medical Center has expanded access to this potentially life-changing therapy – both in price and proximity. 

“We hope to perform one to two of these procedures per week,” Dr. Razack said. “Our location in Lake Nona serves many seniors, which is the population most plagued by essential tremor. By creating access to focused ultrasound here in our region, we are positioned to help these patients restore their ability to perform everyday activities like eating and writing with full control of their hands.”

Of course, not all patients are good candidates for this new treatment. Since it relies on sound wave therapy, Dr. Razack must determine factors like skull thickness and skull density ratio to ensure success. Still, he encourages neurologists to familiarize themselves with focused ultrasound as an alternative to deep brain stimulation (DBS), thalamotomy and gamma-knife surgery (GKS).
“This procedure is a new tool in our arsenal to help restore quality of life and independence for essential tremor and Parkinson’s tremor patients,” added Dr. Razack. “Whether focused ultrasound patients are self-referred or referred by their neurologist, the procedure still requires a lot of management. Patients need to continue to return to their neurologist for ongoing observation and medication.”

Embracing Change

While focused ultrasound is an outpatient procedure with often immediate results, the therapy requires the same level of patience and expertise as alternative practices. Prior to administering sound waves to the brain, Dr. Razack utilizes computer software and calculations to ensure the beams of energy are all focused into an extremely small target. In total, the procedure takes about two to three hours.

“After 30 years as a neurosurgeon, I’ve seen it all,” said Dr. Razack. “Neurosurgery is a field that relies very heavily on technology – and you have to keep up with ever-changing technology to stay relevant and effective. You have to be ready for dramatic changes in the procedures you’re performing every five to eight years.”

When asked if he had any advice for medical students considering neurosurgery, Dr. Razack encourages physicians-in-training to watch a brain or spine surgery to see if it matches up with their goals and skill set. Looking ahead, virtual reality, computer software and imaging will become increasingly critical in this field, so it is important to not only have an affinity for technology, but to also have an interest in it.

Dr. Razack also highlights the importance of stamina – critical for making it through lengthy and complicated procedures. In medical school, he recalls a general surgery colleague joking that, “These guys in neurosurgery don’t sleep,” something he’s come to learn firsthand.

“This job is challenging, labor-intensive and often very stressful,” said Dr. Razack. “It’s imperative that you have a healthy mind and a healthy body to navigate these stressors. You can find me in the gym every morning at 5 a.m. before surgery. Exercise is the best way I’ve found to maintain physical and emotional health – beyond spending time with family and friends.”

A Note of Gratitude

Dr. Razack reflects on his career and the many lessons he’s learned along the way. It’s through his tireless dedication to his field, to his patients, and to his own continued education and physical training that he is now among the pioneering physicians performing focused ultrasound therapy.

“Being named the consulting physician for focused ultrasounds at UCF Lake Nona Medical Center is a testament to the hospital leadership’s confidence in my reputation and my abilities to treat patients, as well as their commitment to delivering effective, innovative care,” Dr. Razack said. “I am honored to be able to provide this new treatment in our region, and I’m eager for the great outcomes we will achieve for our patients.”

To learn more about focused ultrasound, please call patient coordinator Roc Cadet at 689-216-8010 or visit https://ucflakenonamedicalcenter.com/service/neurological-services.