Physician Detail

Paul Joseph Schwartz, MD, PhD

Director, Neurosurgical Oncology and Skull Base Surgery, Hartford Hospital


Practice

Hartford HealthCare Medical Group

Specialty

Neurosurgery < Accepting new patients for this specialty
Spine Surgery < Accepting new patients for this specialty

Areas of Interest

Acoustic Neuromas, Awake Craniotomy, Brain Surgery-Minimally Invasive, Brain Tumor Surgery, Cervical Spine Surgery, Endoscopic Brain Surgery, Minimally Invasive Skull Base Surgery, Pituitary Tumors, Skull Base Tumors, Spine Surgery-Complex, Spine Tumor Surgery, Spine Tumors, Stereotactic Radiosurgery, Trigeminal Neuralgia

Physician Quicklink

https://hartfordhealthcare.org/PaulSchwartz

Institute URL

https://hartfordhealthcare.org/neuro

Phone

860.278.0070

Call for Appointment

Gender
Male

Languages
English
Spanish


Office Locations



Bio

Doctors at Hartford HealthCare are seeing more patients with spine tumors. Tumors from metastatic disease can often affect the stability of the spine. And, if these tumors are not treated aggressively they can lead to paralysis.

Dr. Paul Schwartz, Director of Neurosurgical Oncology and Skull Base Surgery at Hartford Hospital.

Q. First, why the rise in patients with spine tumors?

A. Great question, and one that speaks a lot to the amazing work that medical scientists have been doing for decades. The fact is that cancer in some cases, is becoming a manageable disease. With the great advances in medical care and cancer treatment paradigms, people are living longer and tumors are showing up in places they typically would not have in years past. We at Harford Healthcare have one of the, (if not the) busiest centers in the state addressing metastatic disease to the spine.

Q. As part of the response, a team of experts was formed to specifically treat patients with spine tumors…

A. About 3-4 years ago we felt the need to begin to coordinate care of patients with spinal metastatic disease across the range of specialties to which these patients were referred. Our Spine and Brain Tumor Disease Management group developed the “Spinal Metastasis Assessment & Remedy Team” to fulfill this purpose. This is a dedicated team of interventional radiologists, radiation oncologists, and spine surgeons who regularly interact with each other and which interfaces with the medical oncologist to provide state-of-the-art care for patients with metastatic disease to the bones of the spine. This can include stereotactic radiotherapy, minimally invasive tumor thermal ablation and vertebral augmentation (Kyphoplasty), or even open surgical tumor resection and spinal reconstruction.

Q. Recently, the FDA approved a new system called the “Vader carbon fiber fixation” system that allows you to track tumor response? How does that work…

A. Traditional surgical reconstruction following tumor resection involves placing multiple titanium screws into the spine and replacing vertebral bodies with titanium or similar metal implants and affixing these screws to each other with rods which again were made of titanium. This amount of metal in an area that has been the home of growing tumor is problematic in that titanium obscures the imaging modalities we use to observe tumor growth or response to therapy. The new system, which is as durable as titanium, is completely transparent to MRI or CT scans allowing us to better observe tumor behavior and potentially intervene earlier with salvage treatment if the tumor is seen to grow. This is a game changer when it comes to managing local recurrence.

Q. How have patients responded to this type of treatment?

A. Our hope is that this system will act biomechanically as well as the traditional titanium material, but will allow more rapid detection of growing tumors. Since the system just came out late in the summer of 2019, the only thing I can really say is that it has lived up to expectations in terms of imaging capability and durability.

If you would like more information about the spine program at Hartford Hospital call 1-855-HHC-HERE.

Advances in the treatment of brain tumors have certainly come a long way…especially in brain tumors categorized as “High Grade” brain tumors like the kind Ted Kennedy and John McCain both had.

Q. I understand Hartford Hospital is the only site in the state to use a technique called “Real-time Tumor Flourescence” to aid in surgery…explain what that is and how it works…

A. We give our patient with a suspected high grade tumor a drink of a compound call 5-ALA (5-aminolevulinic acid), a normal metabolite that your cells produce on a limited basis. This concentrates over a couple of hours in tumor cells in the brain. We then begin the surgery and when we get to the tumor (using image guidance) we turn on a blue fluorescent light which is part of the microscope and the tumor lights up a bright pink. Normal brain remains blue, blood vessels look greenish, but the tumor looks like magma, making it very easy to safely re-sect all of the tumor without disrupting normal brain.

Q. A “safe” tumor resection is associated with improved outcomes for patients…tell us how effective it has been?

A. We know that we need to get about 75% of the tumor out to significantly improve outcomes. Any less than that, and the risk of surgery itself is greater than the observed benefit. After that, we know that the more tumor that is resected, the better the long term prognosis. This is especially true with what we call “gross total resection” that is rescting all tumor that can be observed with current imaging techniques (usually MRI scans). This is true only if the resection does not result in significant new neurological deficit, like inability to speak, or paralysis. The great thing about 5-ALA is that anything we see lighting up as pink is non-functional tissue and thus removal of the pink portion almost never confers new neurological deficit.

Q. Tell us how you are using imaging guidance to target brain tumors?

A. Image guidance is like GPS in the operating room. Our patient gets preoperative high resolution MRI and CT scans and cameras in the operating room tell us where we are in the head. This allows us to dissect through the lease amount of normal brain tissue to get to the tumor. When we start to take the tumor out, however, the anatomy changes rendering the image guidance less effective. If we combine this with the fluorescent marker (the 5-ALA), we can now get to the tumor with minimal brain disruption and safely take out the maximal amount of tumor possible.

Q. How have patients responded to this type of treatment?

A. Since we initiated the combined image guidance and real time fluorescence techniques, we have seen significant improvement in resection completeness, with no patient suffering any unexpected neurological complications. We are very pleased to be able offer this highly advanced technology to our patients.

If you would like more information, please call 1-855-HHC-HERE.


Education

Medical School

  • Albany Medical College 2002 MD

Internship

  • University of Medicine & Dentistry of NJ 2008, Surgery

Residency

  • University of Medicine and Dentistry of New Jersey, Neurosurgery

Undergraduate

  • Colgate University BA

Graduate School

  • Johns Hopkins University PHD

Research Fellowship

  • Massachusetts General Hospital

Insurance Accepted*

Aetna, Anthem, BCBS Medicare, Cigna Healthcare, Colonial Cooperative Care, Community Health Network of Connecticut, Inc., Connecticare, Connecticare Commercial, Connecticare Medicare, Corvel, Coventry, Essence Healthcare, Evercare, First Health Group Corp., Focus, Harvard Pilgrim, Health Connecticut, Health Direct, Health New England, Healthy Connecticut, HMC/Northeast Healthcare, Medspan Commercial, Medspan Medicare, Multiplan, Northeast Health Direct, One Health Plan/Great-West Healthcare, Oxford Health Plans, Prime Health Services, Private Health Care Systems, Inc., Senior Whole Health, United Healthcare, WellCare of Connecticut, Inc.

*This information is subject to change at any time. Please check with your insurance provider before scheduling your appointment or receiving services to confirm they are a participating member of the Hartford HealthCare network.


Hartford HealthCare


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