David Limbrick, MD, PhD, is neurosurgeon whose areas of interest include pediatric neurosurgery, epilepsy surgery, neuro-endoscopy, hydrocephalus, pediatric brain tumors, deep brain stimulation, radiosurgery and pediatric spine.
Please call 314-454-2810 for an appointment.
What happened in the course of schooling to influence you to choose your specialty as a neurosurgeon?
In medical school I did research in epilepsy and was certain I was going to be a neurologist. Along the way, I thought it was important for a neurologist to be familiar with what neurosurgeons did. So I spent four weeks during my 4th year of medical school as a neurosurgery student.
Although I didn’t change my specialty to neurosurgery until sometime later, it was my wife who told me she knew I was going to be a neurosurgeon within the first two days of my neurosurgery rotation. She said she knew something was noticeably different — I would go to and come home from work very excited about what I was doing and seeing every day.
What brought you to Washington University?
Because I changed my specialty during my 4th year of medical school, I had to hastily adjust my residency choices. I came here based on my mentor, Dr. Ross Bullock’s recommendation. He said if I was interested in neurosurgery and neurosurgery research, I needed to look at Washington University.
Within a few weeks of starting my residency here, I got to know Dr. Ralph Dacey, chairman of the department, and Dr. T.S. Park, head of pediatric neurosurgery. They told me I would fit in well here — and I felt the same way. The research going on at the moment was very much in line with what I’d done in graduate school and I was excited to get started.
What is your current area of research?
One of my major areas of research is in the field of Chiari malformations and syringomyelia. I am very fortunate to be a part of the Park-Reeves Syringomyelia Research Consortium. This is a large philanthropic project made possible by a generous donor whose granddaughter was affected by Chiari and syringomyelia. We have created a North American network of children’s hospitals to establish a registry for patients with Chiari malformation associated with syringomyelia.
Can you explain chiari and syringomyelia?
Chiari malformations are developmental abnormalities of the base of the brain and craniovertebral junction. There are multiple kinds of Chiari malformations, but my primary interest is Chiari type 1 malformation. In this malformation (link to top story) the lowest portion of the cerebellum descends through the base of the skull into the top portion of the cervical spinal canal. This results in the restriction of the movement of fluid between the cranial and spinal spaces and, ultimately, the accumulation of fluid within the spinal cord, termed syringomyelia.
There are different surgical treatments for these conditions. Surgery on the Chiari malformation often results in resolution of the syringomyelia. If the conditions are left untreated, debilitating problems like pain, weakness, paralysis, sensory loss, or inability to walk can occur. We try to identify the best way to treat each individual.
There are people with Chiari, who don’t have syringomyelia. And there are people with syringomyelia without Chiari. But they very commonly happen together.
Are you involved in any other research?
I’m helping to lead the Park-Reeves Syringomyelia Research Consortium. We are accruing information on 1000 patients across 28 different institutions in North America in order to determine the best surgical approach to treat Chiari-associated syringomyelia. In addition, I am interested in looking to improve the ways in which children with hydrocephalus are diagnosed and treated.
Because people with Chiari can be diagnosed when they are children or as young adults, we’ve created an adult Chiari clinic at the Center for Advanced Medicine. Our goal is to have a longer term view of the illness to see what problems may occur, regardless of whether treatment begins when the patient is a child or an adult.
Which aspect of your practice do you find most interesting?
For neurosurgery, the introduction of new technologies into patient care is most exciting. Neurosurgery is one of the fields where we can rapidly apply innovative technologies to clinical care.
Where are you from?
My wife and I are native Virginians. We moved here in 2002, so we’ve been here for quite some time. We love St. Louis.
Is there a particular award or achievement that is most gratifying?
This past year I was given an award for humanitarian efforts in Haiti from the American Association of Neurological Surgeons (AANS). Dr. Keith Rich, another neurosurgeon at Washington University, and I’ve been traveling to Haiti every four to six months since 2009 to treat children with hydrocephalus.
I really enjoy everything I do here in St. Louis, but it is also gratifying to go to Haiti to care for these children who have no pediatric neurosurgeon. It’s a unique opportunity.
We have one nurse who lives in Haiti and organizes the clinics for us. The first day of the clinic we’ll see 60-90 patients. For the next four to five days, we usually perform about 25 surgeries.
Everyone on our medical team is from St. Louis – Barnes-Jewish Hospital, Children’s Hospital, and other places in the community. It’s a rewarding experience.
We usually stay in Haiti about a week, but thanks to cell phones and email, we can still be quite involved with post-operative patient care when we return to St. Louis.
What is the best advice you’ve received?
The best advice I’ve received in medicine was from Dr. Mike Chicoine, one of the Washington University neurosurgeons who helped to train me. He said, “Before you can be a good surgeon, you must first be a good doctor.” For him, this means that when he accepts the care of a patient, he takes care of the whole patient – making sure he or she receives appropriate care for current health concerns, whether its neurosurgical or not. I try to carry this advice into my practice as well.
If you weren’t a doctor, what would you like to be doing?
I love music. In the distant past I had a go at a being a musician, but it didn’t pan out. And here I am.