Robert A. Mericle, MD — Brain Repair

Mar 04, 2014 at 04:23 pm by Staff

Robert A. Mericle, MD, likes to get into a patient’s head and fix things.

The neurosurgeon specializes in treating brain aneurysms, brain and spinal arteriovenous malformation (AVMs), brain tumors, trigeminal neuralgia, Moyamoya disease, carotid stenosis, and stroke, among other neurological issues. Although Mericle is internationally recognized as a leader in performing minimally invasive treatments of brain aneurysms and AVM through needle stick using liquid embolic agents, to his patients, he is simply known as “Dr. Miracle.”

His two favorite procedures, he said, involve eliminating the severe pain of trigeminal neuralgia, which has been likened to being hit in the head with a cattle prod, and performing brain bypasses to prevent strokes for sufferers of Moyamoya disease. Moyamoya disease is a rare and progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in the area of the basal ganglia. It is characterized by a narrowing of the internal carotid artery, middle cerebral artery, and anterior cerebral artery, leading to irreversible blockage of the main blood vessels to the brain as they enter into the skull.

Moyamoya disease was first described in Japan in the 1960s. Since then, cases have been reported in individuals in the United States, Europe, Australia, and Africa. The singsong name, which means “puff of smoke” in Japanese, is used to describe the way the tangle of tiny vessels that are formed to compensate for the blockage look when imaging the brain.

The disease primarily affects children, but it can also occur in adults, often striking in the third to fourth decades of life. Children with Moyamoya present with symptoms of stroke, such as weakness of an arm or leg, or seizures. Adults tend to present with ischemic or hemorrhagic stroke. Mericle explained treatment starts with blood thinning therapy, usually aspirin, to help the blood travel through the narrowed intracranial vessels. Surgery is indicated if there are worsening symptoms. An extracranial to intracranial (EC-IC) bypass that provides a direct and immediate supply of fresh blood to the affected area is the preferred treatment whenever possible.

An expert in the procedure, Mericle is president of Nashville Neurosurgery Group PLC, located at Medical Plaza One on the campus of Saint Thomas Midtown Hospital. Prior to going into private practice, he performed the majority of EC-IC bypass operations done at Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital over the past decade.

Mericle and partner Arthur Ulm, MD, who are both nationally recognized leaders in the treatment of trigeminal neuralgia and have extensive experience performing surgery for hemifacial spasm, were principals with HW Neurological Institute, which merged with Tennessee Brain and Spine last year to form the Nashville Neurosurgery Group. A past president of the Tennessee Neurosurgical Society, Mericle is a Fellow of the American Association of Neurological Surgeons.

Growing up in a tiny town outside Barlettsville, Okla., where not one of the 3,000 residents had gone to college, it’s doubtful Mericle could have foreseen the path his career would take. However, he recalled, “I knew I wanted a progressive career, like the eye doctor I went to in Barlettsville, and that college was necessary for that.”

He enrolled at the University of Oklahoma, graduating in the top 3 percent of a class of 25,000 students, and was named to Phi Beta Kappa … just one of many accolades he has received throughout his education and the course of his practice.

In high school science classes, Mericle was always fascinated by the way the brain interprets information from sound and light waves and decided he wanted to pursue that line of investigation. After graduating from Oklahoma summa cum laude with a BA in psychology and BS in zoology, Mericle applied to medical school.

He was accepted to Vanderbilt University School of Medicine and awarded the prestigious Canby Robinson Scholarship – a four-year, full-tuition merit scholarship. After graduation from Vanderbilt, Mericle continued with a general surgery internship and neurosurgery residency at the University of Florida with a two-year neuroendovascular fellowship at the State University of New York in Buffalo. Upon completing his residency at Florida, he served as chief of Endovascular Neurosurgery Service and program director for the university’s fellowship program in his specialty.

In 2004, Mericle received a call from George Allen, MD, who was chair of Neurosurgery at Vanderbilt at that time. Allen, who remembered Mericle from his student days in medical school, offered him an opportunity to return to Nashville to help build the academic medical center’s cerebrovascular and endovascular neurosurgery program.

“I was glad to return to Vanderbilt,” Mericle said. “My wife and I love Nashville.”

Since his return 10 years ago, Mericle has treated thousands of neurosurgery patients and has taught dozens of physicians from around the country. Widely published, he has contributed to more than 100 books and medical journals on neurology topics.

When Mericle ponders the changes that have occurred in neurosurgery since he started his training, he is most aware of the rapid growth of the use of technology.

“We used to have to get to the brain by going though the cranium and opening up the skull. Now we have five or six ways to treat an aneurysm that are so much less invasive and less difficult for the patient,” he observed.

“I can use 600 milligram thread to bypass a blockage and sew the two sections together to an artery in the scalp,” he continued of advances in the field, adding this provides an increased blood flow expansion allowing the vessel to actually grow and get stronger.

When he isn’t busy repairing brains, he loves spending time with his family. Mericle’s wife is in her last year of training as a medical pharmacist, and the couple has three children, ages 19, 17 and 11.

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