Nitesh V Patel, M.D., is a board-certified neurosurgeon with advanced fellowship training in the treatment of brain and spinal tumors, and is co-director of the Neurosurgical Oncology program at Jersey Shore University Medical Center. He’s also one of many surgeons who collaborates with MedCAD to create patient-specific implants as part of his practice.
Dr. Patel recently made the news as part of a patient story, when he used a custom MedCAD implant to replace the deteriorating bone in the skull of his patient, Greg Morrison. The operation was a success, and the news hook gave us the opportunity to talk to Dr. Patel about his life story, his practice, and his philosophy for treating the entire patient.
Q: What made you want to become a doctor, and what was your path for getting there?
Dr. Patel: My father passed away when I was a teenager and that exposed me to medicine for the first time. Prior to that, I wanted to be an architect.
I got familiar with being in a hospital as my dad was there getting care, and I started seeing different specialties taking care of him. One of them was in neurosurgery, and I was very much captivated his bedside manner, the decision making, the courtesy he showed speaking with my family and just the general wholesomeness of the conversations with him.
Now, not all neurosurgeons are like that; I’ve learned that, very much so. But fortunately, this surgeon was, and it was a tough time for me. He was certainly a rock for our family.
So I was in high school, and had decided that I wanted to do health care. And I just told myself, I’m going to be a neurosurgeon. It was kind of a wild thing to say in high school, considering the challenges of becoming one and the odds of getting through every gateway you have to get through to get to that point. But I told myself I’d do it.
And, you know, I went to college, studied as hard as I could at Rutgers. I got into an accelerated bachelor’s M.D. program at Robert Wood Johnson Medical School as part of Rutgers, so I was able to shave off a year of undergrad and start med school early.
I subsequently matched to neurosurgery at Rutgers as well, and spent seven years of my time there doing neurosurgery residency training. One of the years — year five of seven — was a research year, during which I could leave Rutgers and go to Lenox Hill. Instead of doing lab research, I was allowed to do a fellowship while still in residency, and I spent a year in New York City and I learned a lot. I did a lot of cases, a lot of tumor cases, a lot of skull-based cases. Then I came back to Rutgers, finished off my sixth and seventh years of residency, and then finally went to Miami post-residency to get additional tumor training so that I could run a tumor program.
And straight out of that, I landed here at Jersey Shore.
Q: Was oncology always part of your plan or did the cancer come into it later?
Dr. Patel: The cancer came into it later. We trained as general neurosurgeons, and then we specialized depending on our fellowships. Early on in my residency I committed to a path of doing brain and spine tumors, said that I’d formalize my training later really call myself an expert in this specific aspect of neurosurgery. I still do general neurosurgery —lots of it because I’m trained to do it — but I focus primarily on tumor and oncology surgery.
Q: How often do your cases require a cranial implant like the ones that MedCAD makes?
Dr. Patel: Probably less than less than 10% of my cranial procedures. And it’s usually in a case where it’s either a tumor involving bone or a trauma where I need to do some sort of reconstructive effort. For example, I did a case a few months back that required orbital reconstruction. You guys were able to do that pretty nicely, which was amazing.
This most recent surgery one with Greg Morrison is another example. I called my local distributor here, Drew DiMino — and I absolutely love this man. He is on point. He is always honest and he gives good feedback. You guys have been phenomenal and so I use you, even though it’s not a large portion of my cases, the product you have is damn good.
Q: Are your designs usually pretty straightforward, or do they often get a little complicated?
Dr. Patel: They sometimes get complicated, depending on what I’m doing. So if it’s a tumor involving bone, I have to reconstruct depending on what the defect is. If it’s a standard hemi-craniectomy, those are slam dunks — for you guys, too, I think — because they’re standard things. But with orbital cases or facial fractures that involve cranial injury, that’s where things get a little wild, and that’s where the discussion with the engineering team is pretty nice. And, you know, they’re creative and they give advice, too.
Q: Is delivery time a big factor for you?
Dr. Patel: It is. I’ve never had a delivery time issue with you guys. And full disclosure, I’ve worked with some other products that may show some promise on a few cases, but delivery time is important to me. You guys are able to turn things around pretty quickly.
Q: How informed are your patients about the implants that are going in? How involved are they in the process?
Dr. Patel: I usually will offer every patient their original bone if I have it available, and I will certainly offer them the 3D implant too, and I go over the pros and cons.
My general pros and cons start by noting that your own bone is your own bone. There’s a lower chance of infection because it’s not a foreign body. There’s a lower chance of having issues with fit because it’s your own bone and it’s from the same cuts. But there’s a higher chance for failure in terms of autologous bone resorption. I mean, that happens all the time. Six months later, it looks like a moth was eating the skull.
So I tell them that’s a much higher risk than it would be with a 3D implant. I tell them the advantage of a 3D implant is it’s a perfect fit, usually, with minimal re-contouring. I can also beef it up to account for any temporalis defect, and it’s going to last longer than they will because it’s not an organic material and it’s not part of their body. And it’s strong; it’s as strong as bone or stronger depending on the material.
Q: You have a concept called ERAS, for Enhanced Recovery After Surgery. What does that look like for you before, during, and after the surgery?
Dr. Patel: Enhanced recovery after surgery is very important to me. My goal is to get patients back to normal — their normal — as fast as possible. I often tell patients, I want you to have your surgery, but I want you on your couch at home as fast as possible. And that timeline is usually 24 hours.
I’ve done a craniotomy for a tumor at 7 a.m. and the patient is having dinner at their table at home at 5 or 6 that evening. It sounds crazy, but the way we do that is with patient counseling, We make sure the patient understands that they’re going to have some discomfort, but it doesn’t mean they need to be bedbound. They’re going to have some anxiety about it, but they’re going to be okay as long as we make sure they have a good support structure.
The intraoperative part is minimizing hair shaving. I don’t usually shave any hair, and I avoid extra IV lines, and a Foley Catheter, and excess medications that aren’t really going to make a difference, such as hyperosmolar agents like mannitol.
Lastly, the postoperative stuff is getting them mobilized as soon as possible after surgery. I don’t put head wraps on patients when they come out because the first thing a patient will do in 2025 is grab their phone and take a selfie. And I don’t want them to look like they had a major surgery because they’re going to feel sicker than they actually are.
And when they come out and they can’t see their incision? You know, they feel automatically better. They’re more motivated to get out of bed, to a chair at least, and mobilize to go home sooner.
Q: What’s the best part of your job?
Dr. Patel: I’ll tell you, there’s two things. One is some days I’m operating super late and it’s 2 a.m., and I’m driving home on the highway, I’m starving. I haven’t eaten, I haven’t peed for God sakes because I haven’t had any water all day And I’m just tired. But there’s a grin on my face because I know I did something good for a patient. It’s really nice to know that even though that surgery was tough, we got the job done. This patient is going to be able to have that quality of life that I promised that I would get them.
The second aspect, and this is what gets me the most excited, is that first post-operative visit, when you know the patient’s done well. And I walk into the room and I see them and they look like they didn’t have any surgery at all. Nothing beats that feeling. Like, I went through all this training, I spent so much time learning this, and I was able to translate that into care for this patient and provide them with relief from what was hurting them. Nothing beats that.
Q: What gets you excited about the future as far as neurosurgery goes?
Dr. Patel: I mean, of course, brain computer interface, BCI stuff was exciting before I started my training. And now we’re already almost over a decade into the future with that stuff. But what gets me excited with this implant stuff is having 3D implants available to help reconstruct people — not just skulls, but also spines.
And I’m excited about the possibility of having this technology available for rapid turnaround. I mean, I can picture a day where the 3D printer is made by you guys, and it lives in the hospital and you can print from it as needed with software and materials you guys provide — any part of the body that’s a structural component. We could just do that on the spot.
Q: Is there anything that might have pulled you away from medicine?
Dr. Patel: I was very much into American history and Civil War studies, and I thought I was going to major in that and not go into medicine for a while, at least for a semester or two. I’m still a big fan of North American history, and I read a lot of books on that stuff. I am very much into cooking and I always thought about being a chef, and for a long time I was a pretty avid distance runner and would run marathons and all that. So those are my other interests. But nowadays it’s my seven-month-old kid, which is my only interest.
Q: Any parting words?
Dr. Patel: You know, I think I’m fortunate to have a good team here where I am at my institution, and to have Drew DiMino as my connection to you guys. I’m very grateful to have these resources right now. I know for a fact that — not just internationally but here in the United States — there are places that don’t have the same sort of resources that I do here. It helps provide better patient care.
I’m just so fortunate to have this.
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2025 | MedCAD