Dr. Masaru Ishii graduated from University of Pennsylvania Perelman School of Medicine. His clinical specialties include surgical management of nasal airway obstruction, chronic sinusitis and sinonasal tumors, as well as endoscopic surgery for skull base tumors. Dr. Ishii is rated as a Distinguished provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Cerebrospinal Fluid Leak, Prolactinoma, Olfactory Neuroblastoma, Septoplasty, and Endoscopic Transnasal Transsphenoidal Surgery.

Dr. Timothy Witham is a professor of neurological surgery and orthopaedic surgery at the Johns Hopkins University School of Medicine. His interests include the surgical treatment of degenerative conditions of the cervical and lumbar spine, including instrumented fusion procedures. He also has an expertise in the treatment of spinal tumors, spinal trauma and spinal deformity. Dr. Witham serves as director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory, director of Johns Hopkins Bayview Medical Center's Spine Program and co-program director of the Johns Hopkins Neurosurgery Residency Program. Dr. Witham received his B.S. in biochemistry from the Pennsylvania State University. He earned his M.D. from the Johns Hopkins University School of Medicine. He completed his residency at the University of Pittsburgh Medical Center. He performed a fellowship in spinal neurosurgery at Johns Hopkins. Dr. Witham joined the Johns Hopkins faculty in 2005. Prior to joining Johns Hopkins, Dr. Witham was chief neurosurgeon at Keesler Medical Center at Keesler Air Force Base in Biloxi, Mississippi. Dr. Witham's research interests include finding novel ways to achieve spinal fusion and improving surgical techniques in the aging spine. A co-author of more than 170 peer-reviewed articles and abstracts, Dr. Witham has been featured as a “Top Doctor” in Baltimore magazine and was a recipient of a United States Air Force meritorious service medal in 2005. He is a member of various professional organizations, including the American College of Surgeons and American Association of Neurological Surgeons. Dr. Witham is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Spinal Stenosis, Bone Tumor, Epidural Abscess, Spinal Fusion, and Laminectomy.

Nicholas Rowan is a sinus and skull base surgeon who helps patients with conditions such as deviated septum, nasal congestion, nasal obstruction, sinus pressure and chronic sinusitis, as well as complex issues like loss of smell, sinus cancers, cerebrospinal fluid (CSF) leaks and tumors that grow near the brain. He frequently performs nasal polyp surgery and endoscopic sinus procedures, using minimally invasive approaches to help patients recover quickly and breathe more easily. For tumors of the skull base or brain, he works closely with neurosurgeons and cancer specialists to deliver coordinated, comprehensive care. Dr. Rowan’s research is focused on improving patients’ quality of life and long-term outcomes after sinus and skull base surgery. A major part of his work involves studying the sense of smell — not just how to restore it, but how it reflects overall health. He explores how smell loss may be an early warning sign of unhealthy aging, frailty or cognitive decline. Through this work, he aims to better understand the biological link between the nose and brain, and what it can reveal about a person’s health trajectory. He works closely with biomedical engineers to develop novel diagnostic and therapeutic technologies, and he is the principal investigator of multiple ongoing clinical trials that are testing new treatments for chronic sinusitis and nasal polyps. A frequent speaker at national and international conferences, Dr. Rowan shares insights from his innovative research and surgical experience. He leads courses and delivers lectures on advanced sinus and skull base techniques, smell loss and the evolving science behind how nasal health connects to overall well-being. Dr. Rowan is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Sinusitis, Anosmia, Pituitary Tumor, Endoscopy, and Septoplasty.

Chetan Bettegowda is the director of the Johns Hopkins Department of Neurosurgery. He offers comprehensive treatments for adult patients with benign and malignant brain tumors, specializing in the treatment of patients with primary brain tumors such as gliomas, meningiomas and pituitary tumors. He performs both open surgery and stereotactic radiosurgery for patients with metastatic tumors to the brain, and also provides stereotactic radiosurgery for other neurological disorders, including spinal tumors, trigeminal neuralgia and skull-base tumors. Dr. Bettegowda is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Trigeminal Neuralgia, Astrocytoma, Glioblastoma, Rhizotomy, and Microvascular Decompression.

Dr. Andrew Lane is the Director of the Johns Hopkins Sinus Center and performs the full range of endoscopic sinus procedures, including transnasal skull base and orbital surgeries. He is dedicated to providing cutting-edge care to his patients and developing new therapies for chronic rhinosinusitis through his clinical and basic science research. He is the longest practicing sinus specialist with advanced fellowship training in the Baltimore/Washington region, with two decades of experience in the medical and surgical management of challenging sinus disease. Dr. Lane received a bachelor's degree from Harvard University and an M.D. from the University of Pennsylvania School of Medicine. He completed his internship in general surgery and residency in Otolaryngology-Head and Neck Surgery at the University of North Carolina at Chapel Hill. He came to Johns Hopkins in 2001, after completing a fellowship in advanced endoscopic sinus surgery techniques at the University of Pennsylvania. Dr. Lane maintains a busy clinical practice while also running an NIH-funded laboratory. His research investigates the causes and potential treatments for chronic rhinosinusitis with nasal polyps, as well as how inflammation affects the sense of smell. An author of over 140 published articles and book chapters, he frequently presents his surgical and research results at national and international meetings. He has earned several prestigious awards for his research about nasal polyps and olfactory loss. Dr. Lane is Editor-in-Chief of Current Otorhinolaryngology Reports, Associate Editor of the American Journal of Rhinology and Allergy, and an Editorial Board member of the International Forum of Allergy & Rhinology. He has served on the Board of Directors of the American Rhinologic Society and chaired the Rhinology and Paranasal Sinus Committee of the American Academy of Otolaryngology – Head and Neck Surgery. He is the Rhinology section leader for the Triological Society’s Best Practice committee. Dr. Lane is often invited to speak at outside medical institutions and regularly conducts media interviews about nasal and sinus issues. Dr. Lane is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), Nasal Polyps, Sinusitis, Endoscopy, and Septoplasty.

Dr. Gary Gallia's specialty is endoscopic endonasal surgical approaches to skull base pathologies with a focus on neurosurgical oncology. He utilizes the latest techniques in preoperative imaging, computer-guided surgical navigation, intraoperative monitoring, and minimally invasive and Neuroendoscopy approaches in the management of patients with benign and malignant brain tumors, metastatic tumors to the brain, skull base neoplasms, and pituitary tumors. He is the director of the Neurosurgery Skull Base Center and surgical director of the Johns Hopkins Pituitary Center. Dr. Gary Gallia graduated summa cum laude from the Gibbons Scholar MD/PhD program at Jefferson Medical College and Thomas Jefferson University. He completed his general surgery internship at The Johns Hopkins Hospital where he was awarded surgical intern of the year. He then completed his neurological surgery residency and a postdoctoral fellowship in neuro-oncology at The Johns Hopkins Hospital. Following residency, he completed a minimally invasive and endoscopic neurosurgery fellowship with Dr. Charles Teo at the Prince of Wales Private Hospital and Sydney Children's Hospital in Sydney, Australia. Dr. Gallia is rated as a Distinguished provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Olfactory Neuroblastoma, Chordoma, Pituitary Tumor, Endoscopic Transnasal Transsphenoidal Surgery, and Awake Craniotomy.

Dr. Mark Luciano is the director of the Johns Hopkins Hydrocephalus and Cerebral Fluid Center. A renowned leader in treating hydrocephalus, Dr. Luciano is distinguished both nationally and internationally for his research and educational and clinical work in neuroendoscopy. Dr. Luciano treats adults with hydrocephalus, pseudotumor cerebri, intracranial hypotension, Chiari malformations, and cerebral and spinal cysts. He has significant expertise treating children and adults with cerebrospinal fluid leaks and congenital disorders. Among his accomplishments in neuroscience research and biomedical engineering are his investigation of the cerebrovascular response to hydrocephalus and the invention of a unique device for control of intracranial pressure (ICP) pulsatility to increase blood flow. His National Institutes of Health-funded studies have explored prolonged compression and hypoxia in the brain as a result of hydrocephalus, as well as the interaction between cerebrospinal fluid and vascular systems. Dr. Luciano is rated as a Distinguished provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Hydrocephalus, Normal Pressure Hydrocephalus, Increased Intracranial Pressure, Posterior Fossa Decompression, and Gastrostomy.

Dr. Majid Khan is a Radiologist and Director, Non-Vascular Spine Intervention at Johns Hopkins University hospitals. Dr. Khan graduated from University of Kashmir, India in 1993. He completed his residency in radiology at the Nassau University Medical Center at Stony Brooks University and then completed his fellowship in Neuroradiology at Johns Hopkins University. Dr. Majid is deeply invested in both diagnostic Neuroradiology with particular emphasis on advanced head & neck and spine tumor imaging. His prime interest is doing spine tumor ablations primarily using microwave ablation devices and has performed the most number of such cases in the United States. He has significant expertise in spine cement augmentation procedures like kyphoplasty and vertebroplasty for treatment of compression fractures due to osteoporosis, multiple myeloma and/or other tumor-associated pathological fractures, sacroplasty for the treatment of fractures of the sacrum, epidural steroid injections, facet and transforaminal nerve blocks. He has treated a considerable number of patients with Tarlov and synovial cysts. Dr. Khan is a core member of Johns Hopkins Headaches and CSF Leak Program doing both targeted and non-targeted blood and fibrin glue patches. In addition, Dr. Khan has performed numerous imaging-guided head and neck biopsies with expertise in deep trans-facial biopsies. Dr. Majid has contributed to numerous publications and book chapters and has given regional, national and international talks, as well as presented research at many national meetings. He is a member of the American Society of Neuroradiology, American College of Radiology, American Society of Spine Radiology, North American Spine Society, Radiologic Society of North America, European Society of Radiology. Dr. Khan is rated as a Distinguished provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Cerebrospinal Fluid Leak, Meningocele, Tarlov Cysts, Vertebroplasty, and Bone Graft.

Dr. Creighton is an ear and lateral skull base surgeon. Dr. Creighton graduated from the Georgia Institute of Technology with a Bachelor of Science in biomedical engineering and earned his M.D. from Emory University. He completed a general surgery internship at the Mass General Hospital and residency in otolaryngology-head and neck surgery at Harvard. Following this he completed a fellowship in neurotology and lateral skull base surgery at Johns Hopkins. His clinical practice specializes in surgical and medical management of middle ear, inner ear, skull base and facial nerve disorders. These include skull base tumors, vestibular schwannomas (acoustic neuromas), hearing loss, cholesteatoma, cochlear implantation, stapedectomy, CSF leaks and ear drum perforations. He is trained in minimally invasive and endoscopic approaches to the ear for cholesteatoma and ear drum perforations, which reduces the need for visible incisions, and performed the first in office tympanoplsty repairs at Johns Hopkins. Dr. Creighton is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Acoustic Neuroma, Schwannoma, Infant Hearing Loss, Mastoidectomy, and Septoplasty.

Leila J. Mady is a head and neck surgical oncologist and reconstructive surgeon whose practice focuses on the care of patients with benign and malignant head and neck tumors, including thyroid/parathyroid disease, HPV-associated cancers, skin cancer (including melanoma) and parotid masses. With extensive experience in head and neck surgery, including sentinel lymph node biopsy, transoral robotic surgery, and complex regional and free flap reconstruction, her surgical skill set is complemented by in-office diagnostic capabilities such as ultrasound and needle biopsy. Dr. Mady is the director of head and neck surgery for the Baltimore region, and she is actively expanding coordinated, multidisciplinary treatment pathways for patients with head and neck and thyroid cancers across Johns Hopkins. Dr. Mady is a funded population and health services researcher who has led multidisciplinary and international teams with research interests in the side effects related to the cost of medical care, frailty, smell and taste changes related to cancer treatment, and patient-reported and oncologic outcomes in head and neck cancer. As a mentor for a wide range of academic training levels, from undergraduate to postgraduate, Dr. Mady has made a commitment to mentor women and underrepresented groups. She has received national recognition for these efforts by the American Academy of Otolaryngology–Head and Neck Surgery. Dr. Mady completed her medical degree, a doctorate in biomedical health sciences, and a master’s degree in public health at Rutgers University, and served as an associate fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Dr. Mady is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. Her top areas of expertise are Head and Neck Squamous Cell Carcinoma (HNSCC), Throat Cancer, Laryngeal Cancer, Glossectomy, and Gastrostomy.

Jean Kim is a surgeon-scientist whose clinical and translational research area of interest is in the pathogenesis of chronic rhinosinusitis with nasal polyposis. She cares for patients with the most severe forms of chronic rhinosinusitis, including patients with sinus disease, nasal polyposis and severe asthma. She also has expertise in the management and study of patients with autoimmune disease and complex sinus disease. Dr. Kim is co-director of the Jerome L. Greene Sjögren’s Disease Center, and is lead consultant for the Johns Hopkins Vasculitis Center and the Primary Ciliary Dyskinesia Foundation Clinical and Research Center at Johns Hopkins. She has considerable experience in conducting clinical trials in sinus and autoimmune diseases. With an active basic and translational research laboratory that studies the underlying mechanisms of airway epithelial dysfunction in sinus disease, Dr. Kim’s work is nationally and internationally recognized in the field of epithelial cell biology and allergic immune responses. She has held sponsored grants from the National Institutes of Health, various foundations and pharmaceutical companies to conduct her clinical, basic and translational research. Additionally, Dr Kim is interested in researching the pathogenesis of climate factors contributing to nonallergic rhinitis. Dr. Kim earned her medical and doctoral degrees from the University of Pittsburgh, and she completed her residency and fellowship training at the Johns Hopkins University School of Medicine. She is a member of the editorial board of the International Forum of Allergy and Rhinology, the nationally #1 ranked rhinology journal. Dr. Kim has served as a study section reviewer for the Medical Research Council of the United Kingdom, the Flight Attendant Medical Research Institute foundation and the Johns Hopkins Institute for Clinical and Translational Research, and she has received Johns Hopkins University School of Medicine Clinician Scientist Career Development Awards. Dr. Kim is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. Her top areas of expertise are Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), Sinusitis, Nasal Polyps, and Sialadenitis.

Dr. Haris Sair is Professor in the Johns Hopkins Medicine Department of Radiology and Radiological Science, and the Director of the Division of Neuroradiology. His areas of clinical expertise include functional Magnetic Resonance Imaging (fMRI) of the brain. He also has a faculty appointment in the Malone Center for Engineering in Healthcare at The Whiting School of Engineering, Johns Hopkins University, investigating the use of machine learning and artificial intelligence in imaging. He is a founding director of the Radiology Artificial Intelligence Lab (RAIL). He previously served as the President of the American Society of Functional Neuroradiology. Dr. Sair earned his M.D. from Duke University School of Medicine. He completed his Radiology residency at Temple University Medical Center, and fellowship in Neuroradiology at Massachusetts General Hospital in Boston, MA. Dr. Sair is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Hydrocephalus, Normal Pressure Hydrocephalus, Traumatic Brain Injury, Cerebrospinal Fluid Leak, and Microvascular Decompression.

Dr. Ali Bydon is a renowned neurosurgeon and director of the Division of Spine Surgery and the Neurosurgical Spine Center at the Johns Hopkins University School of Medicine. As the endowed Ziya Gokaslan Professor of Neurosurgery, he is dedicated to advancing the field through innovative clinical practices and extensive research. Additionally, Dr. Bydon serves as the vice chair for strategic planning within the Department of Neurosurgery. Dr. Bydon’s clinical practice is centered on degenerative disorders of the spine, spinal tumors, spinal trauma and complex spinal reconstruction. He is an esteemed member of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Dr. Bydon earned his medical degree from the University of Michigan School of Medicine in 1999 and completed his residency in neurological surgery at Henry Ford Hospital in Detroit, where he graduated with distinction in 2006. He further honed his skillset by completing fellowships in minimally invasive spine surgery and the surgical treatment of peripheral nerves, followed by a one-year instructorship in spinal oncology and complex reconstructive spinal surgery at Johns Hopkins in 2007. His research focuses on spinal biomechanics and surgical outcomes. He has co-authored over 265 peer-reviewed manuscripts and numerous book chapters. Dr. Bydon has made significant contributions to the understanding of optimal surgical management for conditions such as spinal synovial cysts, cervical myelopathy, lumbar spondylolisthesis, ossified posterior longitudinal ligament, cervical degenerative disorders, cervical myelopathy, thoracic myelopathy and metastatic diseases to the spine, among others. Dr. Bydon has presented at more than 200 national and international scientific meetings, underscoring his commitment to advancing knowledge in the field. An educator who has trained over 75 practicing neurosurgeons, Dr. Bydon has received prestigious accolades, including the Richard Otenasak Faculty Teaching Award and the Chairman’s Neurosurgical Teacher of the Year Award. His leadership roles have included serving on the residency review committee and the patient access committee at Johns Hopkins, as well as a yearlong term as the neurosurgical representative on the Johns Hopkins Faculty Senate. He has also served as a medical director with Johns Hopkins Medicine International, overseeing clinical and educational activities at renowned institutions in Lebanon and Brazil. Dr. Bydon has performed more than 5,000 surgeries. His commitment to excellence in patient care, education and research makes him a leading authority in spine surgery, dedicated to providing transformative care to patients seeking relief and recovery. Dr. Bydon is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Spondylolisthesis, Spinal Stenosis, Invertebral Disc Disease, Laminectomy, and Spinal Fusion.

Neurotologist John Carey specializes in the health and diseases of the inner ear that affect both balance and hearing mechanisms. He is a national expert in superior canal dehiscence syndrome, Menière’s disease, vestibular migraine, acoustic neuromas and other causes of vertigo, and serves as chief of the Division of Otology, Neurotology and Skull Base Surgery in the Department of Otolaryngology–Head and Neck Surgery at the Johns Hopkins University School of Medicine. Dr. Carey earned a medical degree from Washington University School of Medicine and completed two years of training in general surgery at Virginia Mason Medical Center. This was followed by residency training in otolaryngology–head and neck surgery at University of Washington Medical Center and fellowship training in neurotology at the Johns Hopkins University School of Medicine. His research interests include superior canal dehiscence syndrome, Menière’s disease, vestibular implants, and the mechanisms of vestibular migraine. He has a particular interest in superior canal dehiscence syndrome, and, with Lloyd Minor, department director from 2003 to 2009, he helped develop the operation used to repair the superior canal. Dr. Carey has been funded by the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health. He has authored or co-authored over 150 peer-reviewed publications, 10 book chapters, and 11 reviews. Dr. Carey is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Vertigo, Meniere Disease, Acoustic Neuroma, Mastoidectomy, and Endoscopy.

Roberto Rey Dios is a Neurosurgery provider in Baltimore, Maryland. Dr. Rey Dios is rated as an Advanced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Pituitary Tumor, Subdural Hematoma, Primitive Neuroectodermal Tumor (PNET), Balloon Sinuplasty, and Awake Craniotomy.

Dr. Guryildirim is an Assistant Professor in Pediatric Radiology and Pediatric Neuroradiology. She earned her medical degree from Hacettepe University and went on to complete her radiology residency at the Gazi University School of Medicine. After residency, she completed a two-year-long fellowship in Neuroradiology at Rush University Medical Center where she was the chief fellow. She then completed a one-year-long fellowship in Advanced Imaging before joining the Rush University Medical Center Neuroradiology faculty. Dr. Guryildirim's research interests focus on functional brain imaging of epilepsy patients, hydrocephalus and headache. Dr. Guryildirim is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. Her top areas of expertise are Legius Syndrome, Headache, Moyamoya Disease, Posterior Fossa Decompression, and Endovascular Embolization.

Dr. Eric Jackson specializes in the evaluation and treatment of patients with a broad range of neurosurgical disorders, including congenital malformations of the brain and spine, hydrocephalus (including endoscopic treatment), chiari malformation, craniosynostosis, spinal dysraphism/tethered cord, brain and spinal cord tumors, and traumatic brain injuries. He is the Principal Investigator for several multi-institution research studies, including: Hydrocephalus Clinical Research Network: currently investigating endoscopic surgery vs shunting for the treatment of hydrocephalus in infants in a $10M randomized trial funded by the NIH Park Reeves Syringomyelia Research Consortium Advancing the treatment for pediatric craniopharyngioma, identifying biological targets for molecular therapy A multi-institutional trial investigating a non-invasive eye tracking device for assessing increased intracranial pressure. Dr. Jackson is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Hydrocephalus, Chiari Malformation, Chiari Malformation Type 2, Posterior Fossa Decompression, and Endoscopy.

Henry Brem is a Neurosurgery provider in Baltimore, Maryland. Dr. Brem is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Gliosarcoma, Glioma, Brain Tumor, Endoscopic Transnasal Transsphenoidal Surgery, and Osteotomy.

Christopher Jackson is a neurosurgeon who specializes in brain tumors and cerebrovascular disorders, including glioma, meningioma, acoustic neuroma, trigeminal neuralgia, brain metastasis, arteriovenous malformation, and aneurysms. He is the director of the Acoustic Neuroma Center. Dr. Jackson earned his medical degree from the Johns Hopkins University School of Medicine, where he also completed his neurosurgical residency. During his residency, Dr. Jackson was honored with multiple distinctions, including the Frank L. Coulson Jr. Award for Clinical Excellence, the Irving J. Sherman Award for Resident Achievement, the Harvey Cushing Hunterian Research Award, and was elected to Alpha Omega Alpha. Dr. Jackson is an active researcher who has published over 35 peer-reviewed articles on brain tumor and cerebrovascular immunology. His laboratory focuses on how brain tumors evade the immune system and become resistant to immunotherapy. Additionally, Dr. Jackson’s laboratory explores the formation of cerebral aneurysms and inflammatory complications of cerebral aneurysm rupture. Dr. Jackson is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Trigeminal Neuralgia, Meningioma, Dysembryoplastic Neuroepithelial Tumors (DNET), Rhizotomy, and Microvascular Decompression.

Dr. William Anderson provides comprehensive treatments - such as including deep brain stimulation (DBS) therapies -for movement disorders including, Parkinson's disease, essential tremor, and dystonia. Dr. William Anderson is also a member of the Epilepsy Surgery team, and performs both resectional procedures such as temporal lobectomy, diagnostic procedures such as implantation of monitoring grids and depth electrodes, and therapeutic neuromodulation using vagal nerve and cortical stimulation. Procedures for pain and spasticity performed include intrathecal baclofen therapy and spinal cord stimulation therapy. Dr. Anderson is rated as an Experienced provider by MediFind in the treatment of Cerebrospinal Fluid Leak. His top areas of expertise are Parkinson's Disease, Essential Tremor, Spasticity, Deep Brain Stimulation, and Awake Craniotomy.