February 20, 2020

William H. McAllister, IV, MD

Riverside Hampton Roads Neurosurgical & Spine Specialists


When William McAllister, IV enrolled at the University of North Carolina Chapel Hill, he fully intended to follow in the footsteps of his father, William III, who had studied journalism at UNC.  The elder McAllister worked for The Virginian-Pilot as well as The Washington Post and The Wall Street Journal, and continues writing today.  The freshman’s career goal was specifically sports journalism; medicine was the furthest thing from his mind.

He made a few friends in the pre-med program, but what really attracted him was what he observed on his nightly run after a long day of classes and studying.  “I’d jog at 11 or 12 at night,” he says, “and most of the campus was quiet, but when I ran by the hospital, all these lights would be on, and all these activities would be happening, the helicopter flying in and bringing patients to the trauma center.” He was 18 years old and a night owl, and he remembers thinking, “These people were up and working at the time I felt I was at my best, while my professors and fellow students were sleeping or working in the library.  It was the pulsing energy of the hospital that drew me in.”

He began taking pre-med classes and discovered a natural proclivity for science.  By his junior year, he was doing research in the hospital.  In his senior year, he did an honors project that exposed him to pulmonology, which he first thought might be his specialty.  Then he considered cardiology, then internal medicine – until his first year in medical school, when a lecture about children born with intracranial deformities got him interested in the brain.  His third-year rotation in the neurosurgery service fascinated him, convincing him that he had found his niche. 

He completed his residency in neurosurgery at Loyola University Medical Center and Cook County Hospital in Chicago, and received training in adult spinal deformities at Rush St. Luke’s Presbyterian Hospital in Chicago.  He then completed additional training in neurology at the University of California, San Francisco.

   “It was right around the time that so many breakthroughs in interventional stroke care were happening,” Dr. McAllister remembers, “things like dealing with aneurysms endovascularly through coiling.  UCSF was at the forefront of that technology, so I got to see that aspect of neurosurgery coming into its own.  As a bonus, I got to live in San Francisco during a Chicago winter.”

There were many job offers, but, he says, “I realized my heart was in the southeast, particularly North Carolina and Virginia.”  He means that quite literally, as he met his wife in Chapel Hill, and his own family is from Norfolk.  He went into private practice in Newport News in 2005, and joined the Riverside Health System in 2005.  He’s been a member of the Riverside team ever since.

As part of that team, Dr. McAllister serves as medical co-director of the radiosurgery unit, “where neurosurgery and radiation oncology come together,” he says.  In that capacity, he’s had the opportunity to oversee some of Riverside’s recent technological acquisitions, which have included an update of the Gamma Knife to the Perfexion™ Unit.  The Perfexion™ system has dramatically streamlined workflow and expanded the treatable volume through an automated, multi-source collimator, allowing the surgeons to expand their ability to treat metastatic tumors and other lesions in the brain.  

The unit has lately acquired another update in the concept of stereotactic radiation, a device called a Varian Edge.  “The Varian is delivering radiation that’s more specifically guided by the anatomy of what we’re treating,” Dr. McAllister explains, “so we’re giving more radiation directly to the precise site of the tumor(s).  We need no longer expose surrounding areas, whether the spinal cord, the kidneys or the back of the throat, to radiation.  This completely elevates the level of precision and safety.”

Dr. McAllister recently oversaw Riverside’s purchase of the O-arm 2 – an intraoperative CT scanner used in brain and especially spine surgeries.  The O-arm 2 provides current patient data in real time, in the operating room itself, eliminating the need to send patients to radiology to be scanned.  In addition, he says, “The more complicated spine surgeries require the placement of screws and rods to hold and stabilize the spine.  With the O-arm 2, we’re essentially using a kind of virtual reality to guide the placement of this hardware with greater precision, which allows us to see a picture of the bone as it exists right then.  It’s a way of making these delicate operations safer, and allowing us to do even more complicated procedures.”

Ten or fifteen years ago, Dr. McAllister says, this would have been considered too risky or too time-consuming.  Today, he says, particularly in spine surgery, “the reality is we’re only a few years away from when we’ll do a scan on a patient and then a robot will come in and place these screws while the surgeon watches.  We’re not there yet, but it’s on the horizon.

“At Riverside, we continue to evaluate the newest technological innovations for these delicate brain and spine surgeries,” he says, “but robots will never replace the judgment and skill of a well-trained, seasoned surgeon.” 

As for surgeons like Dr. McAllister, robots notwithstanding, there will still be the satisfaction of making the treatment decision and guiding the actual procedure.  “It’ll be a long time before robots will be sophisticated enough to do some of the more nuanced things we do in the OR.”