NEUROSURGERY OUTCOMES 2017 - Texas Children's Hospital...The pediatric neurosurgeons at Texas...
Transcript of NEUROSURGERY OUTCOMES 2017 - Texas Children's Hospital...The pediatric neurosurgeons at Texas...
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TABLE OF CONTENTS
WELCOME 2
VOLUMES & OUTCOMES 6
PROGRAMS 12
CONGENITAL MALFORMATIONS / FETAL SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CRANIOFACIAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
EPILEPSY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
FUNCTIONAL NEUROSURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
HYDROCEPHALUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
SKULL BASE SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
TRAUMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
TUMOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
VASCULAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
PATIENT STORIES 34
LUKE: TUBEROUS SCLEROSIS COMPLEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
EVERETT: SPINA BIFIDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
MATTHEW: CRANIOSYNOSTOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
FACULTY & PUBLICATIONS 40
FACULTY & STAFF DIRECTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
SELECTED PUBLICATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
CONTACT US . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
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Dear colleagues, parents and friends,
It is my true privilege to introduce you to the Neurosurgery Division at Texas Children’s Hospital®.
Texas Children’s Hospital is the largest pediatric hospital in the United States and is ranked #4 nationally by U.S. News & World Report, an extraordinary distinction
surgeons, under the leadership of Dr. Larry Hollier, Jr., surgeon-in-chief.
hydrocephalus, spine, trauma, tumor and vascular pediatric neurosurgery. Every faculty member is innovating in a
over the last decade.
We are extremely excited about the next phase of neurosurgery at Texas Children’s. Our collective vision is to be the
prestigious academic positions in neurosurgery departments across the country.
Sincerely,
Howard L. Weiner, M.D., F.A.C.S., F.A.A.P., F.A.A.N.S.Chief of Neurosurgery, Texas Children’s HospitalProfessor and Vice Chairman, Department of Neurosurgery, Baylor College of Medicine
WELCOME
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Legacy Tower, Texas Children’s newest building, opens in 2018. The expansion includes new
high-intensity surgical operating rooms and a neurological intensive care unit.
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TEXAS CHILDREN’S HOSPITAL
Texas Children’s Hospital® is one of the nation’s largest and most comprehensive specialty pediatric hospitals, with more than 2.4 million patient encounters in 2017. Texas Children’s mission is to create a healthier future for children and women throughout our global community by leading in patient care, education and research. Renowned worldwide for its expertise and breakthrough developments in clinical care and research, Texas Children’s Hospital is ranked #4 nationally by U.S. News & World Report.
Texas Children’s Hospital is located near downtown Houston in the Texas Medical Center, the largest medical center in the world. The medical center campus includes more than 600 licensed beds; the Wallace Tower for outpatient visits; the Feigin Tower for pediatric research; and Texas Children’s Pavilion for Women for comprehensive OB/GYN care. Located nearby is the Jan and Dan Duncan Neurological Research Institute® at Texas Children’s Hospital, a basic research institute dedicated to solving childhood neurological diseases. In 2018, the new Legacy Tower will be completed to increase capacity for critical and surgical care.
Texas Children’s Hospital® West Campus and Texas Children’s Hospital® The Woodlands bring specialty pediatric care, including acute and critical care beds, 24/7 pediatric emergency centers, surgical suites and more than 20 subspecialty clinics, to a rapidly expanding population of children west and north of Houston. Texas Children’s also operates Texas Children’s® Health Plan, the nation’s
® Pediatrics, the largest pediatric network in the nation. Texas Children’s® Health Centers, Specialty Care and Urgent Care locations provide enhanced access to care throughout the Greater Houston community. Texas Children’s Health Plan partners with the State of Texas to form STAR Kids, a Medicaid-managed care plan for children with disabilities and complex medical needs offering streamlined management and coordination of care.
ACADEMIC AFFILIATION ® in the
areas of pediatrics, pediatric surgery and obstetrics and gynecology. Baylor is ranked by U.S. News & World Report as one of the nation’s top 10 medical schools for pediatrics. Currently and throughout our 63 year partnership, Texas Children’s Hospital serves as Baylor’s primary pediatric training site. The collaboration between Texas Children’s Hospital and Baylor is one of the
Institutes of Health.
With a staff of more than 13,500 employees and more than 2,000 board-
subspecialists, pediatric surgical subspecialists and dentists, Texas Children’s offers more than 40 subspecialties, programs and services. Physicians are employees of Baylor College of Medicine, not Texas Children’s Hospital. Because they practice at Texas Children’s Hospital, they may be referred to as “our team” or “Texas Children’s physicians” throughout this report.
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TEXAS CHILDREN’S NEUROSCIENCE CENTER
components – Neurology, Neurosurgery and the Jan and Dan Duncan Neurological Research Institute®.
One of the largest pediatric neurology programs in the country, the Neuroscience Center receives more than 30,000 clinic visits and performs more than 1,000 surgeries each year. It is a comprehensive destination for children suffering from common neurological conditions like epilepsy and muscular dystrophy to more complex and
families. Experts in pediatric neurology, neurosurgery, neurophysiology, neurological critical care and genetics deliver complete care in 13 clinics. In 2017, U.S. News & World Report ranked Texas Children’s Hospital fourth in the nation for pediatric neurology and neurosurgery.
Neuroscience team members are also active participants and consultants in the hospital’s Level 1 Trauma Center and in research efforts at the Jan and Dan Duncan Neurological Research Institute (NRI) at Texas Children’s Hospital. The
neurological diseases.
PIONEERS IN PEDIATRIC NEUROSURGICAL CARE
In 1975, Dr. William R. Cheek established a full-time pediatric Neurosurgery Division at Texas Children’s Hospital, and
Baylor College of Medicine. A graduate of Baylor College of Medicine, Dr. Cheek completed his neurosurgical residency
as president of the American Society of Pediatric Neurosurgeons and chair of the AANS/CNS Section on Pediatric Neurological Surgery. Dr. Cheek recruited pediatric neurosurgeons Dr. Jack Laurent in 1980 and Dr. Robert Dauser in
of the top pediatric neurosurgery programs in the nation, pioneering breakthrough surgical treatments for epilepsy,
of Neurosurgery.
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V O L U M E S & O U T C O M E S
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Our program is among the largest and most experienced pediatric neurosurgery units in the United States. Despite being a national and international referral center for many of the most
neurosurgery, our outcomes consistently defy expectations and offer new hope for conditions previously considered untreatable.
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OUTPATIENT VISITS
SURGICAL CASES BY DIAGNOSIS
CASES, ADMISSIONS AND CONSULTATIONS by year
Year Hospital Admissions Hospital Consultations Surgical Cases
2015 1,192 1,082 906
2016 1,154 1,121 890
2017 1,126 1,008 1,001
7,000
7,100
7,200
7,300
7,400
7,500
7,600
7,700
7,800
7,900
8,000
2015 2016 2017
Hydrocephalus
EpilepsyCraniosynostosis
TumorCongenital Malformations
Functional Neurosurgery
VascularTraumaSpine (Non-Traumatic)
ChiariInfection/Inflammation
Minor Scalp & Skull Lesions
PainO
ther
Hydrocephalus
EpilepsyCraniosynostosis
TumorCongenital Malformations
Functional Neurosurgery
VascularTraumaSpine (Non-Traumatic)
ChiariInfection/Inflammation
Minor Scalp & Skull Lesions
PainO
ther
Hydrocephalus
EpilepsyCraniosynostosis
TumorCongenital Malformations
Functional Neurosurgery
VascularTraumaSpine (Non-Traumatic)
ChiariInfection/Inflammation
Minor Scalp & Skull Lesions
PainO
ther
323
101
63 67
20
5538
24 28 26
3 5
52
101
285
112
5140
5538
2813 16
3 3
70 70
106
364
145
49
2442
922 22 24
4 4
83
119
400
300
200
100
0
2015 2016 2017
90
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11.3%
10.17%
3.95%
3.95%
3.39%
1.69%
1.69%
0.56%
Shunt Failure
CSF Leak
Post-Operative Infection
Shunt Infection
ETV Failure
Post-Operative Hemorrhage
Residual Brain Tumor
Other
Baclofen Pump Revision
Post-Operative Raised ICP
EVD Failure
0% 10% 20% 30% 40%
37.29%
18.08%
7.91%
BREAKDOWN OF INDICATIONS FOR UNPLANNED RETURN TO THE OPERATING ROOMwithin 30 days of initial surgery
MORTALITY RATEwithin 30 days of initial surgery
Year Overall Cranial Procedure
Spine Procedure
CSF Shunting/ Diversion Procedure
Peripheral Nerve
Procedure
Other Procedure
2015 1.22% (11/905) 2.27% (7/308) 0% (0/113) 0.31% (1/322) 0% (0/7) 1.94% (3/155)
2016 0.9% (8/889) 0.96% (3/314) 0.76% (1/131) 1.4% (4/286) 0% (0/4) 3.25% (5/154)
2017 0.7% (7/997) 0.29% (1/346) 0% (0/108) 1.37% (5/365) 0% (0/1) 0.56% (1/177)
UNPLANNED RETURN TO THE OPERATING ROOM within 30 days of initial surgery
Year Rate
2015 6.28% (57/906)
2016 6.29% (56/890)
2017 6.39% (64/1001)
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P R O G R A M S
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The pediatric neurosurgeons at Texas Children’s Hospital are committed to setting a new standard for the surgical treatment of infants and children with neurological disease and to pioneering innovative therapies for children with life-threatening and severely debilitating conditions. Our expertise continues to grow in the following robust programs and subspecialties.
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CONGENITAL MALFORMATIONS / FETAL SURGERYThe Neurosurgery Division at Texas Children’s Hospital treats all forms of congenital malformations of the brain and spine. Many of our patients are diagnosed prenatally and seen by the Neurosurgery team at Texas Children’s Fetal Center® before they are even born to discuss the abnormality and possible treatment options. Most malformations are treated postnatally and many do not need surgery at all. In 2011, a randomized control trial was conducted in the United States that showed that closure of an open neural tube defect, myelomeningocele (MMC),
Texas Children’s Fetal Center started offering this treatment option in November 2011. It has been shown to decrease the risk of hydrocephalus
extremity strength over the course of the
pregnancy, however, the surgery requires opening the uterus during the second trimester, which increases the chance of prematurity and complications.
Seeking a less-invasive alternative to open fetal surgery, Texas Children’s OB/GYN-in-Chief Dr. Michael Belfort and Texas Children’s neurosurgeon Dr. William Whitehead pioneered a fetoscopic procedure that offers the same
risk of prematurity and complications. In a recently
and Whitehead reported zero deaths, fewer fetuses needing shunts after birth, and longer pregnancies, on average, compared to the open procedure. Many of the mothers were able to have vaginal deliveries, an option that is not typically not possible following open fetal surgery.
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22
36
26
0
10
20
30
40
2015 2016 2017
Volu
me
Postnatal Closures Fetal Closures
VOLUME OF PATIENTS SURGICALLY TREATED FOR MYELOMENINGOCELEby year
PERCENTAGE OF MYELOMENINGOCELE PATIENTS WHO REQUIRE TREATMENT FOR HYDROCEPHALUSfrom 2015-2017
70%
22.92%
0%
20%
40%
60%
80%
100%
Postnatal Repair Fetal Repair
Perc
enta
ge
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CRANIOFACIAL
CRANIOSYNOSTOSISThe multidisciplinary craniofacial surgery program at Texas Children’s Hospital provides specialized care for skull and facial abnormalities, offering a comprehensive approach that is centered on the needs of patients and families. Conditions treated include positional plagiocephaly, craniosynostosis and other craniofacial syndromes. Our highly active clinic screens over 1,000 abnormal head shapes in babies every year, most often helping to distinguish between positional plagiocephaly and craniosynostosis.
Positional plagiocephaly, an asymmetric head shape without a fused suture, is addressed by nonsurgical therapy such as repositioning, physical therapy or helmet therapy. Craniosynostosis is a congenital premature fusion (closure) of one or more sutures on a baby’s skull that is usually addressed by surgery. Sutures are seams that connect individual skull bones and when patent as expected (open and not fused), allow the skull to expand when the brain is growing rapidly in infancy. When a suture has closed too early, the skull cannot expand in a uniform fashion, which leads to an abnormal head shape. In some cases, this may lead to increased pressure on the brain (elevated intracranial pressure), which can produce signs and symptoms such as headache, irritability, visual changes and developmental delay. Elevated intracranial pressure occurs around 10 percent of the time when a single suture is affected and up to half the time when more than one suture has fused early.
Our surgical team works together to perform the safest procedure with the best results at the right time for each patient. We tailor treatments to each patient and family to provide the most positive experience possible. Types of surgeries offered include endoscopic craniosynostosis surgery, calvarial vault remodeling, frontal orbital advancement, posterior vault distraction and Monobloc advancement.
We stay engaged with patient families throughout the year, not just when medical needs arise, with an active support group and a Family Advisory Board to help us continually improve the program.
FrontalBone
AnteriorFontanelle
ParietalBone
MetopicSynostotic
Trigonocephaly
SagittalSynostotic
Scaphocephaly
LambdoidSynostotic Posterior
Plagiocephaly
BicoronalSynostotic
Brachycephaly
UnicoronalSynostotic Anterior
Plagiocephaly
(All Sutures Open)Deformational Posterior
Plagiocephaly
PosteriorFontanelle
Metopic (Frontal)Suture
CoronalSuture
SagittalSuture
LamboldSuture
OccipitalBone
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AVERAGE LENGTH OF STAYby procedure type
VOLUME OF CRANIOFACIAL SURGICAL CASES by procedure type
12 14
10
46
29 30
11
15
0
10
20
30
40
50
2015 2016 2017
Volu
me
Endoscopic Open Craniosynostosis/Craniofacial Reconstruction Cranioplasty/Skull Reconstruction
18
2
5.8 6.02
8
6
4
2
0Endoscopic Open Craniosynostosis/
Craniofacial Reconstruction Cranioplasty/
Skull Reconstruction
Day
s
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UNPLANNED RETURN TO THE OPERATING ROOM within 30 days of initial surgery
MORTALITY RATEwithin 30 days of initial surgery
Procedure Rate
Endoscopic 2.78%
Open Craniosynostosis/ Craniofacial Reconstruction 0%
Cranioplasty/Skull Reconstruction 2.27%
Procedure Rate
Endoscopic 0%
Open Craniosynostosis/ Craniofacial Reconstruction 0%
Cranioplasty/Skull Reconstruction 0%
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EPILEPSYOur goal is to become the best pediatric epilepsy program for our patients, and thanks to a concerted multidisciplinary focus and several
The core foundation of our program is our team. We have assembled an outstanding faculty of recognized leaders in both pediatric neurology
Children’s from all over the United States and
other top-ranked pediatric hospitals directly refer their patients to us for epilepsy surgery
positioned to offer this care. We have all of the state-of-the-art imaging modalities (MEG, PET, SPECT, fMRI and TMS) under one roof for comprehensive and convenient pre-surgical
traditional brain surgery and minimally invasive epilepsy surgery. Our faculty members are invited as featured speakers at medical conferences
has dramatically increased. Epilepsy surgical case
VOLUME OF SURGICAL PROCEDURESby year
9
24 21
42
14
26 24
39
30
39
23
40
0
9
18
27
36
45
Invasive Monitoring Laser Ablation Resection Stimulation (VNS/RNS)
Volu
me
2015 2016 2017
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VAGUS NERVE STIMULATION (VNS) INFECTION RATE by year
Year Rate
2015 0%
2016 0%
2017 0%
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FUNCTIONAL NEUROSURGERY
multidisciplinary team of expert specialists in neurology, neurosurgery and physical medicine
a variety of functional neurologic conditions, including movement disorders such as spasticity and dystonia, and pain. A number of cutting-edge surgical interventions are available, including deep brain stimulation (DBS), intrathecal pump therapy, selective dorsal rhizotomy, spinal cord
stimulation, vagal nerve stimulation, peripheral nerve stimulation, transcranial magnetic stimulation (TMS) and neuro-ablative procedures. Patients are seen
team collectively determines the optimal treatment for that individual child. The Neurosurgery Division
functional neurosurgical interventions.
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BACLOFEN PUMP INFECTION RATEby year
VOLUME OF PATIENTS SURGICALLY TREATED FOR SPASTICITY by year
36 37
63
0
14
28
42
56
70
2015 2016 2017
Volu
me
2.38% 2.33% 2.08%
0%
2%
4%
6%
8%
10%
2015 2016 2017
Rat
e
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HYDROCEPHALUSThe most common disease treated by pediatric neurosurgeons is hydrocephalus. All members of the Neurosurgery Division are skilled at the diagnosis and treatment of hydrocephalus. We offer all available treatment options for this condition
The division also conducts extensive clinical
We actively participate in the Hydrocephalus
rate, improve our shunt survival rate and create better selection criteria for endoscopic ventriculostomy.
VOLUME OF INITIAL PROCEDURES FOR TREATMENT OF HYDROCEPHALUS by year
33
60
54
20 19 22
0
20
40
60
80
2015 2016 2017
Volu
me
First Endoscopic Third Ventriculostomy/Choroid Plexus Cauterization (ETV/CPC)
First Endoscopic Third Ventriculostomy (ETV)
First-Time Ventricular Shunts
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SHUNT INFECTION RATEby year
3.28% 3.17%
5.81%
0%
2%
4%
6%
8%
10%
2015 2016 2017
Rat
e
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FIRST-TIME VENTRICULOPERITONEAL (VP) SHUNT SURVIVAL
PERCENTAGE OF SHUNTS FUNCTIONING AT ONE YEAR AFTER PLACEMENTby year
2013 2014 2015 2016
71.7% 84.3% 67.3% 83.6%
PERCENTAGE OF ETV FUNCTIONING AT ONE YEARby years
2012-2016
39.6%
FIRST-TIME ETV/CPC SURVIVAL
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5Years
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5Years
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VOLUME OF SKULL BASE SURGERIESby year
SKULL BASE SURGERYSkull base tumors are rare in the pediatric population, but need to be addressed. These types of tumors require accurate diagnosis, detailed pre-operative planning and multidisciplinary care. Started in 2007, our skull base program includes a team of otolaryngologists, plastic surgeons, ophthalmologists, neuroradiologists, neuropathologists and oncologists. As these
discussed by the entire physician team and surgical plans are meticulously made in advance. We offer both open and minimally invasive techniques, depending on the pathology. Texas Children’s Hospital typically cares for 5-10 skull base tumor patients annually and our outcomes are tracked on a regular basis.
9
5
9
0
1
2
3
4
5
6
7
8
9
10
2015 2016 2017
Volu
me
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NUMBER OF CEREBROSPINAL FLUID (CSF) LEAKS AFTER SKULL BASE SURGERY by year
MORTALITY RATEwithin 30 days of initial surgery
Year Rate
2015 0%
2016 0%
2017 0%
Year Number
2015 0/9
2016 0/5
2017 2/9
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TRAUMA
accredited Level I Trauma Centers for pediatric patients in the country, Texas Children’s Hospital is committed to the prevention, treatment and
We care for all aspects of traumatic brain
includes pediatric surgeons, critical care specialists,
orthopedic surgeons, otolaryngologists and physical medicine and rehabilitation specialists. We see over 500 trauma patients each year and approximately 10% require surgical intervention. Should a patient require rehabilitation for
Hospital has one of the only pediatric inpatient
providing a variety of intensive treatment options including cognitive testing, physical therapy, occupational therapy and speech therapy.
VOLUME OF TRAUMA CONSULTS AND SURGICAL CASES by year
516 509 484
55 55
0
70
140
210
280
350
420
490
560
2015 2016 2017
Volu
me
Inpatients Seen by Neurosurgery Surgical Cases
42
N E U R O S U R G E R Y O U T C O M E S 2 0 1 730
TUMOR
VOLUME OF SPINE AND BRAIN TUMORSby year
We offer comprehensive, multidisciplinary care for children with tumors of the central nervous system, in conjunction with our colleagues in pediatric neuro-oncology, neurology, ophthalmology, physical medicine and rehabilitation, endocrinology, radiology, pathology and pediatrics.
With a surgical volume exceeding 100 brain and spinal tumors annually, we are one of the busiest pediatric neurosurgical oncology programs in the United States. We utilize state-of-the-art surgical technology, including frameless stereotactic image guidance, microsurgery, brain mapping, intra-operative MRI imaging, robotic assisted surgery and awake craniotomy to care for our
many patients who may have posterior fossa, pineal region, suprasellar, hemispheric, intraventricular and deep-seated brain tumors.
Texas Children’s Cancer Center® is ranked fourth in the nation by U.S. News & World Report for pediatric cancer and Texas Children’s Hospital is a member of several collaborative consortia, including the Pediatric Brain Tumor Consortium (PBTC), which allows us to offer our patients the very latest novel therapeutic options. This overall effort is also enhanced by several ongoing basic science brain tumor research projects underway at Baylor College of Medicine.
68 62
13
0
20
40
60
80
2015 2016 2017
Volu
me
of p
atie
nts
Recurrence - Spine Tumor New Diagnosis - Spine Tumor Recurrence - Brain Tumor New Diagnosis - Brain Tumor
17
78
18
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RATE AT WHICH PATIENTS REQUIRE TREATMENT FOR HYDROCEPHALUS FOLLOWING POSTERIOR FOSSA TUMOR RESECTIONby year
17.65%
28.57%
36.67%
0%
25%
50%
75%
100%
2015 2016 2017
Rat
e
MORTALITY RATEwithin 30 days of initial surgery
Year Rate
2015 1.04%
2016 0%
2017 0%
N E U R O S U R G E R Y O U T C O M E S 2 0 1 732
VASCULAR
VOLUME OF ENDOVASCULAR AND OPEN PROCEDURESby year
Neurovascular or cerebrovascular disease refers to conditions affecting blood vessels in and around the brain and the spine. While neurovascular disease affects people of all ages, children often have a different biology than adults. For instance, these diseases can be related to genetic factors and can
disease face the risk of either bleeding in the brain (hemorrhagic stroke) or the risk of stroke from not enough blood supply to the brain (ischemic stroke). Both types of stroke can be life-threatening, and can also cause serious damage to the brain. Our goal is to diagnose and treat children before they are affected by such dangerous events. Conditions
moyamoya, cerebral cavernous malformation,
and vein of Galen malformations.
The Neurosurgery Division is part of a multidisciplinary vascular anomalies clinic at
Texas Children’s Hospital, alongside specialists in neurology, neuroradiology, neurocritical care, genetics, hematology/oncology, physical medicine and rehabilitation, ophthalmology and more. We continue
the treatment of neurovascular anomalies, and our patients have access to the latest diagnostic and treatment technologies and investigational studies. Each patient has an individualized treatment plan endorsed by the multidisciplinary team, and our goal
Open neurosurgery, endovascular interventions or medical therapies are options for addressing pediatric neurovascular or cerebrovascular conditions. We evaluate, diagnose and treat each
approaches, choosing from various neurosurgical, neurointerventional and medical therapies and often combining these modalities to achieve the safest and most effective results.
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2015 2016 2017
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All data is represented by academic year which runs from July 1- June 30, unless otherwise noted.
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P A T I E N T S T O R I E S
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LUKE STEMLE
complex (TSC), a rare disease that
on the brain and other vital organs.
home in Kentucky. Unfortunately the seizures returned after 10 days, landing him in critical condition in the ICU. With medication and time, his seizures became more manageable, but he still
limited his independence and quality of
skull to grant access to the brain and is therefore
serious and life-threatening conditions.
Pioneered by Texas Children’s neurosurgeon Dr. Daniel Curry, this laser ablation technique requires a hole only the size of a pen and uses an MRI-guided laser to destroy the tubers causing the seizures. The surgery has had tremendously positive
In fall of 2016, Luke and his family came to Texas
to ensure that all of the affected areas of his brain
moved to tears. In addition to his seizure activity,
abnormality in 45 minutes,” said Luke’s mother, Stephanie. “The surgery has done much more than stop Luke’s seizures, it has given Luke peace
relationships uninterrupted. It is a sigh of relief and gratitude after years of holding our breath in fear and chaos.”
Luke has not had a single seizure since leaving Texas Children’s more than a year ago, and his doctors and
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EVERETT KERRES
At an 18-week ultrasound, Johnna and Adam Kerres were devastated to
The Kerres immediately put their nesting and baby shower plans on hold while they learned everything
®
developed a less invasive fetal surgery option with tremendous promise to
At 24 weeks gestation, Belfort and Whitehead
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MATTHEW BOLER
have abnormally shaped heads due to
through the birth canal. For that reason, Megan and Michael Boler
Bolers immediately to Texas Children’s
craniosynostosis, a rare and serious birth defect that causes the skull bones to fuse together too early.
When a baby’s skull closes prematurely, the brain at
in an unsual shape. Eventually, the baby’s brain has no
problems and even death in extreme cases.
before any long-term damage could occur,” said Dr. Sandi Lam, director of the cerebrovascular neurosurgery program at Texas Children’s Hospital.
bone at the top of his skull.
eventually on the third day, he perked up, started breastfeeding again and returned to his usual cheerful self.”
shaped head.
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FA C U LT Y & P U B L I C AT I O N S
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FACULTY & STAFF DIRECTORYHoward L. Weiner, M.D., F.A.C.S., F.A.A.P., Chief Guillermo M. Aldave, M.D., Ph.D.Brandy Berger, M.S.N., R.N., C.P.N.P.-P.C. Natalie Cormier, M.S.N., R.N., F.N.P.-B.C. Daniel J. Curry, M.D. Robert C. Dauser, M.D. Brian J. Kelley, M.D., Ph.D.
Heidi Kerns, M.S.N., R.N., F.N.P.-B.C. Sandi K. Lam, M.D., M.B.A. Amee Moreno, M.S.N., R.N., C.P.N.P.-P.C. I-Wen Pan, Ph.D. Brenda Perry, C.P.N.P.-P.C. Lucia Ruggieri, P.A.-C. William E. Whitehead, M.D., M.P.H.
Howard L. Weiner, M.D., F.A.C.S., F.A.A.P.Chief of Neurosurgery, Texas Children’s HospitalProfessor and Vice Chairman, Department of Neurosurgery, Baylor College of MedicineDr. Weiner has become one of the country’s leading pediatric epilepsy surgeons, attracting patients from across the United States and abroad because of his innovative approach. Over the last 20 years, he has become a recognized national and international leader in the surgical treatment of childhood epilepsy, and has been a pioneer in advancing the care of children with tuberous sclerosis complex, for which he is considered one of the world’s leading experts. His expertise also includes the operative treatment of childhood brain tumors, spasticity, hydrocephalus, congenital
Guillermo M. Aldave, M.D., Ph.D. Assistant Professor, Pediatric Neurosurgery, Baylor College of MedicineDr. Aldave’s clinical interests include maximizing the safe treatment of pediatric brain tumors and improving patients’ clinical outcomes and quality of life. His research interests include the use of oncolytic virus in the treatment of high grade pediatric brain tumors and the development new and unique strategies of treatment for tumor patients,
Daniel J. Curry, M.D.Associate Professor, Pediatric Neurosurgery, Baylor College of MedicineDr. Curry’s clinical interests include minimally invasive treatment in epilepsy surgery, treatment of pediatric movement disorders and chronic pain. His research interests include study of the mechanisms of dystonia and non-invasive detection of epilepsy networks.
Robert C. Dauser, M.D.Associate Professor, Pediatric Neurosurgery, Baylor College of MedicineDr. Dauser’s clinical interests include the diagnosis and treatment of moyamoya, hydrocephalus, brain tumors and craniofacial abnormalities. His research interests include spinal cord regeneration, optic nerve regeneration, as well as moyamoya.
NEUROSURGEONS
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SELECTED PUBLICATIONSAldave G, Hansen D, Hwang S, Moreno A, Briceno V, Jea A “Spinal Column Shortening for Tethered Cord Syndrome Associated with Myelomeningocele, Lumbosacral Lipoma, and Lipomyelomeningocele in Children and Young Adults. J Neurosurg Pediatr June. 2016.
Aldave G, Hansen D, Luerssen T, Jea A. Assessing Resident Operative Skills for Shunt Surgery in Pediatric Neurosurgery. J Neurosurg Pediatr April. 2016. Boerwinkle VL, Vedantam A, Lam S, Wilfong AA, Curry DJ. Connectivity Changes after laser ablation: Resting-state fMRI. Epilepsy Res 2017 Sep 28.pii:S0920-1211(17)3035-0. doi:10.1016/j.eplepsyres.2017 09.015.
Boom M, Raskin JS, Curry DJ, Weiner HL, Peters JM. Technological advances in pediatric epilepsy surgery: implications for tuberous sclerosis complex. Future Neurol 12:101-115, 2017.
Brian J. Kelley, M.D., Ph.D.Assistant Professor, Pediatric Neurosurgery, Baylor College of MedicineDr. Kelley’s clinical interests include complex spinal deformity and scoliosis in collaboration with the Orthopedic Surgery program, congenital spinal dysraphism, cranio-cervical junction instability (traumatic and congenital), traumatic brain and spinal cord injuries, spondylolysis/spondylolisthesis, Chiari malformation, tethered cord syndrome and spinal tumors. His research interests include neurotrauma (basic science and clinical), including therapeutic treatment modalities and advanced neuroimaging techniques.
Sandi K. Lam, M.D., M.B.A.Associate Professor, Pediatric Neurosurgery, Baylor College of MedicineDr. Lam’s clinical interests include pediatric cerebrovascular surgery, epilepsy surgery and craniofacial surgery. In particular, Dr. Lam applies minimally invasive surgery through endoscopic approaches for epilepsy and craniosynostosis. Quality improvement is incorporated into her clinical practice. Dr. Lam’s areas of research include health services research for pediatric neurosurgery and the analysis of national and institutional data to look at patterns of care, health care utilization and health outcomes to understand disparities and to develop models for improving health care delivery.
William E. Whitehead, M.D., M.P.H.Associate Professor, Pediatric Neurosurgery, Baylor College of MedicineDr. Whitehead’s primary clinical interests relate to the treatment of hydrocephalus,
nervous system, brain and spine tumors, vascular malformations and skull base diseases. His research focuses on hydrocephalus and fetal myelomeningocele repair. He also has a major grant from PCORI (Patient Centered Outcomes Research Institute), which focuses on the surgical treatment of hydrocephalus.
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Cherian J, Belfort MA, Shamshirsaz AA, Espinoza J, Olutoye OA, Cass DL, Olutoye OO, Whitehead WE. Two-Port Endoscopic Fetal Closure of Myelomeningocele. Videoscopy 2017, DOI: 10.1089/vor.2017.0452.
Hidalgo ET, Orillac C, Hersh A, Harter DH, Rizzo WB, Weiner HL. Intrathecal baclofen therapy for the treatment of spasticity in Sjogren-Larsson Syndrome. J Child Neurol 32:100-103, 2017.
Kelley BJ and MG Vitale. Early Onset Scoliosis and Congenital Spinal Anomalies, In: Orthopedic Knowledge Update – Series 5; Ed. E. Truumees and H. Prather; AAOS 2017.
Kelley BJ, Minkara AJ, Angevine PD, Vitale MG, Lenke LG, Anderson R CE. Temporary Occipital Fixation in Young Children with Severe Cervical-Thoracic Spinal Deformity. Neurosurg Focus (accepted).
Lopresti M, Daniels B, Buchanan E, Monson LA, Lam S. Virtual surgical planning and 3D printing in redo calvarial vault reconstruction. J Neurosurg Pediatr 19(4):490-494. Apr 2017.
North RY, Raskin JS, Curry DJ. MRI-Guided Laser Interstitial Thermal Therapy for Epilepsy. Neurosurg Clin N Am 2017 Oct;28(4):545-557. doi 10.1016/j.nec 2017.06.001.
Raskin JS, Hansen D, Mohan AC, Pan IW, Curry DJ, Lam S. Perioperative antibiotic use in vagus nerve stimulator implantation – a clinical series. Childs Nerv Syst 33(5):801-804. May 2017.
Sato M, Gunther JR, Mahajan A, Jo E, Paulino AC, Adesena AM, Jones JY, Ketonen LM, Su JM, Okcu MF, Khatua S, Dauser RC, Whitehead WE, Weinberg J, Chintagumpala MM. Progression-free survival of children with localized ependymoma treated with intensity-modulated radiation therapy or proton beam radiation. Cancer 123(13): 2570-2578, 2017.
Wallace S, Guo DC, Regalado E, Mellor-Crummey L, Bamshad M, Nickerson DA, Dauser R, Hanchard N, Marom R, Martin E, Berka V, Sharina I, Ganesan V, Saunders D, Morris SA, Milewicz DM. Disrupted nitric oxide signaling due to GUCY1A3 mutations increases risk for moyamoya disease, achalasia, and hypertension. Clin Genet 90(4): 351-60, 2016.
Wellons JC, Shannon CN, Holubkov R, Riva-Cambrin J, Kulkarni AV, Whitehead WE, Browd S, Rozzelle C, Simon TD, Tamber MS, Oakes WJ, Drake J, Luerssen TG, Kestle J for the Hydrocephalus Clinical Research Network. Shunting Outcomes in Posthemorrhagic hydrocephalus: results of a HCRN prospective Cohort Study. J Neurosurg Pediatr 2017 Jul; 20(1): 19-29.
CONTACT USTo refer a patient to Texas Children’s Neurosurgery program, please visit texaschildrens.org/refer or contact us directly.
Clinic Location Mailing Address Phone6701 Fannin St., 9th Floor 6701 Fannin St., Suite 1230.01 832-822-3950Houston, TX 77030 Houston, TX 77030
For additional information about the Neurosurgery Division, visit texaschildrens.org/neurosurgery.
texaschildrens.org/neurosurgery© 2018 Texas Children’s Hospital. All rights reserved. Neuro115