NEUROSURGERY OUTCOMES 2017
NEUROSURGERY OUTCOMES 2017 1
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 2 NEUROSURGERY OUTCOMES 2017
WELCOME
Dear colleagues, parents and friends,
It is my true privilege to introduce you to the Neurosurgery Division at Texas Children’s Hospital®.
/RFDWHGLQ+RXVWRQ7H[DVDQGDFDGHPLFDOO\DIÀOLDWHGZLWK%D\ORU&ROOHJHRI0HGLFLQH 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 FRQVLGHULQJLWVIRXQGLQJRQO\LQ :HDUHRQHRIÀYHKRVSLWDOVLWHVWKDWFRPSULVHWKH 1HXURORJLFDO6XUJHU\5HVLGHQF\SURJUDPDW%D\ORU&ROOHJHRI0HGLFLQHXQGHU'U'DQLHO ,DUULYHGLQ+RXVWRQLQ0D\DIWHUQHDUO\\HDUVZRUNLQJDWDVLQJOHLQVWLWXWLRQLQ1HZ We are extremely excited about the next phase of neurosurgery at Texas Children’s. Our collective vision is to be the SULPDU\GHVWLQDWLRQIRULQQRYDWLYHKLJKTXDOLW\DWWHQWLYHZRUOGFODVVQHXURVXUJLFDOFDUHIRUFKLOGUHQWRWUDLQWKHIXWXUH OHDGHUVRIRXUVSHFLDOW\DQGWRLQYHVWLJDWHWKHFRQGLWLRQVIRUZKLFKZHKDYHXQLTXHDFFHVVDQGLQVLJKW*LYHQWKHULFK FOLQLFDOH[SHULHQFHIRUWUDLQHHVZLWKDSSUR[LPDWHO\RSHUDWLRQVSHUIRUPHGDQQXDOO\ZHKDYHDKLJKO\VRXJKWDIWHU $&31)DFFUHGLWHGRQH\HDUSRVWUHVLGHQF\IHOORZVKLSLQSHGLDWULFQHXURVXUJHU\2XUHOHYHQIHOORZVKLSJUDGXDWHVKROG prestigious academic positions in neurosurgery departments across the country. :HDUHGHOLJKWHGWRVKDUHRXUUHFHQWH[SHULHQFHVDQGRXWFRPHVZLWK\RXLQWKLVRYHUYLHZRIRXUSURJUDP:HORRN IRUZDUGWRFRQWLQXLQJWRVHUYH\RXDQGZRUNZLWK\RXLQWKH\HDUVWRFRPH 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 Hospital Professor and Vice Chairman, Department of Neurosurgery, Baylor College of Medicine NEUROSURGERY OUTCOMES 2017 3 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. 4 NEUROSURGERY OUTCOMES 2017 TEXAS CHILDREN’S HOSPITAL Texas Children’s Hospital® is one of the nation’s largest and most comprehensive With a staff of more than specialty pediatric hospitals, with more than 2.4 million patient encounters in 2017. 13,500 employees and Texas Children’s mission is to create a healthier future for children and women more than 2,000 board- throughout our global community by leading in patient care, education and FHUWLÀHGSK\VLFLDQVSHGLDWULF research. Renowned worldwide for its expertise and breakthrough developments subspecialists, pediatric in clinical care and research, Texas Children’s Hospital is ranked #4 nationally by U.S. News & World Report. surgical subspecialists and dentists, Texas Children’s Texas Children’s Hospital is located near downtown Houston in the Texas offers more than 40 Medical Center, the largest medical center in the world. The medical center subspecialties, programs campus includes more than 600 licensed beds; the Wallace Tower for outpatient and services. Physicians are visits; the Feigin Tower for pediatric research; and Texas Children’s Pavilion for employees of Baylor College Women for comprehensive OB/GYN care. Located nearby is the Jan and Dan ® of Medicine, not Texas Duncan Neurological Research Institute at Texas Children’s Hospital, a basic Children’s Hospital. Because research institute dedicated to solving childhood neurological diseases. In 2018, the new Legacy Tower will be completed to increase capacity for critical and they practice at Texas surgical care. Children’s Hospital, they may be referred to as “our Texas Children’s Hospital® West Campus and Texas Children’s Hospital® The team” or “Texas Children’s Woodlands bring specialty pediatric care, including acute and critical care beds, physicians” throughout 24/7 pediatric emergency centers, surgical suites and more than 20 subspecialty this report. 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 ÀUVW+02IRUFKLOGUHQDQG7H[DV&KLOGUHQ·V® 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 7H[DV&KLOGUHQ·V+RVSLWDOLVDIÀOLDWHGZLWK%D\ORU&ROOHJHRI0HGLFLQH® 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 WRSÀYHVXFKSDUWQHUVKLSVIRUSHGLDWULFUHVHDUFKIXQGLQJIURPWKH1DWLRQDO Institutes of Health. NEUROSURGERY OUTCOMES 2017 5 TEXAS CHILDREN’S NEUROSCIENCE CENTER 7H[DV&KLOGUHQ·V1HXURVFLHQFH&HQWHULVPDGHXSRIWKUHHUHQRZQHGDQGLQWHJUDWHG 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 UDUHGLVRUGHUVOLNHOLVVHQFHSKDO\DQG5HWWV\QGURPH%\FRPELQLQJFOLQLFDOFDUHZLWK HDV\DFFHVVWRVXUJHU\ZHDUHDEOHWRVWUHDPOLQHWUHDWPHQWIRUSDWLHQWVDQGWKHLU 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 ZRUOG·VÀUVWEDVLFUHVHDUFKLQVWLWXWHGHGLFDWHGWRFKLOGKRRGQHXURORJLFDOGLVHDVHVWKH15,LVFRPPLWWHGWRSURYLGLQJ VFLHQWLVWVZLWKDZRUOGFODVVWHFKQRORJ\LQIUDVWUXFWXUHFDUHIXOO\GHVLJQHGWRIRVWHUFROODERUDWLRQDPRQJEDVLFIDFXOW\ DQGFOLQLFLDQVFLHQWLVWVZLWKWKHJRDORIDFFHOHUDWLQJWKHSDFHRIGLVFRYHULHVDQGGHYHORSLQJWUHDWPHQWVIRUFKLOGKRRG 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 ZDVWKHÀUVWFKLHIRIVHUYLFH$WWKDWWLPH'U&KHHNZDVDOVRWKHDFWLQJKHDGRIWKH'LYLVLRQRI1HXURORJLFDO6XUJHU\DW Baylor College of Medicine. A graduate of Baylor College of Medicine, Dr. Cheek completed his neurosurgical residency WUDLQLQJDWWKH&ROXPELD8QLYHUVLW\1HXURORJLFDO,QVWLWXWHLQ +HZDVDGLVWLQJXLVKHGOHDGHULQWKHÀHOGVHUYLQJ 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 WR+RXVWRQ'U/DXUHQWVHUYHGDVFKLHIRI1HXURVXUJHU\IURP WR,Q'U7KRPDV/XHUVVHQZDV QDPHGFKLHIRIVHUYLFHZKHUHKHUHPDLQHGIRUDGHFDGH8QGHUKLVOHDGHUVKLS7H[DV&KLOGUHQ·V+RVSLWDOJUHZLQWRRQH of the top pediatric neurosurgery programs in the nation, pioneering breakthrough surgical treatments for epilepsy, VSLQDELÀGDDQGPXFKPRUH'U+RZDUG:HLQHUZDVUHFUXLWHGLQIURP1<8/DQJRQH0HGLFDO&HQWHUDVFKLHI of Neurosurgery. 6 NEUROSURGERY OUTCOMES 2017 VOLUMES & OUTCOMES NEUROSURGERY OUTCOMES 2017 7 8 NEUROSURGERY OUTCOMES 2017 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 FRPSOH[DQGGLIÀFXOWWRWUHDWFDVHVLQSHGLDWULF neurosurgery, our outcomes consistently defy expectations and offer new hope for conditions previously considered untreatable. NEUROSURGERY OUTCOMES 2017 9 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 OUTPATIENT VISITS 8,000 7,900 7,800 7,700 7,600 7,500 7,400 7,300 7,200 7,100 7,000 2015 2016 2017 SURGICAL CASES BY DIAGNOSIS 2015 2016 2017 400 364 323 300 285 200 145 112 119 101 101 106 100 83 90 63 67 70 70 52 55 51 55 49 38 40 38 42 24 28 26 28 24 22 22 24 20 13 16 3 5 33 9 44 0 HydrocephalusEpilepsyCraniosynostosisTumorCongenitalFunctional MalformationsVascular NeurosurgeryTraumaSpine Chiari(Non-Traumatic)Infection/InflammationMinorPain ScalpOther & Skull LesionsHydrocephalusEpilepsyCraniosynostosisTumorCongenitalFunctional MalformationsVascular NeurosurgeryTraumaSpine Chiari(Non-Traumatic)Infection/InflammationMinorPain ScalpOther & Skull LesionsHydrocephalusEpilepsyCraniosynostosisTumorCongenitalFunctional MalformationsVascular NeurosurgeryTraumaSpine Chiari(Non-Traumatic)Infection/InflammationMinorPain ScalpOther & Skull Lesions 10 NEUROSURGERY OUTCOMES 2017 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) BREAKDOWN OF INDICATIONS FOR UNPLANNED RETURN TO THE OPERATING ROOM within 30 days of initial surgery EVD Failure 0.56% Post-Operative Raised ICP 1.69% Baclofen Pump Revision 1.69% Other 3.39% Residual Brain Tumor 3.95% Post-Operative Hemorrhage 3.95% ETV Failure 7.91% Shunt Infection 10.17% Post-Operative Infection 11.3% CSF Leak 18.08% Shunt Failure 37.29% 0% 10% 20% 30% 40% MORTALITY RATE within 30 days of initial surgery CSF Peripheral Cranial Spine Shunting/ Other Year Overall Nerve Procedure Procedure Diversion Procedure Procedure 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) NEUROSURGERY OUTCOMES 2017 11 12 NEUROSURGERY OUTCOMES 2017 PROGRAMS NEUROSURGERY OUTCOMES 2017 13 14 NEUROSURGERY OUTCOMES 2017 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. NEUROSURGERY OUTCOMES 2017 15 CONGENITAL MALFORMATIONS / FETAL SURGERY The Neurosurgery Division at Texas Children’s pregnancy, however, the surgery requires opening Hospital treats all forms of congenital malformations the uterus during the second trimester, which of the brain and spine. Many of our patients are increases the chance of prematurity diagnosed prenatally and seen by the Neurosurgery and complications. team at Texas Children’s Fetal Center® before they are even born to discuss the abnormality and possible Seeking a less-invasive alternative to open fetal treatment options. Most malformations are treated surgery, Texas Children’s OB/GYN-in-Chief postnatally and many do not need surgery at all. Dr. Michael Belfort and Texas Children’s neurosurgeon Dr. William Whitehead pioneered In 2011, a randomized control trial was conducted a fetoscopic procedure that offers the same in the United States that showed that closure of an EHQHÀWVRILQXWHURVSLQDELÀGDUHSDLUZLWKOHVV open neural tube defect, myelomeningocele (MMC), risk of prematurity and complications. In a recently DW\SHRIVSLQDELÀGDFRXOGKDYHVLJQLÀFDQW SXEOLVKHGVWXG\RIWKHLUÀUVWSURFHGXUHV%HOIRUW EHQHÀWVWRWKHEDE\·VGHYHORSPHQWDIWHUELUWK and Whitehead reported zero deaths, fewer fetuses Texas Children’s Fetal Center started offering this needing shunts after birth, and longer pregnancies, treatment option in November 2011. It has been on average, compared to the open procedure. shown to decrease the risk of hydrocephalus Many of the mothers were able to have vaginal LQVSLQDELÀGDSDWLHQWVDQGLWSUHVHUYHVORZHU deliveries, an option that is not typically not extremity strength over the course of the possible following open fetal surgery. 16 NEUROSURGERY OUTCOMES 2017 VOLUME OF PATIENTS SURGICALLY TREATED FOR MYELOMENINGOCELE by year 40 36 30 26 22 20 Volume Volume 10 0 2015 2016 2017 Postnatal Closures Fetal Closures PERCENTAGE OF MYELOMENINGOCELE PATIENTS WHO REQUIRE TREATMENT FOR HYDROCEPHALUS from 2015-2017 100% 80% 70% 60% Percentage 40% 22.92% 20% 0% Postnatal Repair Fetal Repair NEUROSURGERY OUTCOMES 2017 17 CRANIOFACIAL The multidisciplinary craniofacial surgery program at CRANIOSYNOSTOSIS 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 Frontal Metopic (Frontal) plagiocephaly, craniosynostosis and other craniofacial Bone Suture syndromes. Our highly active clinic screens over 1,000 Anterior Coronal Fontanelle abnormal head shapes in babies every year, most often Suture Parietal helping to distinguish between positional plagiocephaly Sagittal Bone Suture and craniosynostosis. Posterior Lambold Fontanelle Suture Positional plagiocephaly, an asymmetric head shape Occipital without a fused suture, is addressed by nonsurgical Bone 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 Metopic Sagittal uniform fashion, which leads to an abnormal head shape. Synostotic Synostotic In some cases, this may lead to increased pressure on the Trigonocephaly Scaphocephaly 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. Lambdoid Bicoronal Our surgical team works together to perform the Synostotic Posterior Synostotic safest procedure with the best results at the right time Plagiocephaly Brachycephaly 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 Unicoronal (All Sutures Open) year, not just when medical needs arise, with an active Synostotic Anterior Deformational Posterior Plagiocephaly Plagiocephaly support group and a Family Advisory Board to help us continually improve the program. 18 NEUROSURGERY OUTCOMES 2017 VOLUME OF CRANIOFACIAL SURGICAL CASES by procedure type 50 46 40 29 30 30 Volume Volume 20 18 14 15 12 11 10 10 0 2015 2016 2017 Endoscopic Open Craniosynostosis/Craniofacial Reconstruction Cranioplasty/Skull Reconstruction AVERAGE LENGTH OF STAY by procedure type 8 6.02 5.8 6 4 Days 2 2 0 Endoscopic Open Craniosynostosis/ Cranioplasty/ Craniofacial Reconstruction Skull Reconstruction NEUROSURGERY OUTCOMES 2017 19 UNPLANNED RETURN TO THE OPERATING ROOM within 30 days of initial surgery Procedure Rate Endoscopic 2.78% Open Craniosynostosis/ 0% Craniofacial Reconstruction Cranioplasty/Skull Reconstruction 2.27% MORTALITY RATE within 30 days of initial surgery Procedure Rate Endoscopic 0% Open Craniosynostosis/ 0% Craniofacial Reconstruction Cranioplasty/Skull Reconstruction 0% 20 NEUROSURGERY OUTCOMES 2017 EPILEPSY Our goal is to become the best pediatric positioned to offer this care. We have all of epilepsy program for our patients, and thanks to the state-of-the-art imaging modalities (MEG, a concerted multidisciplinary focus and several PET, SPECT, fMRI and TMS) under one roof for PDMRULQQRYDWLRQVLQUHFHQW\HDUVZHDUHZHOORQ comprehensive and convenient pre-surgical RXUZD\WRZDUGVDFKLHYLQJWKLVJRDO ZRUNXSVDQGZHKDYHVXUJLFDOH[SHUWLVHLQERWK traditional brain surgery and minimally invasive The core foundation of our program is our team. epilepsy surgery. Our faculty members are invited We have assembled an outstanding faculty of as featured speakers at medical conferences recognized leaders in both pediatric neurology DURXQGWKHZRUOG DQGQHXURVXUJHU\ZKRDWWUDFWSDWLHQWVWR7H[DV Children’s from all over the United States and +DYLQJÀQLVKHGDVVHPEOLQJRXUHSLOHSV\WHDPLQ WKHZRUOGIRUHYDOXDWLRQDQGWUHDWPHQW6HYHUDO 0D\RIRXUFDSDFLW\WRWDNHRQQHZFDVHV other top-ranked pediatric hospitals directly has dramatically increased. Epilepsy surgical case refer their patients to us for epilepsy surgery YROXPHLQFUHDVHGEHWZHHQDQG RQDURXWLQHEDVLVEHFDXVHZHDUHXQLTXHO\ZHOO DQGLWLQFUHDVHGEHWZHHQDQG VOLUME OF SURGICAL PROCEDURES by year 45 42 39 39 40 36 30 26 27 24 24 23 21 Volume Volume 18 14 9 9 0 Invasive Monitoring Laser Ablation Resection Stimulation (VNS/RNS) 2015 2016 2017 NEUROSURGERY OUTCOMES 2017 21 VAGUS NERVE STIMULATION (VNS) INFECTION RATE by year Year Rate 2015 0% 2016 0% 2017 0% 22 NEUROSURGERY OUTCOMES 2017 FUNCTIONAL NEUROSURGERY $W7H[DV&KLOGUHQ·V+RVSLWDOZHKDYHD stimulation, vagal nerve stimulation, peripheral nerve multidisciplinary team of expert specialists in stimulation, transcranial magnetic stimulation (TMS) neurology, neurosurgery and physical medicine and neuro-ablative procedures. Patients are seen DQGUHKDELOLWDWLRQZKRFDUHIRUFKLOGUHQZLWK DQGHYDOXDWHGÀUVWDQGWKHQWKHLUFDVHLVGLVFXVVHG a variety of functional neurologic conditions, DWDPXOWLGLVFLSOLQDU\FRQIHUHQFHGXULQJZKLFKWKH including movement disorders such as spasticity team collectively determines the optimal treatment and dystonia, and pain. A number of cutting-edge for that individual child. The Neurosurgery Division surgical interventions are available, including LVPDMRUUHIHUUDOFHQWHUIRUFKLOGUHQLQQHHGRI deep brain stimulation (DBS), intrathecal pump functional neurosurgical interventions. therapy, selective dorsal rhizotomy, spinal cord NEUROSURGERY OUTCOMES 2017 23 VOLUME OF PATIENTS SURGICALLY TREATED FOR SPASTICITY by year 70 63 56 42 36 37 Volume Volume 28 14 0 2015 2016 2017 BACLOFEN PUMP INFECTION RATE by year 10% 8% 6% Rate 4% 2.38% 2.33% 2.08% 2% 0% 2015 2016 2017 24 NEUROSURGERY OUTCOMES 2017 HYDROCEPHALUS The most common disease treated by pediatric We actively participate in the Hydrocephalus neurosurgeons is hydrocephalus. All members $VVRFLDWLRQDQGZHDUHDPHPEHURIWKH of the Neurosurgery Division are skilled at the +\GURFHSKDOXV&OLQLFDO5HVHDUFK1HWZRUN2YHU diagnosis and treatment of hydrocephalus. We offer WKHODVWVHYHUDO\HDUVZHKDYHPDGHK\GURFHSKDOXV all available treatment options for this condition TXDOLW\LPSURYHPHQWVDSULRULW\DQGZHKDYH LQFOXGLQJHQGRVFRSLFYHQWULFXORVWRP\ZLWKRU ZRUNHGGLOLJHQWO\WRGHFUHDVHRXUVKXQWLQIHFWLRQ ZLWKRXWFKRURLGSOH[XVFRDJXODWLRQDQGVKXQWLQJ rate, improve our shunt survival rate and The division also conducts extensive clinical create better selection criteria for endoscopic UHVHDUFKLQWKHFRQGLWLRQZLWKWKHJRDORILPSURYLQJ ventriculostomy. WKHOLYHVRIFKLOGUHQZLWKK\GURFHSKDOXV VOLUME OF INITIAL PROCEDURES FOR TREATMENT OF HYDROCEPHALUS by year 80 60 60 54 40 33 Volume Volume 22 20 19 20 0 2015 2016 2017 First Endoscopic Third Ventriculostomy/Choroid Plexus Cauterization (ETV/CPC) First Endoscopic Third Ventriculostomy (ETV) First-Time Ventricular Shunts NEUROSURGERY OUTCOMES 2017 25 SHUNT INFECTION RATE by year 10% 8% 5.81% 6% Rate 4% 3.28% 3.17% 2% 0% 2015 2016 2017 26 NEUROSURGERY OUTCOMES 2017 FIRST-TIME VENTRICULOPERITONEAL (VP) SHUNT SURVIVAL 1.00 0.75 0.50 0.25 0.00 012345 Ye a r s PERCENTAGE OF SHUNTS FUNCTIONING AT ONE YEAR AFTER PLACEMENT by year 2013 2014 2015 2016 71.7% 84.3% 67.3% 83.6% FIRST-TIME ETV/CPC SURVIVAL 1.00 0.75 0.50 0.25 0.00 012345 Ye a r s PERCENTAGE OF ETV FUNCTIONING AT ONE YEAR by years 2012-2016 39.6% NEUROSURGERY OUTCOMES 2017 27 SKULL BASE SURGERY Skull 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 FDVHVWHQGWREHFRPSOH[WKH\DUHUHYLHZHGDQG 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. VOLUME OF SKULL BASE SURGERIES by year 10 9 9 9 8 7 6 5 5 Volume Volume 4 3 2 1 0 2015 2016 2017 28 NEUROSURGERY OUTCOMES 2017 NUMBER OF CEREBROSPINAL FLUID (CSF) LEAKS AFTER SKULL BASE SURGERY by year Year Number 2015 0/9 2016 0/5 2017 2/9 MORTALITY RATE within 30 days of initial surgery Year Rate 2015 0% 2016 0% 2017 0% NEUROSURGERY OUTCOMES 2017 29 TRAUMA 7UDXPDLVWKHPRVWVLJQLÀFDQWFDXVHRIPRUELGLW\ orthopedic surgeons, otolaryngologists and DQGPRUWDOLW\LQFKLOGUHQ$VRQHRIWKHIHZ physical medicine and rehabilitation specialists. accredited Level I Trauma Centers for pediatric We see over 500 trauma patients each year and patients in the country, Texas Children’s Hospital approximately 10% require surgical intervention. is committed to the prevention, treatment and Should a patient require rehabilitation for UHKDELOLWDWLRQRIDOOW\SHVRIWUDXPDWLFLQMXULHV DWUDXPDWLFEUDLQLQMXU\7H[DV&KLOGUHQ·V We care for all aspects of traumatic brain Hospital has one of the only pediatric inpatient LQMXU\VSLQDOFRUGLQMXU\DQGSHULSKHUDOQHUYH UHKDELOLWDWLRQXQLWVLQWKHVRXWKZHVW8QLWHG6WDWHV LQMXU\1HXURVXUJLFDOWUHDWPHQWLVSURYLGHG providing a variety of intensive treatment options LQFRRUGLQDWLRQZLWKWKHWUDXPDWHDPZKLFK including cognitive testing, physical therapy, includes pediatric surgeons, critical care specialists, occupational therapy and speech therapy. VOLUME OF TRAUMA CONSULTS AND SURGICAL CASES by year 560 516 509 484 490 420 350 280 Volume Volume 210 140 55 55 70 42 0 2015 2016 2017 Inpatients Seen by Neurosurgery Surgical Cases 30 NEUROSURGERY OUTCOMES 2017 TUMOR We offer comprehensive, multidisciplinary care many patients who may have posterior fossa, pineal for children with tumors of the central nervous region, suprasellar, hemispheric, intraventricular and system, in conjunction with our colleagues in deep-seated brain tumors. pediatric neuro-oncology, neurology, ophthalmology, physical medicine and rehabilitation, endocrinology, Texas Children’s Cancer Center® is ranked fourth radiology, pathology and pediatrics. in the nation by U.S. News & World Report for pediatric cancer and Texas Children’s Hospital With a surgical volume exceeding 100 brain is a member of several collaborative consortia, and spinal tumors annually, we are one of the including the Pediatric Brain Tumor Consortium busiest pediatric neurosurgical oncology programs (PBTC), which allows us to offer our patients the in the United States. We utilize state-of-the-art very latest novel therapeutic options. This overall surgical technology, including frameless stereotactic effort is also enhanced by several ongoing basic image guidance, microsurgery, brain mapping, science brain tumor research projects underway at intra-operative MRI imaging, robotic assisted Baylor College of Medicine. surgery and awake craniotomy to care for our VOLUME OF SPINE AND BRAIN TUMORS by year 80 78 68 62 60 40 Volume of patients Volume 20 17 18 13 0 2015 2016 2017 Recurrence - Spine Tumor New Diagnosis - Spine Tumor Recurrence - Brain Tumor New Diagnosis - Brain Tumor NEUROSURGERY OUTCOMES 2017 31 RATE AT WHICH PATIENTS REQUIRE TREATMENT FOR HYDROCEPHALUS FOLLOWING POSTERIOR FOSSA TUMOR RESECTION by year 100% 75% 50% Rate 36.67% 28.57% 25% 17.65% 0% 2015 2016 2017 MORTALITY RATE within 30 days of initial surgery Year Rate 2015 1.04% 2016 0% 2017 0% 32 NEUROSURGERY OUTCOMES 2017 VASCULAR Neurovascular or cerebrovascular disease refers to Texas Children’s Hospital, alongside specialists conditions affecting blood vessels in and around the in neurology, neuroradiology, neurocritical care, brain and the spine. While neurovascular disease genetics, hematology/oncology, physical medicine and affects people of all ages, children often have a rehabilitation, ophthalmology and more. We continue different biology than adults. For instance, these WRGHYHORSQHZXQGHUVWDQGLQJVRIWKHEDVLVIRUDQG diseases can be related to genetic factors and can the treatment of neurovascular anomalies, and our SURJUHVVRUFRPHEDFNDVFKLOGUHQDUHJURZLQJ patients have access to the latest diagnostic and &KLOGUHQZLWKQHXURYDVFXODURUFHUHEURYDVFXODU treatment technologies and investigational studies. disease face the risk of either bleeding in the brain Each patient has an individualized treatment plan (hemorrhagic stroke) or the risk of stroke from not endorsed by the multidisciplinary team, and our goal enough blood supply to the brain (ischemic stroke). LVWRVHHSDWLHQWVZKRSUHYLRXVO\KDGIHZRSWLRQV Both types of stroke can be life-threatening, and WKULYHDQGJURZRYHUWLPH can also cause serious damage to the brain. Our goal is to diagnose and treat children before they Open neurosurgery, endovascular interventions are affected by such dangerous events. Conditions or medical therapies are options for addressing ZHWUHDWLQFOXGHDUWHULRYHQRXVPDOIRUPDWLRQ pediatric neurovascular or cerebrovascular moyamoya, cerebral cavernous malformation, conditions. We evaluate, diagnose and treat each DUWHULRYHQRXVÀVWXODDQHXU\VPGLVVHFWLRQVWURNH SDWLHQWZLWKFRQVLGHUDWLRQWRWKHPRVWDSSURSULDWH and vein of Galen malformations. approaches, choosing from various neurosurgical, neurointerventional and medical therapies and often The Neurosurgery Division is part of a combining these modalities to achieve the safest and multidisciplinary vascular anomalies clinic at most effective results. VOLUME OF ENDOVASCULAR AND OPEN PROCEDURES by year 90 83 80 76 70 60 50 40 36 Volume Volume 34 30 20 20 15 10 0 2015 2016 2017 Endovascular Open All data is represented by academic year which runs from July 1-June 30, unless otherwise noted. NEUROSURGERY OUTCOMES 2017 33 34 NEUROSURGERY OUTCOMES 2017 PATIENT STORIES NEUROSURGERY OUTCOMES 2017 35 36 NEUROSURGERY OUTCOMES 2017 LUKE STEMLE $WZHHNVROG/XNH6WHPOHZDV GLDJQRVHGZLWKWXEHURXVVFOHURVLV complex (TSC), a rare disease that FDXVHVWXEHUVRUEHQLJQWXPRUVWRJURZ on the brain and other vital organs. /XNHXQGHUZHQWKLVÀUVWEUDLQVXUJHU\ DWZHHNVROGDWDKRVSLWDOQHDUKLV 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 FRQWLQXHGWRH[SHULHQFHWKHPZKLFK limited his independence and quality of OLIHDVKHFRQWLQXHGWRJURZ :KHQ/XNHZDV\HDUVROGKLVGRFWRU UHFRPPHQGHGDQHZW\SHRIVXUJHU\IRUFKLOGUHQ ´:KHQZHUHFHLYHGWKHUHVXOWVRIKLV((*,ZDV ZLWK76&ZKLFKZDVDYDLODEOHDW7H[DV&KLOGUHQ·V moved to tears. In addition to his seizure activity, +RVSLWDO,WZDVOHVVLQYDVLYHWKDQDWUDGLWLRQDO /XNH·VEUDLQXVHGWRVKRZDEQRUPDODFWLYLW\QLQH FUDQLRWRP\ZKLFKUHPRYHVDSRUWLRQRIDSDWLHQW·V VHFRQGVRXWRIWHQ7KHODVW((*KDGMXVWRQH skull to grant access to the brain and is therefore abnormality in 45 minutes,” said Luke’s mother, RQO\UHFRPPHQGHGIRUSDWLHQWVZLWKWKHPRVW Stephanie. “The surgery has done much more serious and life-threatening conditions. than stop Luke’s seizures, it has given Luke peace IRUWKHÀUVWWLPHLQKLVOLIHµVKHVDLG´+LVEUDLQLV Pioneered by Texas Children’s neurosurgeon EHLQJJLYHQWKHFKDQFHWRJURZDQGOHDUQDQGEXLOG Dr. Daniel Curry, this laser ablation technique relationships uninterrupted. It is a sigh of relief and requires a hole only the size of a pen and uses an gratitude after years of holding our breath in fear MRI-guided laser to destroy the tubers causing the and chaos.” seizures. The surgery has had tremendously positive UHVXOWVIRUSDWLHQWVZLWK76& Luke has not had a single seizure since leaving Texas Children’s more than a year ago, and his doctors and In fall of 2016, Luke and his family came to Texas IDPLO\DUHKRSHIXODQGRSWLPLVWLFLWZLOOVWD\WKDWZD\ &KLOGUHQ·V+RVSLWDO+HXQGHUZHQWWZRVXUJHULHV to ensure that all of the affected areas of his brain ZHUHUHPRYHG NEUROSURGERY OUTCOMES 2017 37 EVERETT KERRES At an 18-week ultrasound, Johnna and Adam Kerres were devastated to OHDUQWKDWWKHLUÀUVWFKLOG(YHUHWW KDGDVHYHUHIRUPRIVSLQDELÀGD $GRFWRUWROGWKHP(YHUHWWZRXOG OLNHO\QHYHUZDON The Kerres immediately put their nesting and baby shower plans on hold while they learned everything WKH\FRXOGDERXWWKHFRQGLWLRQ 7KHLUGRFWRUSRLQWHGWKHPLQWKH GLUHFWLRQRI7H[DV&KLOGUHQ·V)HWDO &HQWHU®ZKHUHGRFWRUVKDGUHFHQWO\ developed a less invasive fetal surgery option with tremendous promise to KHOSEDELHVOLNH(YHUHWW 8QOLNHRSHQIHWDOVXUJHU\ZKLFKFXWV At 24 weeks gestation, Belfort and Whitehead RSHQWKHXWHUXVWRGLUHFWO\RSHUDWHRQWKHIHWXV OHGDODUJHPXOWLGLVFLSOLQDU\IHWDOVXUJHU\ WKHIHWRVFRSLFPHWKRGRIIHUVWKHVDPHEHQHÀWV WHDPWRVXFFHVVIXOO\SHUIRUPWKHSURFHGXUH RILQXWHURVSLQDELÀGDUHSDLUZLWKOHVVULVNRI $IWHUZDUGV-RKQQD·VSUHJQDQF\SURFHHGHGZLWKRXW SUHPDWXUHODERUDQGDVVRFLDWHGFRPSOLFDWLRQV FRPSOLFDWLRQDQGDW ZHHNVDQGGD\VKH GHOLYHUHG(YHUHWWYDJLQDOO\)URPELUWKWRQRZPRUH ´:HEHOLHYHWKLVRSWLRQFDQOHDGWRGUDPDWLFDOO\ WKDQD\HDUROG(YHUHWWKDVFRQWLQXHGWRGHI\WKH EHWWHURXWFRPHVIRUEDELHVZLWKVSLQDELÀGDDQG RGGV7RGD\KHLVKDSS\VPDUWDQGH[WUHPHO\FKDWW\ ZH·UHZRUNLQJKDUGWRJHWWKHZRUGRXWWR DQGFXUUHQWO\ZRUNLQJRQOHDUQLQJKRZWRZDON 2%*<1VHYHU\ZKHUHµVDLG'U0LFKDHO%HOIRUW 2%*<1LQFKLHIZKRSLRQHHUHGWKHSURFHGXUH ´(YHUHWW·VUHSDLUZDVRQHRIWKHEHVWUHYHUVDOV ZLWK7H[DV&KLOGUHQ·V+RVSLWDOQHXURVXUJHRQ ,·YHVHHQVLQFHZH·YHEHHQSHUIRUPLQJWKLV 'U:LOOLDP:KLWHKHDG LQWHUYHQWLRQµVDLG'U:KLWHKHDG´7KHRXWFRPH ZDVUHPDUNDEOHµ 38 NEUROSURGERY OUTCOMES 2017 MATTHEW BOLER ,W·VZLGHO\NQRZQWKDWPDQ\QHZERUQV have abnormally shaped heads due to SRVLWLRQLQJLQWKHZRPERUMRXUQH\LQJ through the birth canal. For that reason, Megan and Michael Boler ZHUHQ·WWRRFRQFHUQHGDERXWWKHORQJ VNLQQ\VKDSHRIWKHLUEDE\0DWWKHZ·V KHDGWKRXJKWKH\GLGZRQGHUZKHQLW ZRXOGURXQGRXW $WDURXWLQHPRQWKZHOOQHVVFKHFN WKHLUSHGLDWULFLDQZDVDODUPHGWRÀQG WKDWWKHVRIWVSRWLQ0DWWKHZ·VKHDG² ZKLFKLVQ·WVXSSRVHGWRFORVHXQWLO PRQWKV²ZDVKDUG6KHUHIHUUHGWKH Bolers immediately to Texas Children’s +RVSLWDOZKHUHKHZDVGLDJQRVHGZLWK craniosynostosis, a rare and serious birth defect that causes the skull bones $WÀUVWWKHUHFRYHU\ZDVZRUVHWKDQWKHVXUJHU\ to fuse together too early. LWVHOIµ0HJDQVDLG´+HZDVXQUHFRJQL]DEOHVR VZROOHQDQGIRUDZKLOHKHZDVLQFRQVRODEOH%XW When a baby’s skull closes prematurely, the brain at eventually on the third day, he perked up, started ÀUVWFRQWLQXHVWRJURZZKLFKFDXVHVWKHVNXOOWRIRUP breastfeeding again and returned to his usual in an unsual shape. Eventually, the baby’s brain has no cheerful self.” URRPWRJURZDQGWKLVFDQFDXVHOLIHORQJQHXURORJLFDO problems and even death in extreme cases. $IWHUWKHVXUJHU\0DWWKHZQHHGHGWRZHDUD VSHFLDOKHOPHWKRXUVDGD\(YHU\WZRZHHNV ´,WZDVYHU\IRUWXQDWHWKDW0DWWKHZ·VSHGLDWULFLDQ WKHKHOPHWZDVFKHFNHGDQGDGMXVWHGWRDLGLQ FDXJKWWKLVYHU\HDUO\JLYLQJXVDFKDQFHWRÀ[LW 0DWWKHZ·VUHFRYHU\,QIDFWKHSURJUHVVHGVR before any long-term damage could occur,” said ZHOOWKDWKHZDVUHOHDVHGIURPKHOPHWWKHUDS\ Dr. Sandi Lam, director of the cerebrovascular DIWHURQO\IRXUPRQWKV1RZRYHU\HDUVROG neurosurgery program at Texas Children’s Hospital. 0DWWKHZ·VSDUHQWVUHSRUWKHLVKDSS\KHDOWK\DQG GHYHORSPHQWDOO\QRUPDOZLWKDSHUIHFWO\ERULQJ :KHQ0DWWKHZZDVZHHNVROG/DPOHGD shaped head. VXFFHVVIXOÀYHKRXUVXUJHU\WRUHPRYHWKHIXVHG bone at the top of his skull. NEUROSURGERY OUTCOMES 2017 39 40 NEUROSURGERY OUTCOMES 2017 FACULTY & PUBLICATIONS NEUROSURGERY OUTCOMES 2017 41 42 NEUROSURGERY OUTCOMES 2017 FACULTY & STAFF DIRECTORY Howard L. Weiner, M.D., F.A.C.S., F.A.A.P., Chief Heidi Kerns, M.S.N., R.N., F.N.P.-B.C. Guillermo M. Aldave, M.D., Ph.D. Sandi K. Lam, M.D., M.B.A. Brandy Berger, M.S.N., R.N., C.P.N.P.-P.C. Amee Moreno, M.S.N., R.N., C.P.N.P.-P.C. Natalie Cormier, M.S.N., R.N., F.N.P.-B.C. I-Wen Pan, Ph.D. Daniel J. Curry, M.D. Brenda Perry, C.P.N.P.-P.C. Robert C. Dauser, M.D. Lucia Ruggieri, P.A.-C. Brian J. Kelley, M.D., Ph.D. William E. Whitehead, M.D., M.P.H. NEUROSURGEONS Howard L. Weiner, M.D., F.A.C.S., F.A.A.P. Chief of Neurosurgery, Texas Children’s Hospital Professor and Vice Chairman, Department of Neurosurgery, Baylor College of Medicine Dr. 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 PDOIRUPDWLRQVWHWKHUHGFRUG&KLDULPDOIRUPDWLRQFUDQLRV\QRVWRVLVDQGVSLQDELÀGD Guillermo M. Aldave, M.D., Ph.D. Assistant Professor, Pediatric Neurosurgery, Baylor College of Medicine Dr. 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, VXFKDVWKHXVHRIÀYHDPLQROHYXOLQLFDFLGIRUWKHUHVHFWLRQRIKLJKJUDGHJOLRPDV Daniel J. Curry, M.D. Associate Professor, Pediatric Neurosurgery, Baylor College of Medicine Dr. 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 Medicine Dr. 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. NEUROSURGERY OUTCOMES 2017 43 Brian J. Kelley, M.D., Ph.D. Assistant Professor, Pediatric Neurosurgery, Baylor College of Medicine Dr. 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 Medicine Dr. 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 Medicine Dr. Whitehead’s primary clinical interests relate to the treatment of hydrocephalus, FRPSOH[VKXQWSUREOHPVVSLQDELÀGDDQGRWKHUFRQJHQLWDOPDOIRUPDWLRQVRIWKH 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. SELECTED PUBLICATIONS Aldave 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. 44 NEUROSURGERY OUTCOMES 2017 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 US To refer a patient to Texas Children’s Neurosurgery program, please visit texaschildrens.org/refer or contact us directly. Clinic Location Mailing Address Phone 6701 Fannin St., 9th Floor 6701 Fannin St., Suite 1230.01 832-822-3950 Houston, 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