The Pediatric Neurosurgery Divsion at Children’s Hospital of Pittsburgh of UPMC is led by Ian Pollack, MD, and includes three other full-time faculty, Elizabeth Tyler-Kabara, MD, PhD, Stephanie Greene, MD, and Mandeep Tamber, MD, PhD. The division provides care for children with tumors, spinal and cranial deformities, vascular malformations, spasticity and epilepsy, and peripheral nerve disorders, and has gained international recognition for the treatment of pediatric brain tumors, cerebral palsy and traumatic brain injury.
The center’s neurosurgeons work closely with specialists in pediatrics, surgery, radiation therapy, oncology, physical therapy, orthopedics, plastic surgery, critical care and social services. Through its neuro-oncology program, the center provides comprehensive, multi-disciplinary care for patients with brain and spinal cord tumors, in collaboration with the oncology and radiation therapy programs. Patients may be eligible for treatment in one of many innovative research protocols at Children’s Hospital. These protocols—several of which are unique to Children’s or available at only a few centers throughout the country—provide Children’s patients access to new treatments and promising studies. Dr. Pollack is the institutional principal investigator and chair of the Neurosurgery Committee in the Pediatric Brain Tumor Consortium, supported by the National Cancer Institute to perform cutting-edge clinical trials in children with brain tumors, and serves as the principal investigator on several studies involving vaccine-based immunotherapy for children with challenging brain tumors.
In addition, Dr. Tyler-Kabara has helped to pioneer the use of endoscopic endonasal approaches to the skull base in the pediatric population. Children’s Hospital offers this minimally invasive approach to skull base pathologies even in children under the age of five. The clinical program is augmented by NIH-funded, laboratory-based research initiatives examining molecular markers of prognosis and novel treatment strategies in patients with glial tumors and ependymomas.
The division is an integral collaborator in the Cleft-Palate and Craniofacial Center in the management of children with craniofacial disorders. Because children with complex craniosynostosis often require a staged approach to the treatment of their cranial, midfacial and lower facial deformities, close multidisciplinary follow-up is maintained throughout childhood and adolescence in order to optimize long-term functional and cosmetic outcome.
The Surgical Epilepsy Program is the only center in the region able to provide comprehensive evaluation and surgical treatment options for children with intractable epilepsy. Dr. Tamber, the lead epilepsy neurosurgeon, collaborates closely with epileptologists within the Division of Pediatric Neurology. A comprehensive pre-surgical evaluation, using state-of-the-art neuro-imaging resources, is carried out to identify the specific site in the brain causing seizures and to determine its relationship to important functional areas of the brain. Surgical candidates benefit from a full spectrum of treatment options, ranging from lesionectomies (guided by intraoperative electrocorticography), tailored cortical resections following a period of invasive subdural EEG monitoring, corpus callosotomies and hemispherectomies. Other patients may benefit from vagus nerve stimulation. Children’s Hospital of Pittsburgh of UPMC has implanted more than 350 vagus nerve stimulators (VNS) making it one of the busiest VNS programs in the country.
The program is also involved in cutting edge clinical and basic research focused on developing and applying new and improved treatments for children with movement disorders. The Spasticity and Movement Disorders Clinic, led by Dr. Tyler-Kabara, is made up of a team of pediatric medical professionals who specialize in the comprehensive, multidisciplinary evaluation and treatment of children and young adults with spasticity and other movement disorders, such as dystonia, chorea, athetosis and tremor. The purpose of the clinic is to determine whether a patient would benefit from treatment with oral medications, intrathecal baclofen, selective dorsal rhizotomy, intramuscular botox injection, deep brain stimulation or other therapies.
The division is also actively involved in the Brain Trauma Research Program, the Fetal Diagnosis and Treatment Center, the Vascular Anomalies Center and the Brachial Plexus Program. A landmark study, the MOMS (Management of Myelomeningocele Study) trial, was published in the New England Journal of Medicine in February 2011, revealing exciting improvements in the outcomes of children with spina bifida who underwent fetal surgery when compared to those who underwent traditional open surgery shortly after birth. In conjunction with a team of specialists at Magee Womens Hospital, Dr. Greene has established a program to treat babies with myelomeningocele, or spina bifida, with in utero surgery here in Pittsburgh. Babies who are not candidates for in utero surgery undergo conventional closure of the defect within several days of birth. These children are seen throughout childhood by a multidisciplinary team of medical professionals in the Spina Bifida Clinic at Children’s Hospital of Pittsburgh, one of the largest such clinics in the country. Expectant mothers are counseled in the pediatric neurosurgery clinic if prenatal imaging reveals a potential neurosurgical abnormality.
The Brachial Plexus Birth Injury Clinic, run through the division of pediatric plastic surgery, manages infants with birth injuries to the brachial plexus in a collaborative fashion with specialists from neurosurgery, plastic surgery, orthopedic surgery, and physical and occupational therapy. Dr. Greene and Lorelei J. Grunwaldt, MD of plastic surgery perform the necessary operations on infants together, bringing their different expertise to bear on the problem in a collaborative fashion. Children’s Hospital of Pittsburgh is one of a handful of centers in the country that have a dedicated multidisciplinary clinic for these patients. Patients with peripheral nerve tumors or injuries are seen by Dr. Greene outside of the Brachial Plexus Program.
Dr. Tamber has worked to include Children’s Hospital of Pittsburgh of UPMC in several large multi-center clinical networks that are dedicated to the study of common pediatric disorders. CHP is a member of the Hydrocephalus Clinical Research Network, a group of seven premier pediatric neurosurgical departments in North America that are dedicated to designing and undertaking field-changing prospective research into pediatric hydrocephalus. In addition, CHP has been selected as a member institution in the Park-Reeves Syringomyelia Research Consortium, a group dedicated to solving important clinical problems within the realm of Chiari malformation and syringomyelia. Dr. Tamber is the institutional Principal Investigator for both of these endeavors.
Patients with vascular anomalies such as aneurysms, arteriovenous malformations, cavernous malformations, and moyamoya syndrome are managed by Dr. Greene. Select patients undergo further evaluation at the department’s Center for Image-Guided Neurosurgery with L. Dade Lunsford, MD, for possible radiosurgical treatment, angiography by Brian Jankowitz, MD, for further definition of anomalies and possible embolization of feeding vessels to reduce blood flow to a malformation, and assessment by a vascular neurologist for management of seizures, dystonia, and coagulopathies that may be identified during the course of the evaluation process. Such comprehensive evaluation best identifies those patients who would benefit from surgical intervention. Patients with vascular problems involving more than one organ system, or those with syndromes such as Sturge-Weber or PHACES, are seen in the multidisciplinary Vascular Anomalies Clinic, one of the largest of its kind in the country.
For more information on our Pediatric Neurosurgery Division, please visit the division's webpages on the Children's Hospital of Pittsburgh website.