The Pediatric Neurosurgery Division at UPMC Children’s Hospital of Pittsburgh is led by Ian Pollack, MD, and includes three other full-time faculty, Elizabeth Tyler-Kabara, MD, PhD, Stephanie Greene, MD, and Taylor Abel,MD. 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, radiationtherapy, oncology, physical therapy, orthopedics, plastic surgery, critical care, pediatric neurology 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. The clinical program has been enhanced by the completion of an intraoperative MRI suite, which facilitates the goal of achieving safer and more extensive resections in challenging childhood brain tumors, and allowing immediate postoperative imaging without the need for a second anesthetic.
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 (tumor, congenital, and trauma), even in children under the age of two. 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.
Patients with vascular anomalies such as aneurysms, arteriovenous malformations, cavernous malformations, and moyamoya syndrome are managed by Dr. Greene, the director of vascular neurosurgery at Children’s Hospital. 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 an endovascular neurosurgical team, 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.
The Pediatric Epilepsy Surgery Program, led by Dr. Abel, is the only center in the region able to provide comprehensive evaluation and surgical treatment options for children with focal or drug-resistant epilepsy. A comprehensive pre-surgical evaluation, using state-of-the-art neuro-imaging and electrophysiology resources, is performed to identify the specific site in the brain causing seizures and to determine its relationship to important functional areas of the brain. Patients with focal epilepsy can be treated with the full range of treatment options including lesionectomy, cortical resection, lobar resection, or hemispheric disconnection-—with or without a period of direct cortical recordings (i.e. SEEG or subdural grids) to elucidate epileptic cortex. The surgical epilepsy program is equipped with both a ROSA robot and O-Arm intraoperative CT scanner, which enables frameless robot-assisted SEEG implantation. Approaches are tailored to minimize the use of craniotomies when possible. A large proportion of patients are treated with MR-guided laser ablation. Direct cortical modulation with responsive neural stimulation (RNS) is also available when the seizure focus involves eloquent cortex. For children with drug-resistant multi-focal or generalized epilepsy, all available palliative procedures are available including MR-guided laser callostomy, traditional callosotomy, vagal nerve stimulation, and deep brain stimulation.
Dr. Abel also leads the Pediatric Brain Electrophysiology Laboratory, located at UPMC Children’s Hospital of Pittsburgh, that uses neural data from SEEG recordings to elucidate the physiologic mechanisms associated with auditory and visual cortical development. The lab is also investigating new methods for improved and less invasive localization of epileptic foci. Clinical research from this laboratory investigates outcomes of SEEG, subdural grid recordings, and neuromodulation.
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. With the ROSA robot and O-Arm, asleep frameless stereotactic deep brain stimulation is available for children with dystonia and other movement disorders requiring neuromodulation.
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 division is actively involved in the Brain Trauma Research Program, the Fetal Diagnosis and Treatment Center, the Vascular Anomalies Center and the Brachial Plexus Program. In conjunction with a team of specialists at UPMC 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, one of the largest such clinics in the country. Expectant mothers are referred by the Fetal Diagnosis and Treatment Center at UPMC Magee-Womens Hospital for counseling 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. UPMC Children’s Hospital of Pittsburgh is one of a handful of centers in the country that have a dedicated multidisciplinary clinic for these patients, and is the only such program in the region. Older patients with peripheral nerve tumors or injuries are seen by Dr. Greene outside of the Brachial Plexus program.
One of the newest collaborations is with The Program for the Study of Neurodevelopment in Rare Disorders (NDRD). Dr. Tyler-Kabara is working with Maria Escolar, MD, MS, a specialist in rare disorders neurodevelopment at UPMC Children’s Hospital of Pittsburgh, to offer clinical trials for gene therapy in this patient population. The first trial has opened for the treatment of patients with mucopolysaccharidosis II (Hunter Syndrome).
UPMC Children’s Hospital of Pittsburgh is a member of the Hydrocephalus Clinical Research Network, a group of 11 premier pediatric neurosurgical departments in North America that are dedicated to designing and undertaking field-changing prospective research into pediatric hydrocephalus. In addition, Children’s is also 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.