The Pediatric Neurosurgery Division at UPMC Children’s Hospital of Pittsburgh (CHP) is led by Ian Pollack, MD, and also includes Stephanie Greene, MD, Taylor Abel, MD, Robert Kellogg, MD and Michael McDowell, 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, intractable epilepsy, neurovascular lesions, cerebral palsy, traumatic brain injury, and disorders of the skull base and cranio-cervical junction.
The center’s neurosurgeons work closely with specialists in pediatrics, surgery, radiation therapy, pediatric neuro-oncology, physical therapy, orthopedics, plastic surgery, otolaryngology, 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 CHP. These protocols—several of which are unique to CHP or available at only a few centers throughout the country—provide CHP patients access to new treatments and promising studies.
Dr. Pollack is the institutional principal investigator and chair of the neurosurgery and translational biology 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.
These clinical advances are coupled with a robust and rapidly growing research enterprise, encompassing a state-of-the-art pediatric brain tumor bank that will soon receive specimens from other regional pediatric neurosurgical sites, as well as a series of eight NIH R01, P01, and R21-funded research projects, and a cadre of rising-star investigators, including Sameer Agnihotri, PhD, Gary Kohanbash, PhD, Baoli Hu, PhD, and Antony MichealRaj, PhD. These activities build upon the division’s existing strength in experimental therapeutics and immunobiology, with a goal of developing the next generations of precision-medicine-based clinical trials.
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, hereditary hemorrhagic telangiectasia 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 epilepsy surgery evaluation and performs > 120 epilepsy surgeries each year. A comprehensive pre-surgical evaluation, using state-of-the-art neuroimaging 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 grid electrodes) 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. For example, the program is one of the highest volume centers for MR-guided laser ablation in North America. 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, vagus nerve stimulation, and deep brain stimulation. A multidisciplinary epilepsy surgery clinic provides streamlined, comprehensive evaluation of children with drug-resistant epilepsy for surgery.
Dr. Abel’s basic research program focuses on understanding the neural basis of voice and speech perception. This effort is funded by multiple federal grants, including an R01 and R21. The epilepsy surgery program’s clinical research efforts, also directed by Dr. Abel, focus on comparative effectiveness of different epilepsy surgery strategies, and is funded by both PCORI and industry.
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. Dr. Kellogg manages this aspect of the practice and participates in The Spasticity and Movement Disorders Clinic that is held weekly. This clinic 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 cerebral palsy, spasticity, 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, orthopedic procedures, or other therapies. Additionally, the division offers intraventricular baclofen pumps, which is a therapy pioneered at UPMC Children’s Hospital of Pittsburgh by A. Leland Albright, MD, that has been revived with the addition of Dr. Kellogg. 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 to adolescence in order to optimize long-term functional and cosmetic outcome. The center offers a panoply of surgical options, ranging from innovative endoscopic techniques that have been refined at CHP, as well as a broad range of open approaches carefully tailored to the child’s anatomy.
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 open 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. Dr. Greene collaborates with maternal-fetal medicine experts at UPMC Magee-Womens Hospital as co-PI on multiple grants to study in utero treatment of congenital aqueductal stenosis, a common cause of hydrocephalus.
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. 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.
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, CHP 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. These efforts have led to dozens of publications that have helped to advance the field in collaboration with other consortium sites.
In recent years, the clinical team has been expanded with the addition of Dr. Kellogg, a former neurosurgical fellow who joined the group in September of 2020. In addition to his management of the Pediatric Neurosurgery Division’s spasticity and movement disorders program noted above, he will be focusing on many clinical research studies conducted within the Hydrocephalus Clinical Research Network and other collaborative initiatives. More recently, the division has added Dr. McDowell to our team, who brings particular expertise in the management of cranial base anomalies, after completing both endoscopic cranial base and pediatric neurosurgical fellowships. With this unique combination of skill sets, he is joined by the other members of the internationally acclaimed UPMC Center for Cranial Base Surgery in proving unmatchable care for disorders of the pituitary gland, skull base, and cranio-cervical junction. Dr. McDowell also brings research expertise in near infrared spectroscopy (NIRS) as a noninvasive way of monitoring brain function and intracranial pressure. He recently received the 2021 Hydrocephalus Association Award for his groundbreaking work that may soon have wide-reaching applications for disorders of intracranial pressure include trauma, Chiari malformation, craniosynostosis, and hydrocephalus. A large-scale clinical trial is underway to validate this technology in children and adults with neurosurgical conditions.
Together, the increased complement of neurosurgeons, supported by five full-time advanced practice providers, has enabled expansion of the division’s outreach program to multiple communities beyond our immediate geographic area, combined with an extensive telemedicine presence. Our research initiatives are also supported by four full-time research coordinators, allowing us to maintain a broad array of clinical studies to place our site on the cutting edge of Pediatric Neurosurgery patient care, while advancing the field in general.
Finally, our division members maintain an active role in organized neurosurgery and allied fields. In addition to his consortium involvement, Dr. Pollack serves as chair of the American Board of Pediatric Neurosurgery, a director on the Accreditation Council for Pediatric Neurosurgical Fellowships, and a principal investigator with the Children’s Brain Tumor Network. Dr. Greene serves on the editorial board of the premier journal in the field, Journal of Neurosurgery: Pediatrics, and is the chair of the Traveling Fellowship SubCommittee of the Education Committee of the AANS/CNS Section on Pediatric Neurosurgery. She is a member of the AANS/CNS Joint Section Executive Committee as well. As the fellowship director at CHP, Dr. Greene is on the American Board of Pediatric Neurological Surgeons Fellowship committee and is a regular guest examiner for the American Board of Neurological Surgeons oral board examination. She is the only neurosurgeon member of the North American Fetal Therapy Network (NAFTNet) Steering Committee and is a member of the National Spina Bifida Patient Registry Coordinating Committee. Dr. Abel serves on multiple committees in the American Epilepsy Society and AANS/CNS Section on Pediatric Neurosurgery, including the AES Membership Council, the AES Neurosurgery Task Force, and is the founding chair of the AES Early Career Committee. Dr. Abel also serves on the AANS/CNS Joint Guidelines Committee. Dr. McDowell is the chair of the Young Neurosurgeons Committee of the AANS/CNS Section on Pediatric Neurosurgery and the course director of the acclaimed “Brain and Blade” course for pre-clinical medical students, for which he was awarded the 2021 University of Pittsburgh Dean’s Distinguished Teaching Award.