Pediatric Neurosurgery in a Non-Academic City Hospital

2008 ◽  
Vol 1 (4) ◽  
pp. A355-A356
Author(s):  
Paul Grabb
Keyword(s):  
Large City ◽  
Spinal Instrumentation ◽  
Pediatric Neurosurgery ◽  
Insurance Premium ◽  
Frameless Stereotaxy ◽  
Trauma Patients ◽  
City Hospital ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Physician Extenders

Introduction Creation of a pediatric neurosurgical service in the community has challenges unique from establishing such a service in an academic setting. I outline the challenges in creating a pediatric neurosurgical service within a large city-owned hospital. Critical equipment system-related and man-power issues were identified. Methods The NACHRI designated children's hospital (Memorial Hospital for Children) serves southern Colorado. Coverage was not provided by the community neurosurgeons. Therefore, children requiring neurosurgical management traveled to Denver or elsewhere. A pediatric neurosurgeon was hired to establish a clinical service in 2004. Results Equipment such as endoscopy, frameless stereotaxy, ICP monitors, and shunt components were obtained easily. Familiarizing the OR/ICU staff with the equipment, however, required months as this technology was rarely utilized by the other surgeons. System-related concerns were many and mostly educational involving the ER, PICU, NICU, and floor. Identifying anesthesiologists with pediatric expertise and desire was critical. Unexpected system-related benefits compared to a university-based Children's Hospital were lack of resistance for imaging studies requiring sedation or invasive studies (angiography), outstanding intraoperative support for spinal instrumentation cases, very rapid transport to OR of trauma patients, and speed of anesthesia. Man-power issues of no cross-coverage remain problematic primarily because of insurance premium increases to provide pediatric coverage. Any increased burden by nonresidents is offset by the support of other specialties (emergency room physicians, intensivists, and trauma surgeons). Physician extenders require a large amount of education and oversight before reducing clinical burden. Conclusion Creating a pediatric neurosurgical service within a community hospital requires financial support from the hospital, a system capable of and willing to care for children with complex problems and other specialties, and physician extenders competent to assist with the service. The medicolegal/insurance landscape hinders more complete coverage within our system. A tremendous educational effort is required to establish and maintain a safe and functional service.

Surgical treatment for primary spinal aneurysmal bone cysts: experience from Children's Hospital Boston

2012 ◽  
Vol 9 (3) ◽  
pp. 305-315 ◽  
Author(s):  
Georgios Zenonos ◽  
Osama Jamil ◽  
Lance S. Governale ◽  
Sarah Jernigan ◽  
Daniel Hedequist ◽  
...  
Keyword(s):  
Spinal Instrumentation ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Bone Cysts ◽  
Children's Hospital ◽  
Initial Intervention ◽  
Children’S Hospital ◽  
Aneurysmal Bone Cysts

Object Spinal aneurysmal bone cysts (ABCs) constitute a rare and clinically challenging disease, primarily affecting the pediatric population. Information regarding the management of spinal ABCs remains sparse. In this study the authors review their experience with spinal ABCs at Children's Hospital Boston. Methods The medical records of all patients treated surgically for primary spinal ABCs between January 1998 and July 2010 were retrospectively reviewed. Results Fourteen cases were identified (6 males and 8 females, ages 5–19 years old). The ABCs were located throughout the spine, with an equal number in the thoracic and lumbar spine, and rarely in the cervical spine. The majority of patients presented with back pain, but neurological deficits and spinal deformity were common. A variety of radiographic techniques were used to establish the diagnosis, including needle biopsy. Preoperative selective arterial embolization was performed in 7 cases (50%), and the majority of cases required spinal instrumentation along with resection. Mean follow-up was 55.9 months (range 15–154 months) after initial intervention. Two ABCs recurred (14%), at 9 months and 8 years after incomplete initial resection, and the patients underwent reoperation. Complete resection was ultimately achieved in all cases. All patients were asymptomatic and neurologically intact at their last follow-up evaluation, and showed no evidence of deformity or recurrence on imaging. Conclusions Computed tomography and MR imaging are adequate for an initial evaluation of spinal ABCs, although solid variants can present a diagnostic challenge. Given the high rates of recurrence with residual disease, complete obliteration of the lesion should be the goal of treatment. Preoperative embolization is often performed, although in the authors' opinion the degree of bleeding tends not to support its routine use. Long-term follow-up is warranted as recurrences can occur years after initial intervention. However, gross-total excision in conjunction with spinal stabilization, as needed, usually provides cure of the ABC and excellent long-term spinal alignment.

scholarly journals Pediatric neurosurgery at British Columbia’s Children’s Hospital

2015 ◽  
Vol 31 (9) ◽  
pp. 1419-1427 ◽  
Author(s):  
Paul Steinbok ◽  
Felix Durity ◽  
John Kestle ◽  
D. Douglas Cochrane
Keyword(s):  
Pediatric Neurosurgery ◽  
Children's Hospital ◽  
Children’S Hospital

Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents

2013 ◽  
Vol 12 (5) ◽  
pp. 422-433 ◽  
Author(s):  
Mark S. Dias ◽  
Jeffrey S. Sussman ◽  
Susan Durham ◽  
Mark R. Iantosca
Keyword(s):  
Brain Injuries ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Fellowship Training ◽  
Web Based ◽  
Intrinsic Nature ◽  
Children's Hospital ◽  
Resident Perceptions ◽  
Children’S Hospital ◽  
Fast Healing

Object Research suggests that there may be a growing disparity between the supply of and demand for both pediatric specialists and neurosurgeons. Whether pediatric neurosurgeons are facing such a disparity is disputable, but interest in pediatric neurosurgery (PNS) has waxed and waned as evidenced by the number of applicants for PNS fellowships. The authors undertook a survey to analyze current neurosurgical residents' perceptions of both benefits and deterrents to a pediatric neurosurgical career. Methods All residents and PNS fellows in the United States and Canada during the academic year 2008–2009 were invited to complete a Web-based survey that assessed 1) demographic and educational information about residents and their residency training, particularly as it related to training in PNS; 2) residents' exposure to mentoring opportunities from pediatric neurosurgical faculty and their plans for the future; and 3) residents' perceptions about how likely 40 various factors were to influence their decision about whether to pursue a PNS career. Results Four hundred ninety-six responses were obtained: 89% of the respondents were male, 63% were married, 75% were in at least their 3rd year of postgraduate training, 61% trained in a children's hospital and 29% in a children's “hospital within a hospital,” and 72% were in programs having one or more dedicated PNS faculty members. The residencies of 56% of respondents offered 6–11 months of PNS training and nearly three-quarters of respondents had completed 2 months of PNS training. During medical school, 92% had been exposed to neurosurgery and 45% to PNS during a clinical rotation, but only 7% identified a PNS mentor. Nearly half (43%) are considering a PNS career, and of these, 61% are definitely or probably considering post-residency fellowship. On the other hand, 68% would prefer an enfolded fellowship during residency. Perceived strengths of PNS included working with children, developing lasting relationships, wider variety of operations, fast healing and lack of comorbidities, and altruism. Perceived significant deterrents included shunts, lower reimbursement, cross-coverage issues, higher malpractice premiums and greater legal exposure, and working with parents and pediatric health professionals. The intrinsic nature of PNS was listed as the most significant deterrent (46%) followed by financial concerns (25%), additional training (12%), longer work hours (12%), and medicolegal issues (4%). The majority felt that fellowship training and PNS certification should be recommended for surgeons treating of all but traumatic brain injuries and Chiari I malformations and performing simple shunt-related procedures, although they felt that these credentials should be required only for treating complex craniosynostosis. Conclusions The nature of PNS is the most significant barrier to attracting residents, although reimbursement, cross-coverage, and legal issues are also important to residents. The authors provide several recommendations that might enhance resident perceptions of PNS and attract trainees to the specialty.

scholarly journals Taking the next step in publication productivity analysis in pediatric neurosurgery

2018 ◽  
Vol 21 (6) ◽  
pp. 655-665 ◽  
Author(s):  
Ryan P. Lee ◽  
Raymond Xu ◽  
Pooja Dave ◽  
Sonia Ajmera ◽  
Jock C. Lillard ◽  
...  
Keyword(s):  
Basic Science ◽  
Pediatric Neurosurgery ◽  
Faculty Members ◽  
Children's Hospital ◽  
Tier 1 ◽  
Children’S Hospital ◽  
Fellowship Programs ◽  
The Mean ◽  
Tier 3 ◽  
Number Of Citations

OBJECTIVEThere has been an increasing interest in the quantitative analysis of publishing within the field of neurosurgery at the individual, group, and institutional levels. The authors present an updated analysis of accredited pediatric neurosurgery training programs.METHODSAll 28 Accreditation Council for Pediatric Neurosurgery Fellowship programs were contacted for the names of pediatric neurosurgeons who were present each year from 2011 through 2015. Faculty names were queried in Scopus for publications and citations during this time period. The 5-year institutional Hirsch index [ih(5)-index] and revised 5-year institutional h-index [ir(5)-index] were calculated to rank programs. Each publication was reviewed to determine authorship value, tier of research, clinical versus basic science research, subject matter, and whether it was pediatrics-specific. A unique 3-tier article classification system was introduced to stratify clinical articles by quality and complexity, with tier 3 being the lowest tier of publication (e.g., case reports) and tier 1 being the highest (e.g., randomized controlled trials).RESULTSAmong 2060 unique publications, 1378 (67%) were pediatrics-specific. The pediatrics-specific articles had a mean of 15.2 citations per publication (median 6), whereas the non–pediatrics-specific articles had a mean of 23.0 citations per publication (median 8; p < 0.0001). For the 46% of papers that had a pediatric neurosurgeon as first or last author, the mean number of citations per publication was 12.1 (median 5.0) compared with 22.5 (median 8.0) for those in which a pediatric neurosurgeon was a middle author (p < 0.0001). Seventy-nine percent of articles were clinical research and 21% were basic science or translational research; however, basic science and translational articles had a mean of 36.9 citations per publication (median 15) compared with 12.6 for clinical publications (median 5.0; p < 0.0001). Among clinical articles, tier 1 papers had a mean of 15.0 citations per publication (median 8.0), tier 2 papers had a mean of 18.7 (median 8.0), and tier 3 papers had a mean of 7.8 (median 3.0). Neuro-oncology papers received the highest number of citations per publication (mean 25.7). The most common journal was the Journal of Neurosurgery: Pediatrics (20%). MD/PhD faculty members had significantly more citations per publication than MD faculty members (mean 26.7 vs 14.0; p < 0.0001) and also a higher number of publications per author (mean 38.6 vs 20.8). The median ih(5)- and ir(5)-indices per program were 14 (range 5–48) and 10 (range 5.6–37.2), respectively. The mean ir(5)/ih(5)-index ratio was 0.8. The top 5 fellowship programs (in descending order) as ranked by the ih(5)-index corrected for number of faculty members were The Hospital for Sick Children, Toronto; Children’s Hospital of Pittsburgh; University of California, San Francisco Benioff Children’s Hospital; Seattle Children’s Hospital; and St. Louis Children’s Hospital.CONCLUSIONSAbout two-thirds of publications authored by pediatric neurosurgeons are pediatrics-specific, although non–pediatrics-specific articles averaged more citations. Most of the articles authored by pediatric neurosurgeons are clinical, with basic and translational articles averaging more citations. Neurosurgeons with PhD degrees averaged more total publications and more citations per publication. In all, this is the most advanced and informative analysis of publication productivity in pediatric neurosurgery to date.

Pediatric neurosurgery at Texas Children’s Hospital: the legacy of Dr. William R. Cheek

2021 ◽  
pp. 1-7
Author(s):  
Nisha Gadgil ◽  
Ganesh Rao ◽  
Raymond Sawaya ◽  
Daniel Yoshor ◽  
Lucia Ruggieri ◽  
...  
Keyword(s):  
Patient Care ◽  
Pediatric Neurosurgery ◽  
Care Education ◽  
Children's Hospital ◽  
The Past ◽  
Children’S Hospital

Texas Children’s Hospital opened its doors in 1954, and since that time the institution has remained dedicated to a three-part mission: patient care, education, and research. Dr. William R. Cheek developed an early interest in pediatric neurosurgery, which led to his efforts in building and developing a service at Texas Children’s Hospital at a time when the field was just emerging. His work with other early pioneers in the field led to the establishment of organized societies, educational texts, and governing bodies that have led to significant advances in the field over the past 50 years.

Franc D. Ingraham and the genesis of pediatric neurosurgery

2013 ◽  
Vol 11 (6) ◽  
pp. 727-733 ◽  
Author(s):  
Subash Lohani ◽  
Alan R. Cohen
Keyword(s):  
Operating Room ◽  
Pediatric Neurosurgery ◽  
Associate Professor ◽  
Children's Hospital ◽  
Novel Treatments ◽  
Infancy And Childhood ◽  
The World ◽  
Children’S Hospital

In 1929, Franc D. Ingraham, Harvey Cushing's protégé, established the first pediatric neurosurgical unit in the world at Boston Children's Hospital and dedicated his career to the neurosurgical care of children. He trained with both Cushing and Dandy and spent 1 year working in Oxford with Sherrington, who considered Ingraham to be the finest operative surgeon ever to work in his laboratory. Ingraham was instrumental in developing novel treatments, which he compiled in his classic book, Neurosurgery of Infancy and Childhood. Although he was modest and shy, Ingraham loved to entertain children with magic and enjoyed photography in and out of the operating room. Unfortunately, his career was plagued by personal illness, and he died young in 1965 at the age of 67. Despite his prolific 36-year neurosurgical career, Ingraham remained an associate professor at Harvard at his retirement. To recognize his remarkable contributions, Harvard established an endowed chair in his name in 1967. Ingraham was a pioneer and a leader in the development of pediatric neurosurgery by virtue of his imagination, intelligence, and ability to lead and inspire others. Cushing has come to be regarded as the founder of neurosurgery. It is fair to conclude that Ingraham, his disciple, is the founder of pediatric neurosurgery.

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