Tuesday, October 19, 2010

Neurosurgery Program Expands

As part of its mission to provide outstanding, personalized, and developmentally appropriate care for infants, children and adolescents, MassGeneral Hospital for Children (MGHfC) has formalized its pediatric neurosurgery program under the leadership of Ann-Christine Duhaime, MD.

Ann-Christine Duhaime, MD

Ann-Christine Duhaime, MD

The program will continue offering multidisciplinary care for children with a variety of nervous system problems, Dr. Duhaime says, while capitalizing on Massachusetts General Hospital’s unique strengths in science and technology to advance understanding of normal brain function and to optimize treatments for diseases affecting children of all ages.

Advances made at Mass General and other major academic medical centers have improved care for adult patients undergoing treatment for cancer and functional disorders, including epilepsy movement disorders, and certain behavioral problems. Experts from a wide range of pediatric and adult specialties are now working together at MGHfC to translate these improvements into safe new treatments for children.

“MassGeneral Hospital for Children combines incredible strength in imaging, psychiatry, neurology, neuroradiology, neurosurgery, ethics, neuropsychology, child development, pediatric social work, pediatric nursing, child behavior, and education with a track record of careful, objective multidisciplinary research into brain function,” Dr. Duhaime says.

The neurosurgery team includes William Butler, MD, neurosurgeon; Paul Chapman, MD, neurosurgical director of the Proton Radiosurgery Program; Emad Eskandar, MD, director of stereotactic and functional neurosurgery at MGHfC Christopher Ogilvy, MD, director of the Brain Aneurysm/AVM Center and Cerebrovascular Surgery Unit; and Brooke Swearingen, MD, neurosurgeon. The team also includes specialists in neurofibromatosis. See neurofibromatosis team.

"The expansion of the pediatric neurosurgery program within a broad array of specialty neurosurgery expertise and guided by a world-renowned leader such as Professor Duhaime will be of great benefit to the community we serve in Boston and all of New England,” says Robert Martuza, MD, chief of neurosurgery at Mass General.

Advancing Treatment of Pediatric Brain Tumors

Mass General has become a leader in the development of personalized medicine for cancer patients. The hospital has established a laboratory in which tumor specimens are genotyped, or evaluated for their genetic composition, to find specific types that are known to respond to existing drugs or that represent new targets for drug development. This approach has revealed opportunities to use targeted therapies in diverse cancers. Routine screening for many cancers, including brain tumors, is already in place for adult patients, and genotyping in pediatric brain tumors could lead to similar advances in the treatment of children. 

MGHfC also continues to offer established treatments for children with brain cancers and to invest in technology and staffing to improve surgical outcomes. The new inpatient and outpatient facility will house a state-of-the-art neurosurgical operative suite, complete with an advanced MRI for use during surgery and other on-site imaging capabilities.

MGHfC is adding a team of specialists with extensive experience monitoring and mapping brain function in children during surgery. “This team, in concert with the other specialists and subspecialists and the tools and techniques already available to us here at MGH, means we have available any resources required by any given patient,” Dr. Duhaime says. “Treatment of tumors, refractory epilepsy, and congenital malformations all may benefit from these new collaborations.”

Understanding Deep Brain Stimulation Use in Children

Deep brain stimulation (DBS), used for the treatment of Parkinson’s disease and other disorders in adults, represents another area where interdisciplinary collaboration can lead to safe and effective translation of adult treatments into improved pediatric care. DBS works by providing a tiny, focused amount of electrical stimulation to a specific part of the brain to allow malfunctioning brain circuits to work more normally. 

DBS has already been used in adolescents and even some younger children for various types of movement disorders. Emad Eskandar, MD, director of stereotactic and functional neurosurgery at MGHfC, is investigating the effect of DBS on disorders with behavioral components like Tourette Syndrome. According to Dr. Duhaime, DBS appears promising for treatment of many other diseases and syndromes, including specific forms of epilepsy, certain types of learning and attention problems, and some behavioral and psychiatric diseases. She is also planning to work with an area rehabilitation hospital to explore how DBS might be used to help patients with brain injuries.

“This technology has the capacity to modulate brain function with treatments that can be titrated or terminated, that don’t involve creating permanent lesions in the brain, and that involve only a brief inpatient stay,” says Dr. Duhaime. “Our role will be to determine whether such an approach presents any long-term benefits or side-effects in the developing brain and, if the technology proves safe, to continue expanding exploration of the potential uses of DBS in the pediatric population.”

Enhancing Brain Recovery Following Injury

Of particular interest to Dr. Duhaime is the brain’s response to injury as a function of the brain’s maturity at the time of injury. Dr. Duhaime’s laboratory is involved in basic science research in this area as well as participating in a multicenter trial using instrumented helmets to study what mechanisms are linked to specific brain problems in young athletes.

Clinical researchers in pediatric neurosurgery at MGHfC are also participating in national studies designed to gather sophisticated data on traumatic brain injury from large numbers of adults and children. Information gleaned from these studies will ultimately be integrated into stratified, multidisciplinary treatment trials for infants, children and adults with various types of traumatic brain injuries, as well as investigating host factors, such as genetics, which influence outcome.

In addition to these new areas of research, MGHfC will continue to provide general pediatric neurosurgical services, including care for patients with hydrocephalus and brain cysts, craniofacial disorders, congenital anomalies of the spine and brain, vascular problems and pediatric brain and spinal cord tumors, with a commitment to providing child-friendly ancillary diagnostic and surgical services.

The hospital will also continue offering proton radiation therapy and consultations for pediatric neurosurgical patients from around the world. Mass General is one of only a handful of centers in the United States offering proton therapy, an important option for children because it minimizes danger to healthy tissue. Proton therapy exemplifies the type of unique treatment options available at MGHfC for children with various nervous system problems. With the expansion of the pediatric neurosurgery program, more children may benefit from the wide variety of innovative services offered at Mass General.

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