Neurosurgery

The Division of Pediatric Neurosurgery is committed to the following core values: •We are dedicated to the delivery of comprehensive, compassionate, and timely family centered care to our patients and families •We collaborate with and respect all members of our regional community •Through clinical research, we hope to develop new and better treatments for neurosurgical disease

PEDIATRIC NEUROSURGERY IN THE TIME OF COVID-19

The year 2020 will be remembered by all of us who lived through it as a time of change. The Neurosurgery division rapidly responded to the challenge of Covid-19 by embracing telemedicine as a means of continuing to serve our patients. This included the development of innovative tools for craniometric assessment and standardized approaches to the evaluation of our patients. Our creative and pioneering approach in this area allowed us to assume leadership nationally on this topic, with division chief Jonathan Martin, MD, serving as moderator for the American Academy of Pediatrics Section on Neurological Surgery webinar entitled ‘Pediatric Neurosurgery Telehealth in the Time of Covid-19’ in April of 2020. The teamwork of our support staff, nurses, advanced practice providers, and physicians allowed us to maintain and improve our high standards of patient care through the pandemic.

PATIENT SATISFACTION

The Division of Pediatric Neurosurgery is committed to providing outstanding service to our referring providers and families. The division continues to earn ratings for patient, family, and provider satisfaction that are among the highest at Connecticut Children’s.

QUALITY IMPROVEMENT INITIATIVES

The Division of Pediatric Neurosurgery remains committed to patient quality and safety. Our internal quality program continues to benchmark our performance against existing national standards. We additionally participate in two national quality databases: the American College of Surgeons’ Pediatric National Surgical Quality Improvement Program (NSQIP), and the Hydrocephalus Research Network quality program (HCRNq), which Connecticut Children’s joined this year. Through ongoing development of clinical care pathways, we strive to provide outstanding care to our patients, families, and referring providers.

SURGICAL VOLUME

The Division of Pediatric Neurosurgery continues to provide the full spectrum of surgical care to the children of western New England. In 2020, nearly 250 children were provided surgical care by our team of expert providers. Our team met or exceeded institutional quality standards in addition to achieving below-benchmark complication rates for surgical site infection, shunt failure, and shunt infection rates as tracked by NSQIP.

CLINICAL INITIATIVES

The Division of Pediatric Neurosurgery strives to improve comprehensive offerings to the children of western New England through collaboration to develop innovative programs at Connecticut Children’s. Innovations in 2020 included: •The development of a combined neurosurgery/ orthopaedics peripheral nerve program which includes comprehensive care for infants with birthrelated brachial plexus injuries •Expansion of our multidisciplinary epilepsy program with performance of surgical offerings to include hemispherotomy for refractory epilepsy •Continued evolution of our craniofacial program to include implementation of care pathways to shorten length of stay and reduce transfusion rates for minimally invasive craniosynostosis surgery to near zero. In partnership with Christopher Hughes, MD,

MPH, in our Division of Plastic Surgery, our team has embraced virtual surgical planning to reduce operative times and improve surgical efficiency in children with complex craniofacial disorders.

EDUCATION, LEADERSHIP, AND RESEARCH

Our division remains committed to the mission of education and research. In cooperation with the University of Connecticut School of Medicine and Hartford Hospital, Connecticut Children’s succeeded in establishing an ACGME-accredited neurosurgical residency program in 2019. The program welcomed its first resident in July of 2019.

Connecticut Children’s neurosurgical providers continue to make their mark nationally. Dr. Martin continues to serve on the executive committee of the Section on Neurological Surgery of the American Academy of Pediatrics. His duties include chair of the Education, Publication, and Newsletter subcommittee. He also serves on the Committee for Quality, Safety, and Advocacy for the American Society of Pediatric Neurosurgeons.

Markus Bookland, MD, has continued in his role as associate director of Research and Academic Affairs

FY 2020 Surgical volume

Angio/Embo Peripheral Epilepsy Vascular Functional Spine Cranial Other Cranial Oncology Craniofacial CSF (Shunt or ETV) Minor Procedures

0 10 20 30 40 50 60 70 80

Quality Metrics, 2020 CT Children’s

National Benchmarks Shunt failure, 90 days 6% 11.5% (30-day data) 1 Shunt infection 0% 6% 2 30-day readmission 6% 8.1% - 11.2% 3,4 1 Piatt JH. JNS Peds 14: 179-183, 2014. 2 Kestle JRW et al. JNS Peds 17: 391-396, 2016. 3 Wrubel DM et al. JNS Peds 13: 216-221, 2014. 4 Sherrod et al. JNS Peds 13: 350-362, 2016.

for the Department of Surgery where his contributions are streamlining research operations for clinicians and researchers throughout Connecticut Children’s.

David Hersh, MD, our newest faculty member, wasted little time in establishing himself as a leader within the institution. He was awarded the prestigious Thrasher Research Fund Early Career Award during his first year at Connecticut Children’s. His publications were recognized with an Editor’s Choice Award by the Journal of Neurosurgery, and a faculty invitation to the International Paediatric Neurosurgery Journal Club. Dr. Hersh also spearheaded the founding of the medical student chapter of the American Association of Neurological Surgeons at the University of Connecticut.

PUBLICATIONS

Ajmera S, Motiwala M, Weeks M, Oravec CS, Hersh DS, Fraser BD, Vaughn B, Klimo P. What variables correlate with different clinical outcomes of abusive head injury? Neurosurgery. 2020 Sep 15;87(4):803-810. doi: 10.1093/neuros/nyaa058. Knopf JD, Kumar R, Barats M, Klimo P Jr, Boop FA, Michael LM 2nd, Martin JE, Bookland M, Hersh DS. Neurosurgical operative videos: an analysis of an increasingly popular educational resource. World Neurosurg. 2020 Sep 1:S1878-8750(20)31956-2. doi: 10.1016/j.wneu.2020.08.187. Epub ahead of print. Hersh DS, Dave P, Weeks M, Hankinson TC, Karimian B, Staulcup S, VanPoppel MD, Wait SD, Vaughn BN, Klimo P. Converting pediatric patients and young adults from a shunt to a third ventriculostomy: a multicenter evaluation. Neurosurgery. 2020 Aug 1;87(2):285-293. doi: 10.1093/neuros/nyz478. Hersh DS, Kumar R, Moore KA, Smith LGF, Tinkle CL, Chiang J, Patay Z, Gajjar A, Choudhri AF, Lee-Diaz JA, Vaughn B, Klimo P. Safety and efficacy of brainstem biopsy in children and young adults. J Neurosurg Pediatr. 2020 Jul 31:1-11. doi: 10.3171/2020.4.PEDS2092. Epub ahead of print. Lee RP, Ajmera S, Thomas F, Dave P, Lillard JC, Wallace D, Broussard A, Motiwala M, Norrdahl S, Venable GT, Khan NR, Harrell C, Jones TL, Vaughn BN, Gooldy T, Hersh DS, Klimo P. Shunt failure – the first 30 days. Neurosurgery. 2020 Jul 1;87(1):123-129. doi: 10.1093/neuros/nyz379. Gordon WE, Gienapp AJ, Khan NR, Hersh DS, Parikh K, Vaughn BN, Michael LM, Klimo P. Commentary: The clinical experience of a junior resident in pediatric neurosurgery and introduction of the Resident Experience Score. Neurosurgery. 2020 May 1;86(5):E447-E454. doi: 10.1093/neuros/nyz565. Norrdahl SP, Jones TL, Dave P, Hersh DS, Vaughn B, Klimo P. A hospital-based analysis of pseudomeningoceles after elective craniotomy in children – what predicts need for intervention? J Neurosurg Pediatr. 2020 Jan 31:1-8. doi: 10.3171/2019.11.PEDS19227. Epub ahead of print. Rocque BG, Weprin BE, Blount JP, Hopson BD, Drake JM, Hamilton MG, Williams MA, White PH, Orrico K, Martin JE*. Healthcare transition in pediatric neurosurgery: a consensus statement from the American Society of Pediatric Neurosurgeons. J Neurosurg Pediatr. 2020 Feb 14;1-9. doi: 10.3171/2019.12.PEDS19524. Epub ahead of print. Martin JE, Rocque B, Jea A, Anderson R, Pahys J, Brockmeyer D. Assessment of craniocervical motion in Down syndrome: a pilot study of two measurement techniques. J Neurosurg Pediatr. 2019 Oct 4;1-7. doi: 10.3171/2019.7.PEDS191. Epub ahead of print. Bookland M, Gillan E, Song X, Kolmakova A. Peripheral circulation miRNA expression of pediatric brain tumors and its relation to tumor miRNA expression levels. J Neurosurg Pediatr. 2020 May 8; 1-9. PMID: 32384264. doi: 10.3171/2020.2.PEDS19715. Epub ahead of print.

BOOK CHAPTERS

Martin JE, Pollack IF, Keating RF. Chapter 6: Neurosurgical techniques and strategies. In: Walker DA, Perilongo G, Taylor RE, Pollack IF, editors. Brain and spinal tumors of childhood. 2nd ed. Boca Raton, FL: CRC Press; 2020. p. 93-111. Shimony N, Hersh DS, Boop FA. Surgical approach to mesencephalic (midbrain) tumors. In: Jallo GI, Noureldine MHA, Shimony N, editors. Brainstem tumors: diagnosis and management. Cham, Switzerland: Springer Nature Switzerland AG; 2020. Nguyen V, Moore K, Hersh DS, Boop FA. Complications of Chiari surgery. In: Tubbs RS, Oskouian RJ, Turgut M, Oakes WJ, editors. The Chiari malformations. 2nd ed. Cham, Switzerland: Springer Nature Switzerland AG; 2020.

STAFF

Jonathan Martin, MD, FAANS, FACS, FAAP, Division Chief Associate Director of Trauma, Connecticut Children’s

Markus Bookland, MD Associate Director of Research and Academic Affairs, Department of Surgery, Connecticut Children’s

David Hersh, MD Allison Labelle, APRN Petronella Stolz, APRN, DNP

Affiliated Faculty Eileen Gillan, MD, Neuro-oncology Mark Lee, MD, Orthopaedic Surgery/Complex Spine Service Charles Castiglione, MD, Craniofacial Surgery Christopher Hughes, MD, Craniofacial Surgery Belachew Tessema, MD, Otolaryngology/ Endonasal Sinus Surgery Martin Ollenschleger, MD, Neurointerventional Radiology Sonia Chaudhry, MD, Orthopaedic Surgery/ Peripheral Nerve Jennifer Madan Cohen, MD, Epilepsy / Neurology Helaine Bertsch, MD, Radiation Oncology Minh Tang-Schomer, PhD, University of Connecticut Roel Verhaak, PhD, Jackson Laboratories