• Advancing Pediatric Neurosurgical Care

    Author: Bruce A. Kaufman

    From the Pediatric Section

    Members of the Pediatric Section are those who are interested in the neurosurgical care of children. I would like to highlight some of our section’s activities, within and outside neurosurgery, which affect that care.

    Meetings Update
    I commend Dr. Benny Iskandar and Dr. Cathy Mazzola for their interactions with both the CNS and AANS and their work done on behalf of the Pediatric Section. Dr. Iskandar and Dr. Mazzola have led our National Meeting subcommittee and have organized the planning of pediatric content throughout the national meeting cycle (Pediatric Section, AANS, CNS) to provide cohesive programming that is not duplicative. We are excited that our vision for coordinating the pediatric neurosurgery content among the national meetings is working so well, and we are committed to continuing these actions in the future.

    The 43rd annual winter meeting of the Pediatric Section was held December 2-5 at the Omni Hotel on Amelia Island. Dr. Phil Aldana and his associates assembled a very complete and interesting program. The meeting theme focused on collaboration in research, education, and quality initiatives. This year we held the first American Academy of Pediatrics/ Section of Neurological Surgery lecture, which was given by Dr. David L. Woods on the transition of care in pediatric neurosurgery patients. The annual Raimondi Lecture, presented by Dr. Pascal Lee, co-founder and chair of the Mars Institute, was titled “From Earth to Mars: Steps Towards the First Human Mission to the Red Planet.”

    There were additional practical courses in pediatric cranio-cervical surgery and in coding specific to our pediatric practice. Symposia were held around collaborative work in research, education, quality, craniosynostosis, and in utero myelomeningocele repair. The popular advanced practice provider full-day course was augmented with APP specific breakfast seminars during the meeting.

    This year the Pediatric Section recognized Dr. Marion “Jack” Walker with the Franc D. Ingraham Award for Distinguished Service and Achievement. Dr. Walker is well known in the pediatric and adult neurosurgical world and is justly deserving of our section’s highest honor.

    The next Pediatric Section winter meeting will be in Seattle, December 8-11, 2015. The local hosts are Dr. Sam Browd and Dr. Amy Lee.

    The Pediatric Section hosts two afternoon sessions during the AANS annual meeting. The annual Matson lecture occurs during one of these sessions and this year is presented by Mark Wietecha, president and CEO of the Children’s Hospital Association (combined from the old CHCA, NACHRI, and NACH in 2011). The title of his presentation is “Current Health Care Trends and Implications for Pediatric Neurosurgery.” Mr. Wietecha was involved in the development of the document “Optimal Surgical Outcomes for Children” and is knowledgeable about the associated program from the American College of Surgeons setting up voluntary certification for children’s hospitals surgical services.

    Research and Educational Efforts
    The Pediatric Section maintains individual efforts and budgets financial support for educational and research activities at the section, national, and international levels.

    NREF financial support continues for another year, and our research committee has worked well this past year with NREF in their selection of awards, and in defining pediatric projects to fund.

    The Pediatric Section has provided research project funding (“seed money”) for pediatric neurosurgery research projects primarily in the clinical, outcomes, and quality areas. The goal is to encourage more extensive work from these projects. The recipients have reported back to the section at our annual winter meeting. The Federation of Latin American Neurosurgeons annual meeting (FLANC) has received ongoing support from our section with a small stipend and provision of faculty. We plan to continue to support this meeting.

    Since 1998, the Pediatric Section has provided funding for observational fellowships. Approximately 27 international and 33 domestic fellowships have been awarded. The domestic one-month fellowships are for North American neurosurgery residents interested in pediatric neurosurgery, and the international three-month fellowships are for international physicians to obtain exposure to pediatric neurosurgery. Our education committee recently surveyed former fellows in this program. The vast majority of funded domestic fellowship participants found the experience extremely beneficial, and most of these residents ended up pursuing formal pediatric neurosurgery training.

    The section leadership and its committees continue to evaluate these programs and to optimize our support. We are exploring and discussing new ideas and opportunities to best serve the interests of the section and its members.

    Quality and Outcomes Work
    The Pediatric Section’s work on hydrocephalus guidelines recently was published in a supplement to the Journal of Neurosurgery and was well received. Our section’s outcomes committee is already working on the next project—pediatric plagiocephaly.

    We maintain a liaison to the American College of Surgeons pediatric surgical quality initiative (Pediatric NSQIP) and to NeuroPoint Alliance, but we wish to create and enhance more pediatric-neurosurgery-focused quality and outcome projects. Toward this end, the section will cultivate a more comprehensive interaction with the American Society of Pediatric Neurosurgery to develop and enhance quality and outcomes work within pediatric neurosurgery.

    Interactions with Outside Medical Groups
    The Pediatric Section continues to have a “liaison” relationship to the Fetal Myelomeningocele Surgery Consortium. The consortium has established and is beginning to populate their database on the procedure and outcomes.

    Also, over the last few years, pediatric neurosurgeons have had an ongoing presence during the development of the “Optimal Resources for Children’s Surgical Care in the United States.” The Pediatric Section supported the final document that was published in the Journal of the American College of Surgeons.

    Subsequently, the American College of Surgeons has worked with the original task force that created the optimal resources document, and has established a process to verify and accredit pediatric surgical care sites according to the criteria noted in the published document. The ACS will be performing the verification and accreditation in a manner similar to that employed with trauma site certification and will begin the process this spring. Our section leadership does not expect there to be any direct impact on neurosurgery.

    These are my last few months as chair of the Pediatric Section, and I have been honored to assist the many members who have worked on behalf of our section and on behalf of neurosurgery. I encourage any CNS members with an interest in pediatric neurosurgery to join our section and participate in our various activities.

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