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Pediatric Neurology at Morgan Stanley

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About Pediatric Neurology at Morgan Stanley Children's Hospital

The NewYork-Presbyterian Morgan Stanley Children's Hospital, located at NewYork-Presbyterian's Columbia University Medical Center campus, is the flagship facility for the most comprehensive pediatric care in the Tri-state area. The Division of Pediatric Neurosurgery, one of the largest in the Northeast, offers comprehensive services for all children with neurosurgical issues. With three full-time pediatric board-certified neurosurgeons practicing at the highest ranked Children's Hospital in the Tri-State area, the Division provides a broad range of expertise in an unparalleled, supportive environment. In conjunction with the Divisions of Pediatric Neurology, Pediatric Oncology, and Pediatric Critical Care, clinical problems including hydrocephalus, brain and spinal tumors, Chiari malformation, craniosynostosis, tethered cord, complex spinal deformity, spasticity, epilepsy, arteriovenous malformations (AVMs), moya-moya, and many other disorders are treated with the most effective methods available (see below). Patients can be seen at nine convenient locations throughout the Tri-state area from Central New Jersey to Southern Connecticut.

Pediatric Neurology Services at Morgan Stanley Children's Hospital

Spasticity

The goal of the multidisciplinary spasticity center at the Morgan Stanley Children's Hospital is to provide the highest level comprehensive care for children with spasticity. By combining expertise in pediatric neurosurgery, neurology, orthopedics, physical therapy, occupational therapy, nursing, orthotics, and social work, our team is able to offer a global team assessment, implement a well-balanced treatment plan, and provide continuous follow-up care. Providing compassionate care in the highest ranked children's hospital in the Tri-state area, our team offers comprehensive physical and occupational therapy assessments, intramuscular injections, oral medications, orthopedic surgical treatments, and neurosurgical treatment options including intrathecal baclofen pump and minimally invasive selective dorsal rhizotomy.

Craniosynostosis

In the Division of Pediatric Neurosurgery at the Morgan Stanley Children's Hospital, recent advances have made surgery for children with craniosynostosis shorter and safer. Minimally invasive endoscopic-assisted craniosynostosis surgery utilizes a small camera to assist with removal of the abnormal bone that causes skull deformity through one or two one-inch incisions. The surgery is performed in one to two hours, children rarely need a blood transfusion, and they typically go home the next day. This is in striking contrast to the traditional approaches used to treat craniosynostosis at nearly all other centers in the Northeast. Traditional approaches typically require a large incision across the top of the head from ear to ear, removal of a much larger amount of bone, and then reshaping and replacement of the removed bone. This surgical approach usually requires 4-6 hours, causes much more pain and swelling, requires a blood transfusion, and children remain in the hospital for about 4-7 days. The key for success using the minimally invasive endoscopic-assisted approach is to intervene early, when the bone is thin. Removal of the prematurely closed suture (the abnormal bone) when the child is between two and six months of age allows the skull to develop a more normal shape as the child grows. The use of a helmet for 6-12 months after surgery helps facilitate this bone remodeling.

Complex spinal deformity

Recent advances in spinal surgery have revolutionized care for children with spinal disorders and scoliosis. Many children, for example, can develop instability at the upper part of the spine (called the craniovertebral junction) either after trauma or secondary to genetic disorders like Down syndrome. It is critical to stabilize the spine in these children or devastating injury to the spinal cord can occur. Traditional approaches have been to perform surgery using bone and wires and then bracing children in a halo for 3-6 months. A halo involves placing a ring around the child's head, which is secured with 6 to 10 screws directly into the skull, and then connecting it with four metal rods to a plastic shell around the chest. Even in the most experienced centers, the success rate for this surgery was only about 80%, there were many complications using the halo, and many children required repeated surgery. Using newer, innovative techniques, we can now safely use rigid instrumentation to directly stabilize the spine without the need for a halo or other cumbersome postoperative bracing. By placing different types of screws into the bone and directly across the joint, they immediately stabilize the damaged region of the spine. Children are able to resume normal activities much earlier than with traditional approaches, and without the discomfort and complications of invasive bracing. Studies have shown that these techniques can be used even in very young children without halting growth of the spine. Our pediatric neurosurgeons have more experience with these techniques than any other center in the Northeast. They have played a major role in advancing the field of spinal instrumentation at the craniovertebral junction in children, with success rates for the surgery approaching 100%.

Epilepsy

The Pediatric Epilepsy Center at the Morgan Stanley Children's Hospital is one of the most active pediatric epilepsy programs on the East Coast and is a major referral program for the treatment of intractable seizures. A comprehensive multidisciplinary team provides evaluation and treatment for the most complex patients. Our state of the art Pediatric Epilepsy Monitoring Unit serves nearly 400 patients a year.

Tumors of the brain and spine

A major thrust of our clinical and research efforts at the Morgan Stanley Children's Hospital revolves around children with tumors of the brain and spine. Weekly multidisciplinary conferences including neurosurgery, neurology, oncology, nursing, and social work allow individually tailored treatment plans to insure the best possible outcomes. Active participation in the Children's Oncology Group allows children to participate in treatment protocols offered only at selected centers across the nation. Furthermore, we are actively conducting both basic science laboratory research and clinical trials to offer hope for children with malignant brain tumors.

Vascular disorders

The Morgan Stanley Children's Hospital has a rich history in managing complex vascular conditions of the young and developing brain. Working in close collaboration with the interventional radiology department we have greatly reduced the risks and improved outcome in children with complex vascular conditions such as arteriovenous malformations (AVM), aneurysms and Moyamoya disease. We have a large collaborative effort with the pediatric hematologists and have published the largest series of children with Moyamoya and Sickle Cell Anemia. Using highly focused radiation therapy in the form of the Gamma Knife (known as stereotactic radiosurgery) allows us to treat AVMs in very delicate and deep seated locations in the brain. Without this technology many of these vascular lesions were thought to be untreatable in the past. Not every child with a vascular lesion of the brain or spinal cord requires surgery. Working with our team, many children have been successfully cured never having to have undergone open neurosurgery.

Pediatric neurocritical care

The intensive care units at the Morgan Stanley Children's Hospital provide care around the clock to infants, children, and adolescents with life-threatening neurological illnesses and injuries, as well as those recovering from major or high-risk neurological surgery. The Critical Care Division oversees all of the clinical care in our 41-bed Pediatric Intensive Care Unit (PICU), treating more than 1,900 patients annually. The staff is committed to the principles of family-centered care. Parents are key participants on their child's health-care team and we encourage them to spend as much time as possible at the bedside in the ICU with their child.

Neuromuscular, metabolic and other neurological disorders

Doctors at the Morgan Stanley Children's Hospital offer particular expertise in the diagnosis and treatment of rare and more common metabolic and genetic diseases, developmental disorders, and neuromuscular conditions. We provide coordinated care through dedicated programs for the treatment of autism and related disorders, muscular dystrophy, and spinal muscular atrophy. Our laboratory and clinical research program enables patients with challenging conditions to participate in trials of experimental therapies.

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