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Cross-Post: A Pediatric Neurosurgeon Reflects on His Job and the Post-Roe Landscape

By Cross Post, PediatricsNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will interest our readers. Today’s post originally appeared in NPR’s Fresh Air on July 28. Dave Davies interviews pediatric neurosurgeon John “Jay” Wellons, III, MD, FAANS, about his memoir “All That Moves Us,” which reflects on his experiences operating on children facing critical illnesses and injuries.

Dr. Wellons relays the story of a 9-year-old pediatric patient in an auto accident in Alabama who had a blood clot pushing her brain. Due to the weather, medevac helicopters weren’t running. Dr. Wellons recounts he arranged for a military Blackhawk to bring her to Birmingham, Ala., for surgery. The surgery was successful, according to Dr. Wellons, “The flicker of the eyes open – that’s a miraculous feeling, Dave, you know, to see somebody wake up after something like that.”

Dr. Wellons also describes an operation on a fetus in the womb, the spine he describes as the size of three grains of rice stacked together. This was surgery to correct a condition that leads to spina bifida.

When asked what he thinks will happen in the post-Roe landscape, Dr. Wellons states, “I can’t tell you how much I think that this ruling is going to affect what it’s like for families to have these substantial — neurologic, cardiac, urologic — encephaloceles where the gut’s outside the body that is hard to be fixed sometimes. Like, we’re going to see a lot more of these now, and we’re going to have to, as a society, understand that we’re going to have to take care of these children. That’s our job. So, yes, I think it’s going to have an impact.”

Click here to access the full interview.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

Cross-Post: If Our Politicians Could See What We See: A Pediatric Neurosurgeon on Gun Violence

By Cross Post, PediatricsNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will be impactful for our readers. Today’s post originally appeared in Time on June 23. Pediatric neurosurgeon John “Jay” Wellons, III, MD, FAANS, recounts his experience treating a patient hit in the skull by a bullet fired into a crowded playground. “As surgeons, we find ourselves left trying to fix the ghastly results of so much of this gun violence that seems endemic in our country,” Dr. Wellons states.

Dr. Wellons recounts how a colleague stood in an emergency department close to Sandy Hook Elementary years ago as the calls began to come in, he and his surgical team in medical gowns ready for the waves of injured children — waiting until they realized that no one survived to make it there. He concludes the article by saying, “Let me be clear, the death of children from any injury or any reason is heartbreaking, and the fact that gun-related death is the number one killer of our children, more than motor vehicle collisions and childhood cancer what our medical journals have been telling us over the last few months is a failure of our society and needs to be changed.”

Editor’s Note: The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have long promoted education programs designed to prevent firearm injuries by teaching and encouraging proper firearm use, safety, storage and ownership responsibility. The AANS and the CNS praised Congress for passing the Bipartisan Safer Communities Act. The neurosurgical groups believe that this gun safety legislation — which would expand background checks, restrict certain individuals from owning firearms and provide incentives for states to enact “red-flag” programs — is a crucial step in preventing tragic and senseless firearm deaths.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

Cross-Post: Brain Tumors in Children

By Brain Tumor, Pediatrics, Tumor, Tumor SeriesNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting pieces from other publications that are worthy of sharing with our readers. Since we are in the middle of our focus series on tumors, we wanted to bring attention to an article published in The New England Journal of Medicine (NEJM) on May 19. Alan R. Cohen, MD, FACS, FAAP, FAANS, discusses recent changes to the classification and management of brain tumors in children. In 2021, the World Health Organization introduced changes in brain tumor taxonomy, emphasizing molecular diagnostic features. These changes reflect the trend of assigning diagnostic categories based on genetic features that, in many cases, drive prognosis and offer potential targets for treatment.

Brain tumors are the leading cause of death from cancer in children. Tumors of the central nervous system (CNS) account for 20% of childhood cancers and are second only to leukemia in frequency. Recent diagnostic and therapeutic advances have improved survival and quality of life for many children with CNS cancers. Sadly, however, the prognosis for many children with brain tumors remains poor.

Click here to read the full NEJM article.

To learn more about Dr. Cohen’s work as a pediatric neurosurgeon and how he uses humor (and Elvis) to bring joy to his patients and their families, check out this oldie but goodie from Good Morning America.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

Alan R. Cohen, MD, FACS, FAAP, FAANS
Department of Neurosurgery, Johns Hopkins University School of Medicine
Baltimore, Md.

Permanently Funding CHIP is Essential for the Health of Our Children

By Guest Post, Health Reform, PediatricsNo Comments

The Children’s Health Insurance Program (CHIP) is a health insurance program that provides coverage to children from low-income families. CHIP was established in 1997 with strong bipartisan support and is an essential state-federal partnership. As many as 15% of children lacked health insurance coverage at the time. According to the American Academy of Pediatrics (AAP), Medicaid and CHIP provided health insurance to more than 50% of U.S. children in 2012, making both programs combined the nation’s largest insurer. These children and their families depend on federally subsidized state Medicaid for their health insurance.

As a pediatric neurosurgeon in New Jersey, I have seen how these programs help children and allow them to have their well visits, sick visits and hospitalizations covered. The program is not perfect — for example, provider reimbursements are typically well below market rates and fail to cover physician practice costs. Thankfully, however, many physicians in our state — and across the U.S. — accept CHIP-covered patients providing access to care is needed for these children who otherwise would not receive the medical and surgical care that they so desperately need. And as we know, healthy children grow up to become healthy adults.

Unfortunately, since the program’s inception, Congress must reauthorize CHIP every few years, putting this vital coverage in jeopardy. In fact, at one point in 2018, CHIP funding lapsed for an unprecedented 114 days. While Congress extended CHIP funding through 2027, the program remains vulnerable without permanent financing.

Fortunately, Congress is currently considering legislation to fund CHIP permanently. One such effort is being led by Reps. Vern Buchanan (R-Fla.) and Lucy McBath (D-Ga.). Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act (H.R. 66) would ensure that gaps in CHIP coverage would never again happen.

Kids need access to care, and pediatric neurosurgical patients depend on CHIP funding. We need to provide adequate health care for children from low-income households. We have a fiduciary responsibility and an ethical obligation to support permanent funding for the CHIP. This is not just my opinion, but truth and reality. If Congress does not act, federal funding for CHIP will expire.

CHIP has provided access to care that low-income families would not have had otherwise. As a nation, we need to come together to support permanently funding CHIP through the CARING for Kids Act or similar federal legislative efforts so our children will have access to health care that they so desperately need.

Please help make permanent funding a reality by taking a moment to contact Congress and ask your representative to co-sponsor H.R. 66. Click here to go to neurosurgery’s Advocacy Action Center to send an email to your elected officials asking them to co-sponsor H.R. 66. A sample message, which can be personalized, is provided. It takes less than a minute to make a difference in the lives of millions of children and their families, so please act today!

 Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FundCHIP.

Catherine A. Mazzola, MD, FAANS
New Jersey Pediatric Neuroscience Institute
Morristown, N.J.

A Memorial Tribute to The Most Interesting Man in the World: James T. Goodrich, MD, PhD

By COVID-19, Faces of Neurosurgery, PediatricsOne Comment

The passing of James T. Goodrich, MD, PhD on March 30, 2020, was a devastating blow — not only to the neurosurgical community, but to his many friends throughout the world. Jim was a kind and compassionate man who was revered by many. He was always willing to help others and traveled extensively to help those who needed his expertise. He was a great teacher, surgeon and student of medical history. His accomplishments were many and varied.

  • He is probably best known for his technique for separating craniopagus twins. See, from the Journal of Neurosurgery: Pediatrics, “Craniopagus twins.” Jim was an advocate for the staged separation technique and brought it to new heights with his development of a multidisciplinary approach and the use of modern neuroimaging.
  • Jim was also an expert in craniofacial surgery. He was sought after for many national and international courses and conferences for his knowledge and teaching abilities. He was a frequent faculty member at the European Pediatric Training courses. He then helped developed these same courses in Asia, Latin and South America, and other locations throughout the world.
  • He had a life-long love of medical history. As a young neurosurgeon in training, he started a business collecting and selling medical artifacts and books of historical significance.
  • Jim was the recipient of multiple awards, including Best Doctors in America. He received the New York City Mayors Award in Science and Technology. He was a former marine and received the Marine of the Year Award for his contribution to society.

Colleagues, friends and family recently held a moving memorial tribute, which tells the story of Jim’s life and times.

He will be greatly missed.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Marion L. Walker, MD, FAANS
Professor Emeritus
Department of Neurosurgery
University of Utah School of Medicine

Congress of Neurological Surgeons Releases New Pediatric Guidelines

By CNS Spotlight, Cross Post, Pediatrics, Quality ImprovementNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. We wanted to bring attention to a Congress of Neurological Surgeons (CNS) evidence-based guideline on pediatric myelomeningocele that recently appeared in Neurosurgery, the official journal of the CNS, which publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology and medicine.

In August, Neurosurgery published the “Congress of Neurological Surgeons (CNS) Systematic Review and Evidence Based Guidelines for Pediatric Myelomeningocele,” which includes 6 chapters that systematically review the literature and include evidence-based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord.

According to the CNS press release, “it is the Guideline Task Force’s aim that these systematic reviews and subsequent evidence-based recommendations will lead to improvement in the quality of life for infants and children with myelomeningocele.”

To read the full Neurosurgery article, click here. The complete guideline can also be found on the CNS website, here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

Catherine A. Mazzola, MD

David F. Bauer, MD