As many friends and colleagues know, we accepted the offer to be chief of neurosurgery
@PhxChildrens
w/ joint appointment as professor
@BarrowNeuro
@uarizona
. Excited to be returning to the SW closer to family. Thankful
@UWNeurosurgery
for the last 7 years. Starting end June!
JUST ANNOUNCED: Dr. Jason Hauptman has been appointed as division chief of neurosurgery, part of Barrow Neurological Institute at Phoenix Children’s. Read more »
@BarrowNeuro
Corpus callosotomy can be a powerful tool, especially for children living with LGS and frequent drop attacks. Now we are able to do these minimally invasively with laser ablation, so no big incisions, brain retraction, or risk of CSF leak!
From concept to reality… LITT for hypothalamic hamartomas has radically changed the HH landscape. No more big craniotomies, home the next day! Right on target with the ROSA.
Looking forward to meeting aspiring pediatric neurosurgeons for fellowship interviews
@PhxChildrens
@BarrowNeuro
. Our fellowship offers incredible faculty, high volume of diverse cases, great mentorship, and amazing weather ☀️ 🌵 🤠. Reach out with any questions!
#neurosurgery
Hemimegalencephaly in a child with medically intractable epilepsy. Generally speaking I still perform the lateral approach to hemispherectomy taught to me by G. Mathern years ago. Corona radiata—>medial temporal—> operculum w insula—>parieto-occipital—>callosotomy—>basofrontal.
Responsive neurostimulation (RNS) to the centromedian nucleus (CM) of the thalamus has opened new doors for children with LGS, generalized, and multifocal epilepsies. Refining signal detection in the thalamus and understanding optimal stimulation parameters —> ⬆️⬆️efficacy.
My wonderful partners
@UWNeurosurgery
@seattlechildren
honored me with an amazing dinner celebrating our time together over the last 7 years. I am thankful for all of them and have learned so much from everyone. I hope to have them all visit me in Phoenix! 🤠 🐴 ☀️ 🌵
C5 teardrop fx in a 16F s/p MVA. Neuro intact. Highly unstable - note retropulsion. MRI confirmed ALL and PLL out, signal in the 5/6 joints and posterior ligaments. Joined by my outstanding colleague Jay Turner MD from
@BarrowNeuro
for C5/6 ACDF.
#neurotwitter
#neurosurgery
LITT of a large subependymal giant cell astrocytoma (SEGA) in a 2 year-old child with Tuberous Sclerosis who failed everolimus. These are great cases and a terrific application of LITT - typically home the next day!
Today was our last day operating together as a fellow. Hannah Goldstein did a fantastic job this year and will be staying on as faculty! Now she doesn’t have to listen to me anymore 😉😀
@DrBrowd
Hemorrhagic venous infarct from CVST in a 9 y/o M. On heparin, right sided swelling progressed to refractory ICP. Stopped heparin gtt, have protamine. Taken for hemicraniectomy. Elected not to chase the clot. CVST is a challenging problem both surgically and medically.
Laser ablation for hypothalamic hamartoma has transformed our treatment of this challenging problem. Minimally invasive, home the next day. Here’s to no more gelastic epilepsy!
LITT to the orbitofrontal region following sEEG. Nonlesional MRI, this was the hot electrode. I think LITT is super reasonable option here - dominant frontal, convincing electrode, nonlesional. If fails, could consider lobectomy (maybe awake with language mapping or grid before)
Infant who suffered severe TBI requiring life-saving b/l hemicraniectomy by our amazing colleagues at
#Harborview
. now time to put the skull back together. our
#plasticsurgery
colleagues are the best in the country and deserve all the credit.
#neurotwitter
#MedTwitter
RNS insertion in a teenager who had both sEEG and grids localizing to the motor strip. Doing great - home next day! I’m hoping for great things once we fire this up!
View from the foramen looking at an ETV stoma, followed by a view through the stoma into the pre-pontine cistern. Getting through the membranes of Lilequist is critical to ensure you’ve done everything you can to maximize the chances of ETV success.
5 yo male with focal right temporal seizures occurring multiple times/day. MRI shows R Ant Temp dysplasia w/ PET hypometabolism. Underwent R ATL
@seattlechildren
, now seizure free. Cortical dysplasia is the most common etiology in peds epi surg.
#NeuroTwitter
#Neurosurgery
One of the most beautiful views in neurosurgery (to me) is looking at the third nerve, PCA, MCA through the pia after a temporal lobectomy. This was an 8 month-old child with a large cortical dysplasia/intractable epilepsy requiring the entire temporal lobe be resected.
One of my greatest joys is seeing children overcome, and not be defined by, their challenges. Cate is one of my TSC heroes. She and her family are amazing. I can’t believe this t shirt is now 3 years old! Saw them at our 2024 TSC walk this morning.
Two appropriately dosed and tolerated anti seizure meds and still having seizures? This is such a great time in epilepsy surgery - in addition to resection there are great neuromodulation options for children. Every child has surgical options!
Every day I'm humbled to be able to take care of children and to work with the incredible team we have here. This is Jiana. She is has been seizure free for over a year following her hemispherectomy for hemimegencephaly and intractable epilepsy. She is doing AMAZING!
Sometimes MRI-negative refractory temporal lobe epilepsy can be challenging to diagnose and treat. Prior sEEG—>LITT—>left temporal lobectomy each with a few months of seizure freedom followed by recurrence. Grids and language mapping are the next step.
Post-infectious hydrocephalus can be incredibly difficult to manage, especially in the setting of multiple loculations. This can result in the need for multiple ventricular catheters.
#hydrocephalus
#Neurosurgery
#neurotwitter
Thanks to
@PESAlliance
for inviting me to talk with Wes Phillips at epilepsy awareness day
@Disneyland
! It was awesome seeing friends
@TaylorAbelMD
@GMI_Canada
and others! Hopefully my kids will forgive me for making them go to school instead!!
7M with MIE secondary to a right perinatal MCA infarct. Hemispherectomy in these kids are great surgeries -many times they have already functionally remapped with minimal deficits post op. Technically easier/faster, faster recovery, higher success scores. Let’s cure epilepsy!
Child p/w subacute failure. Astute trainee sees something on shunt series. Confirms break on CT recon. When I see a Rickham shear like this, I replace the entire distal system thinking something is putting tension on it from below.
#Neurosurgery
#neurotwitter
#MedTwitter
Young child with explosive daily seizures emanating from a right parietal lesion filling the inferior aspect of superior parietal lobule, wrapping around the temporal parietal operculum and abutting primary motor. Resected with motor strip mapping and ECOG. Likely dysplasia plus.
Left hippocampal laser ablation - we started using multiple catheters/trajectories to increase the anterior coverage. Now we do the usual one occipito-temporal and a second one orthogonal into the amygdala to increase anterior/superior/medial coverage.
Busy call week. Very occluded ventricular catheter in a young child presenting in shunt failure. Lots of work still needs to be done to understand the etiology of, and potential treatment options for this potentially lethal problem.
#hydrocephalus
#neurotwitter
#MedTwitter
6F with one week h/o otitis, tx by PCP. Came to ED with lethargy, ataxia, vomiting. Imaging showed p fossa cystic lesion with hydrocephalus. Emergent EVD placement, suboccip craniotomy with abscess washout followed by mastoidectomy.
#MedTwitter
#neuro
#neurosurgery
#neurotwitter
Bilateral CMPf DBS in an 11 yo child with LGS/MIE who is s/p VNS and corpus callosotomy. In our opinion - jury is still out on DBS vs RNS in thalamus. Both have advantages/disadvantages and probably doing equal numbers of both nowadays. Thoughts?
Large encephalocele in a newborn. When thinking about surgery, venous imaging critical. Prognosis based on presence of other congenital anomalies, microcephaly, seizures, hydro. Always think about hydro in the periop period.
#Neurosurgery
#neurotwitter
#MedTwitter
#neuro
In this episode of “unsolved shunt mysteries” - child presents in shunt failure and proximal catheter appears disconnected on imaging. Open up and find that the rickham tip has actually sheared off - resulting in said disconnection.
#hydrocephalus
#Neurosurgery
#neurotwitter
18F with MR negative MIE. Did a sEEG localizing to R occipital lobe. Already had a quadrant cut preop. Performed R occipital lobectomy w ECOG - hot over entire occipital lobe. White matter felt very firm like cortical dysplasia, tracking towards ventricle (common for FCD).
Congratulations to Jeffrey Ojemann, MD, for being honored with an alumni achievement award from
@WashUAlumni
for his contributions to
#epilepsy
research and surgery. His career exemplifies the
#WashUWay
, and we're proud to call him one of our own.
@seattlechildren
@UWMedicine
I wish you all health, prosperity, and peace in the upcoming year. To all my medical colleagues out there: each and every one of you is loved and appreciated. Your work is irreplaceable. Your hearts are big and tenacity unparalleled. Stay strong my friends.
Watch a clip from Jasmine’s conversation with the surgical team at Seattle Children's during her awake craniotomy procedure, led by
@jshauptman
, and learn how the program is giving more patients like Jasmine hope for a life without seizures.
Sometimes sEEG is not enough and you need to follow it up with a subdural grid placement for localization and mapping. Interhemispheric grids can be tricky - gotta respect the midline veins!!
Today we are launching BrainChild-04, a phase 1 clinical trial that will be our first chimeric antigen receptor (CAR) T-cell clinical trial that targets four antigens at the same time by delivering
#CARTcells
directly to the brain.
#DIPG
#DMG
#CNStumors
Beautiful views from our new 4K storz flexible endoscope. ETV for hydrocephalus from a mixed germ cell tumor. Note ETV stoma, then retroflexed scope for view of aqueduct and pineal region tumor.
Wearing a helmet while riding ATVs is a MUST. Riding in uneven terrain at a high speed can result in serious injury. Open depressed skull fx with dural lac and brain egress. Required I&D/crani, frontal sinus exent, and EVD. We have an amazing plastics, ophthalmology, trauma team!
Weekends are for mountains, dirt, and mountains of dirt. Take it from your local pediatric neurosurgeon - ATVs are cool, ATV helmets are even cooler. I’m on pit mechanic duty - but making sure the ones I love ride safely. No one wants to spend a weekend in the neuroICU!
#ridesafe
Awake craniotomies, once depicted by Hollywood as exotic and dramatic, are now a routine tool in the surgical toolbox. As noninvasive mapping improves, there will probably be a time when we can put this on the back shelf. Until then, still one of the coolest things we do!
Recurrent brain abscess of unclear etiology in a young girl. Pre (left) and post (right) from washout. Think local spread (sinuses, post-op, dental, trauma) or hematogenous (cardiac, pulmonary, CF, septicemia). Can be small AVFs or AVMs.
#neurosurgery
#neurotwitter
#MedTwitter
Young child with rapidly growing arachnoid cyst (grew 300% larger in 2 years!) and headache. Indications for fenestrating these are few and far between. Most should be left alone.
Even though as of late the vast majority of invasive monitoring cases have been minimally invasive robot-assisted sEEG, sometimes the old ways are the best ways.....
@UWNeurosurgery
@UWMedNSI
Had a great time at the CNS - was able to connect with many talented and kind colleagues from around the country. Enjoyed teaching (and learning) at the pediatric LITT course and moderating a session on pediatric sEEG. Austin is a fun town!
Interesting case. VP shunt placed, abdominal exposure done by mini lap. Liver visualized. Post op films show tight coiling. Asked g surg to take a look with scope, catheter intraperitoneal but coiled in a liver adhesion —> falciform.