MDNews - Long Island

SPECIAL FEATURE "Alternatively, motor mapping begins with stimulation of the motor cortex, and if that results in movement in the body, that means the motor pathways are intact." Vascular Treatment Dr. Grant may also use radiosurgery An image of a Chiari malformation hypothalamus makes it particularly dangerous, as it can cause behavioral, endocrine, and obesity problems. Instead of aggressively resecting the entire tumor, Dr. Grant resects as much as he can, leav- ing portions close to the hypothalamus or its stalk. Because children younger than age 9 are susceptible to whole-brain radia- tion, Dr. Grant delivers focused radiation to the tumor's remnants with Gamma Knife or CyberKnife radiation therapy. When surgical intervention is suitable for pediatric brain tumor patients, the extensive monitoring program used by Neurological Surgery, P.C.'s neurosur- geons maps both sensory and motor pathways, enabling physicians the vis- ibility necessary to ensure the procedure itself does no harm to the patient. "This system assesses whether the pathways are intact across the area where you're working," says Dr. Grant. technology in cases such as arteriove- nous malformations; however he notes that when performing vascular surgery, having a skilled team can be as important as any technology. The vascular team, consisting of Dr. Grant; Michael H. Brisman, M.D., FACS; and John Pile-Spellman, M.D., FACR, provides a wide array of treatments for patients with vascular problems. According to Dr. Grant, the most fre- quent pediatric condition they treat is moyamoya — the Japanese word meaning "puff of smoke" and an apt description of the appearance of the tangle of arteries seen on an MRI. The condition presents with stroke or recurring ministrokes, accompanied by muscle weakness, paralysis limited to one side of the body and seizures. To reopen the blocked arteries, Dr. Grant performs an encephaloduro- arteriosynangiosis (EDAS) procedure, taking the superficial temporal artery and sewing it directly to the surface of the brain. Dr. Grant notes the importance of Dr. Grant studies images of hydrocephalus on a CT scan. a team that can provide expert vascular care, but is skilled in anesthetizing pediatric patients. Straightening Up Neurological Surgery, P.C. neurosur- geons provide specialized care for not only spinal tumors, but also structural spinal abnormalities. With special expertise in spine surgery and orthopedic spine deformity training, Dr. George provides care for patients of all ages, but part of his practice is dedicated to treat- ing pediatric spinal problems, including adolescent idiopathic scoliosis (AIS). The American Academy of Orthopedic Surgeons presents a three-tiered treat- ment protocol for patients with AIS: Observation is typically utilized when the patient has a mild spinal curve of less than 20º or is near spinal maturity. According to Dr. George, physicians measure spinal maturity using three techniques in addition to scoliosis films, which show both anteroposterior and lateral dimensions. Tanner staging is a standard evaluation of maturity and involves the examining of external signs of growth. Physicians also mea- sure triradiate cartilage openness and combine that information with a Risser score to find the patient's maturity. The Risser Grading System utilizes film and radiographic images to measure the location of the iliac crest apophysis to see how much future growth can be expected from the pelvis. Depending upon its location, spinal maturity is rated on a numerical scale of increasing maturity from zero to five. Bracing is the recommended treat- ment for growing children whose spinal curvature is within the 25º to 45º range. Dr. George notes that patients in this category may be braced until they reach skeletal maturity. Although bracing will not cure the spinal curvature, it can prevent it from worsening. While bracing presents a viable solu- tion for maintaining a child's starting degree of curvature, Dr. George explains this method can prove challenging

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