Pediatric Neurosurgery: Watch... Video Transcript

Participants

, Fred J. Epstein MD, George Jallo MD

Summary

Brain tumors in children are a serious condition, and more common than you might imagine. Fortunately, in many cases, pediatric brain tumors can be cured completely through surgical removal--with no further treatment required. Modern surgical techniques have made this procedure safer and more effective than ever before.

Webcast Transcript

FRED J. EPSTEIN, MD: I'm Fred Epstein. And I am the Director of Pediatric Neurosurgery at the Beth Israel Medical Center where we're all standing right now. And what you're going to see is an operation on a child with a brain tumor. This is a wonderful young child, and he has a brain tumor which we are quite sure is a completely benign, non-cancerous tumor. So in other words, if we can remove it completely, he'll live to be 100 years of age.

And as the surgery unfolds, what you're going to do is get an idea of how it takes more than one person, working together, to achieve this. You're going to see how the anesthesiologist, who is specialized in neurosurgical problems, because it takes special anesthesia here, puts the child to sleep.

You're going to see how the technology works in terms of using guidance systems, almost like airplanes use for instrument landings, to show us precisely where a tumor is before we even make the skin incision.

You're going to have an opportunity to see how nowadays, and this is something that we've only been doing for two or three years, we can do a very major life threatening operation, through a very tiny opening, through only making an opening maybe an inch or an inch and a half. And that makes it less life threatening. That makes it possible for a child to recover more quickly and to go home sooner.

And now what we're going to have a look at, and the next thing which is always so interesting to me, Dr. Jallo, who's doing the operation together with me, we work together, will give you an idea of how we diagnose these tumors. You'll see the MRI scans. You will see how tumors are so beautifully diagnosed through this technology. Technology that, 10 or 15 years ago—20 years ago, would have seemed like a complete fantasy.

GEORGE JALLO, MD: Hello, I'm Dr. George Jallo, pediatric neurosurgeon here at Beth Israel Medical Center. What we have here this morning are the MRIs that were done on our patient prior to surgery. He has a tumor in his posterior fascia, which is very common in children, and especially in his age group. He's an 11 year old boy.

On the MRIs that were done this morning, we have three different images in different planes. You have a coronal, sagittal and axial images, all with contrast. You see this tumor that's bright, that's enhancing, probably measure about two centimeters, maybe a centimeter and a half. And then around it is a cyst, it's a fluid filled cavity that's usually associated with the tumor. And you can see that the brain has shifted to the left.

If you look at it on the sagittal—again, here it is—the back of the brain here, in the cerebellum there's this enhancing tumor that we can see. And then the associated cyst with it.

One other view that just helps us better understand exactly where this tumor is. You can see the tumor's on the right side. Tumor's a bright thing. And then here's the cyst, the black density around it.

What we'll do this morning in surgery is approach this using an image guided system to help us localize it, turn a small bone flap, and take out the tumor and decompress the cyst. By removing the whole tumor, the cyst will disappear and his symptoms should improve shortly after surgery.

DR. PATRICIA BROUSE: Hi. My name is Dr. Patricia Brouse. I'm the attending anesthesiologist on this case. We're at the Institute of Neurosurgery, INN. And I'd like to tell you a little bit about this case. We met this patient earlier and thought about what he needs to have as a safe anesthetic.