Today, doctors can cure about 80 percent of children with brain tumors or epilepsy. Dr. Erin Kiehna joined Novant Health this September as a pediatric neurosurgeon to help children with these conditions and others. Here’s a look inside her world.
Q: What is it about neurosurgery that hooked you?
A: Like many medical students I rotated through all the medical specialties. I remember watching the delicate removal of a tumor from off a child’s brainstem, being mesmerized by the anatomy, and watching him make a perfect recovery. I remember thinking, I want to learn how to do that … and now I do. I’m fortunate to get to do what I love every day, and love what I do.
Q: What do you love most about working with children?
A: Their strength of character, their courage, their resiliency. They defy all odds, and they do it with a smile.
Q: How does pediatric neurosurgery differ from adult neurosurgery?
A: Pediatric neurosurgery has developed as a subspecialty because a child's developing brain and spinal cord are not merely a miniature version of an adult's. The infants, children and young adults that we care for have their own unique conditions.
Q: What types of things do pediatric neurosurgeons treat?
A: Brain and spinal cord development start at three weeks of pregnancy and continue through the first few years of life. When the spine and/or spinal cord do not develop appropriately, spina bifida or spinal dysraphism with tethered cord syndrome may occur. Abnormalities with skull development can result in early fusion of the skull, or craniosynostosis. If brain cells fails to migrate properly, epilepsy can occur. If the normal cerebrospinal fluid of the brain fails to circulate or be absorbed properly, it can build up on the brain, causing hydrocephalus.
Q: How do pediatric brain tumors differ from adults?
A: There are many differences in the types of tumors, the locations, and the treatments necessary to cure them. For instance, the majority of brain tumors seen in children are found in the posterior fossa (the back part of the brain), while most adult tumors are found in the cerebral hemispheres. The most common type of brain tumor seen in adults are metastatic tumors that have spread from other parts of the body. In children, brain tumors usually arise from the brain. The good news is that we are able to cure 80 percent of pediatric brain tumors. In order to achieve these cures, it requires the painstaking removal of every bit of that tumor, often followed by either radiation therapy or chemotherapy.
Q: What are the biggest misconceptions when it comes to kids and neurosurgery?
A: That surgeons don’t follow their patients! For me, one of the best parts of my practice is watching children grow up, to celebrate holidays, birthdays and graduations from kindergarten to high school.
Q: Tell me about a case where your work made a difference.
A: Fighting cancer isn’t easy, and there are often many rounds to be fought, but I don’t ever give up. To approach a tumor deemed “inoperable” by others is a challenge. But when the alternative is death, how can you not attempt the impossible? This past summer I had the privilege of watching one of my closest patients walk the stage at her high school graduation, cancer-free for the first time in 10 years. I cried. She fought the fight, it was an honor to be there when she needed me.
Q: When do you perform surgery for children with epilepsy?
A: Seizures, or abnormal electrical discharges in the brain, can impact anyone of any age. When the seizures are recurrent, we call it epilepsy. There are many different antiepileptic medications, but 30 percent of people don’t respond to those and they are considered to have “medically refractory epilepsy.”
These patients go through very thorough evaluations as we perform EEGs and detailed MRIs looking for a focus for their epilepsy, then further testing as we evaluate whether that is part of the brain that we can disconnect or remove. The good news is that the majority of our surgery patients have a significant reduction in their seizures following surgery and approximately 80 percent are seizure-free.
This changes everything for the child and their family. They can learn to ride a bike, go swimming, sleep in their own bed, go to school. Our goal is for them is to live the childhood they deserve.
Even when we cannot find a seizure focus for medically refractory epilepsy, I may be able to offer hope for additional control of the seizures with a vagal nerve stimulator. This device is placed under the skin, and its wires send an impulse up the vagus nerve to the brain to interrupt seizures and try to stop them from starting. Up to 50 percent of patients have a significant reduction in seizures following placement of a VNS and it can half the risk of SUDEP (sudden unexplained death in epilepsy) over the first two to three years of placement.
Q: How do parents know when they might need to consult a pediatric neurosurgeon?
A: Oftentimes children are referred to my clinic when their pediatrician feels that the head isn’t growing right, or they have dimples or birthmarks on their lower back where they shouldn’t, or perhaps they aren’t meeting their developmental milestones. Our pediatricians at Novant Health do an excellent job of identifying potential areas of concern and referring them for evaluation by me.
Q: What do say to parents when you have to operate on their child?
A: I treat every child as if they were part of my own family. I will ensure that you get the very best care, we will care for your child as a team, and we will get through this together.