Pediatric Neurosurgery at Stanford

Neuroendoscopy is an advanced procedure that allows our surgeons to look into the skull, brain and spine through a small incision with minimal trauma. The team performs complex skull-based surgery via a trans-nasal endoscopic route rather than a formal craniotomy, which is a rarity for pediatric programs. This procedure is performed for the management of deep skull base tumors to avoid a large craniotomy. We also treat hydrocephalus and craniosynostosis using endoscopic minimally invasive techniques. We are combining  choroid plexus cauterization (CPC) in combination with endoscopic third ventriculostomy  (ETV), as an effective alternative to the traditional shunt procedures used in hydrocephalus cases.

Lucile Packard Children’s Hospital at Stanford is the only hospital in Northern California to offer the ROSA™ robotic surgical assistant for pediatric neurosurgery. ROSA™ assists surgeons in performing minimally invasive brain surgery for epilepsy and other neurologic conditions, in a safer, faster, more effective way. ROSA™ has been shown to significantly reduce the time a child needs to be under anesthesia which allows for faster recovery. Its brain mapping technology also helps surgeons target areas on the brain with increased precision and accuracy, and is minimally-invasive, meaning there is less post-surgery pain. We also use the Mazor robotic platform for deep brain stimulation and neurostimulation cases to maximize efficiency and precision.

Lucile Packard Children's Hospital at Stanford offers the state of the art high resolution 3-Tesla magnetic resonance imaging (MRI) scanners, which allows us to study detailed maps and images of critical functions. This level of accuracy in diagnosis provides an essential advantage for your child by allowing us to develop unique, lower-risk surgical treatments tailored to their specific needs. Lucile Packard Children's Hospital at Stanford also uses this functional neuroimaging and brain mapping to determine surgical candidacy, and to guide the surgical approach. The combined PET-MRI unit in the new hospital will also be transformative for the epilepsy work up in children. Significant advances in imaging are also being developed by our team. Pediatric neurosurgeons and neuroradiologists are working together collaboratively to use a nanoparticle Ferraheme to visualize arteriovenous malformations with amazing resolution and tumor-associated macrophages which will be critical for these upcoming clinical brain tumor immunotherapy trials. Dr. Grant is also PI on a translational blood-brain barrier laboratory to study how to enhance the ability of targeted drugs to reach brain tumors in children .

Cystine-knot miniproteins, or knottins as well as highly specialized antibodies, are currently being investigated in collaboration with Stanford bioengineer Jennifer Cochran, PhD and Dr. Eben Rosenthal from the Stanford Cancer Institute to maximize tumor resection during surgery. Surgeons can apply or inject fluorescent knottins or antibody that are tumor-specific, and therefore have the capacity during surgery to visualize tumor margin with greater sensitivity and specificity.