MORGANTOWN, W.Va. – Thanks to rapid growth in the Section of Pediatric Neurosurgery at WVU Medicine Children's and the WVU Rockefeller Neuroscience Institute, patients and their families do not have to travel out of state to receive the specialized treatment they need.
“Pediatric Neurosurgery here at WVU Medicine is uniquely positioned to provide care for a
wide range of neurological disorders and diseases,” Hal Meltzer, M.D., Pediatric Neurosurgery section chief, said. “Our specialists are able to use advanced treatment modalities for chronic conditions, such as epilepsy, in addition to common injuries and trauma. We want to let the families of West Virginia know that we have their children covered, and we have the best, world-class subspecialty care. We also have the pride of knowing that we are supporting the families and children of West Virginia.”
treated with medication, but medication is ineffective for 40 percent of epilepsy patients. Surgical options provide a long-term solution for these patients, frequently eliminating all symptoms with a single treatment.
“Epilepsy can have a profound impact on our patients’ lives,” Dr. Lee said. “Our patients frequently experience five or more seizures a day, which can have a profound impact on their development. This can lead to developmental delays or missed educational opportunities. Once their seizures start to have an impact on their education, it can have a significant impact over the course of their lives. The earlier we are able to permanently stop a patient’s seizures, the more likely they are to lead a normal life.”
According to Lee, early medical intervention is the best way to help children with epilepsy reach the developmental milestones needed to live a normal life.
“We have children come in who are on four or five medications and are still having 10 or more seizures a day,” Lee said. “Once two or more medications prove to be ineffective in controlling a child’s seizures, there is a less than one percent chance that another medication would help. These are the patients that we would consider for surgical intervention.”
The techniques for surgically treating epilepsy have evolved since they were first attempted in the 1940s, but they still operate on the premise of removing the epilepsy-affected part of the brain. Modern techniques allow for minimally invasive procedures that require much shorter recovery times and less risk of damaging unaffected areas of the brain.
“Our goal here at WVU Medicine is to become a regional and national player,” Lee said. “What that requires is bringing in people to be on the team. Right now, we’re putting together the business plan to make all these recruitments. WVU Medicine has been very supportive on the technology side, providing cutting-edge technology, including surgical robotics and laser ablation equipment. We are working toward getting more advanced diagnostic equipment, including magnetoencephalography (MEG), which will allow us to better map brain activity and target the areas of the brain that are causing the patient’s seizures.”
One of WVU Medicine’s newest technologies for the treatment of epilepsy is laser ablation. This technique allows neurosurgeons to access the affected part of the brain through a small hole in the skull using computer guidance and burn away the portion of the brain that is causing the child’s seizures. This reduces the potential for damage to the portions of the brain that are not affected, while providing a potentially curative treatment.
“Patients who undergo laser ablation come in for the procedure and spend that night in the hospital for observation. Then, they are able to go home the next day and resume their normal activity, including sports, within a couple weeks,” Lee said. “This is opening up epilepsy surgery for more patients, and it is attractive for referring neurologists because they see it as less risk. Less invasive means will open doors for earlier surgeries because of the reduced risk.”
Lee said he sees families being more open to less invasive epilepsy surgery as an alternative to a lifetime of controlling seizures using medication. He said that, while surgery may be expensive up front, the cost will be reduced over the lifetime of the patient when compared to prescriptions, emergency room visits, and hospital stays.
Danica Miner, 4, of Star City, had not shown any obvious symptoms before she started having seizures in May.
“She would bend over and draw her hands in and giggle, and we would ask her if she was tickling herself,” Derrick Miner, her father, said. “We thought she was just being silly, but it turned out to be the onset of these seizures.”
Danica was taking a bath when the presentation of her seizures changed and left her unresponsive. Derrick and Tricia Miner, her
mother, realized something was wrong. They took her to urgent care, where she was sent to WVU Medicine Children’s.
“Looking back, there are things that we can see in her behavior that may have been the start of these seizures,” Derrick Miner said. “Her babysitter mentioned that she would ask Danica questions like what she wanted for dinner, and she just wasn’t there. We didn’t think anything of it because we thought she was just being a four year old.”
Lee diagnosed Danica with focal dysplasia seizures. The seizures lasted only 15 to 20 seconds at first but rapidly increased in duration and frequency despite treatment with medication. She had as many as 21 seizures in a day at the height of their frequency, often with several in succession, and it was taking longer to recover each time.
Lee knew Danica required surgical intervention to stop her seizures because she was in danger of permanent damage. He performed surgery to place electrodes to stimulate areas of the brain and determine the region that was causing the seizures. The next day, Danica underwent a second surgery to remove brain tissue from the affected area. Lee performed a third surgery a week later to remove more tissue because Danica continued to seize.
“Our family asked why she had to have so many surgeries, but Dr. Lee explained to us that you can take away brain tissue, but you can’t put it back,” Derrick Miner said. “Once he explained this, it was like a switch flipped. We knew the doctors were doing everything they could to fix Danica’s seizures without leaving her with deficits or disabilities.”
After the third surgery, Danica continued to experience seizures that were uncontrolled by medication. Lee suggested laser ablation to cauterize a remaining lesion that extended deep into her brain.
“Before Danica went in for the laser surgery, she would have a seizure and, just when she got her wits about her from it, she’d have another seizure 15 or 20 seconds later,” Derrick Miner said. “They told us that with this surgery, we would either notice results immediately or not. When she came back from the surgery, the seizures were gone, and she hasn’t had another since.”
After a six-week stay, Danica was able to go home and return to her normal life. She still experiences some difficulty with speech and the use of her right hand, but she is working with physical, occupational, and speech therapists to address those problems.
“Our friends and family members suggested that we should take Danica to a different hospital, but we knew that she was in the right place,” Derrick Miner said. “We’re just really grateful that this happened at the right time and that the right doctors were here to help her.”
The capabilities of the Pediatric Neurosurgery team at WVU Medicine reaches beyond the treatment of epilepsy. Whether a condition is caused by sudden trauma or an underlying condition, the pediatric neurosurgeons at WVU Medicine are able to provide care for these patients in their own communities.
The Cooley family from Morgantown said they were glad to have such state-of-the-art care nearby when their daughter Ella, 6, fell from a treehouse ladder and hit her head. According to Ella’s mother, Charlotte, she felt fine after the fall but developed a headache and vomiting, symptoms of a concussion, four days later. When the Cooley family arrived at J.W. Ruby Memorial Hospital, they found out the true cause of Ella’s symptoms was a brain tumor near her pituitary gland.
“Ella landed really hard when she fell out of the tree, so we were really concerned that she had a concussion,” Charlotte Cooley said. “We never even thought that it could be something like a tumor that was causing her pain. The doctors in the Emergency Department said that if we had brought her in the day of the fall, they probably wouldn’t have found the tumor because it wasn’t normal procedure to do a CT scan.”
Ella was admitted overnight to receive an MRI and other tests, which showed that the tumor was preventing fluid from draining properly, causing her headaches. A drain was placed to relieve the pressure, providing immediate relief.
Dr. Meltzer performed a surgery to remove the tumor and allow the flow of fluid. Pathology results determined that the tumor was benign. Ella was able to go home just days after her surgery with no long-term effects.
“We are incredibly proud to be able to provide care for children like Ella in the community where her family is comfortable and where they can receive care in West Virginia from West Virginians,” Meltzer said. “We have a lot of pride in our state and in our institutions. WVU Medicine Children’s wants to be able to take care of the children of the state, and we want to take care of these children and their families where they are comfortable and have their support system.”
Ella’s father, Jim Cooley, says he did not expect Ella to recover so quickly after the surgery.
“We’re just blessed to have doctors like Dr. Meltzer here in Morgantown, where we didn’t have to travel for Ella’s surgery,” he said. “All the staff here were incredible, and they did everything they could to make sure that Ella was comfortable and could recover quickly.”
Other children are born with congenital conditions that require surgical intervention. Many of the cases performed by the pediatric neurosurgeons at WVU Medicine are for craniofacial malformations, which affect the development of the skull and facial bones, causing pressure on the brain.
Sophia Fenstermacher, 3, of Philippi, was born prematurely at 24 weeks with cerebral palsy. As she grew, her parents noticed that she began to suffer from intense migraines that would cause her to become inconsolable and require frequent trips to the emergency room. Her mother, Sarah Fenstermacher, reached out to Sophia’s neurologists, who found that Sophia was suffering from increased brain pressure due to a fused sagittal suture that was not allowing her head to grow properly.
Meltzer worked with Aaron Mason, M.D., pediatric plastic and craniofacial surgeon at WVU Medicine Children's, to perform a cranial vault reconstruction to open the prematurely fused cranial suture, relieve the pressure on Sophia’s brain, and alleviate her pain.
“Before Sophia had her surgery, she was very agitated and would scream for hours at a time because she was in so much pain,” Fenstermacher said. “Just the difference after the surgery has blown us away. We tell Dr. Meltzer that it’s like we came to the hospital with one baby and left with a completely different one.”
According to Meltzer, the Pediatric Neurosurgery program will continue to expand its offering of services, becoming a destination for the treatment of children’s brain conditions.
“We want to be seen as a leader and a place people go when they need top-of-the-line care for their children,” Meltzer said. “We are dedicated to learning and pushing forward through the use of new technology, so we can make a lasting impact in the lives of these children.”