Section on Pediatric Neurological Surgery The American Association of Neurological Surgeons 22 South Washington Street, Park Ridge, IL 60068-4287 John P. Laurent, MD, Editor April 1995
Section on Pediatric Neurological Surgery The American Association of Neurological Surgeons 22 South Washington Street, Park Ridge, IL 60068-4287
John P. Laurent, MD, Editor April 1995
Since the December meeting and the last newsletter there are two important items of which the membership needs to be aware. First we have requested from the Health Care Financing Administration (HCFA) a pediatric modifier for CPT codes. It is not clear whether they will give us that. There is, however, precedent for it.
This came about after notice from the Washington Counsel of the AANS that HCFA was looking at pediatric codes and felt that what they had was all they needed. The deadline given to us was very short. Fortunately, however, this coincided with the ASPN meeting. We were thus, with the help of ASPN, able to mobilize 51 members of the section and take a whole day of the meeting to review CPT codes.
The outcome of this work was most fruitful and produced a revision of our CPT code document. The work product will now have to go through many stages before we can wend our way through the governmental systems to get our ideas reviewed.
The first step in this process will be to form a cohesive task force which will need to be appointed over the next few months. This task force will find itself with considerable work. It will need to get together literally within a day or two notice. The deadlines we are given frequently are minimal, sometimes less than a week. Once a task force has reviewed and revised the document in the proper form, we will need to go through AMA channels to have our ideas reviewed.
Along the way a practice survey will be required, which as many of you will recall requires significant paper work. We will need to identify a group of approximately 50 to 75 people who are willing to put aside their work for a day and spend time going over the survey. This group will be necessary for the continued existence of pediatric neurosurgery from a practical financial standpoint.
The next major development has been draft #5 of the severe head injury guidelines in the trauma section. This is the first draft I have reviewed. The document deals with head injuries in adults. The section is currently working with the American Academy of Pediatrics hopefully to develop a document for pediatric head injuries. Hopefully, the two of these can be combined to be considered as a unified parameter of practice. Tom Luerssen has received few volunteers for his request to work on the pediatric guidelines. This is a very major undertaking and requires searchers of literature and reviewers of vast amounts of material. It cannot be done by one person and, in fact, should have a committee of approximately ten to reduce the work load on everyone involved.
Bob Florin has been of great aid to the section in both of the above. These issues consume the majority of his time. The section needs to commend him for this.
Our formal Joint Section status with the Congress is still not complete because of changes required in our by-laws. Essentially, the only change now required, as I currently understand it, is to replace the language in our by-laws stating we are a section of the AANS with a statement that we are a Joint Section of the AANS and CNS. These by-laws will have to be approved by the full membership and hopefully will be circulated in the near future.
We are honored to have John Holter as our Matson Lecturer at the April meeting. As all of you know, he essentially is the father of the modern day shunt. We hope his talk will be well attended. A reception honoring him will be held at the meeting; invitations to that event will be sent to all members of the section.
The Research Foundation will, this year, present a grant for research in pediatric neurosurgery supported by the Pediatric Section. This will be announced at the April meeting. It supports a topic in pediatric neurosurgery. The selection committee was very careful to use our donation for a pediatric topic. The section will need to decide whether this is an effort we should continue to support or if our financial status will not allows us. Perhaps we could do this on an every other or every third year basis depending on our financial status.
It has been an education and a pleasure to be chairman of the section. I wish Hal Rekate the best as he takes over this position. I encourage the membership to support Hal in this endeavor, both emotionally and by volunteering their services when requested. I want to thank, again, all the members who have helped me over the past couple of years.
Best Regards.
Sincerely,
Arthur E. Marlin, MD
II. The minutes of the previous meeting in San Diego, California, April 12, 1994, were approved as published in Short Cuts, November 1994.
III. Committee Reports:
13 Breakfast Seminars
Social Aspects
VI. The meeting was adjourned
Minutes of the Annual Meeting in San Diego, California, April 12, 1994, as published in Short Cuts, November 1994, were approved.
Reports by Committees and discussions paralleled the Executive Committee meeting in San Diego, California, April 12, 1994.
The meeting was adjourned.
Submitted by John P. Laurent, MD
Mark S. Dias, MD, at the Children’s Hospital of Buffalo, will be funded for one year as a Young Clinician Investigator. This is the first award co-sponsored by the Pediatric Section and the Research Foundation of the AANS. He will be presented to the AANS Membership by Robert G. Ojemann, MD, Chairman of the Research Foundation, at the Convocation to be held at the Orange County Convention Center in Orlando on Monday, April 24, 1995.
Dr. Dias’ project is entitled “Spinal Cord Histogenesis in an Animal Model of Neural Tube Defect.” Neural tube defects (NTDs), such as myelomen-ingocele, constitute the most common developmental CNS abnormality, and afflict approximately 1:1000 newborns annually. While the thrust of research efforts have thus far been directed toward understanding both the embryo genesis and prevention of the disorder, remarkably little is known about the impact of the NTD, once it has occurred, on the subsequent development of the nervous system.
A number of clinical and experimental observations suggest that 1) anatomical and functional connections from the placode to the lower limb musculature are remarkably preserved in many children with complete muscular paralysis, 2) some spinal cord function may well be retained until late in gestation, and 3) some evidence of spinal cord function is present even post-natally in many children with this disorder. Despite these exciting observations, the anatomical and physiological substrate for sensorimotor paralysis in these children remains an important and uncharted area of investigation. In contrast, the normal development of the spinal cord has been extensively studied in several animal models; how these normal processes are altered in the face of an NTD is unknown.
Dr. Dias plans to investigate the histogenesis of the spinal cord in a chick model of NTD. He will study both the initial proliferation and subsequent programmed, or apoptotic, cell death in chick spinal cord motoneurons. Ultimately, he will examine the directed outgrowth of axons from spinal cord motoneurons to lower limb muscle targets. These studies will provide a much better understanding of neuronal growth and development in the face of an NTD, and hopefully will lead to experimental and, ultimately, clinical interventions whose goal is to improve motoneuron survival and spinal cord function for these children.
When Dr. Dias completes his year as a young Clinician Investigator, we will update you with his findings.
The Pediatric Section wished to provide the following information about the activities covered by the "accompanying person" registration fee for the 1994 Pediatric Section Annual Meeting so that registrants would have more information as to the components which determined this fee.
A successful Annual Meeting was held in St. Louis, Missouri. T.S. Park, MD, and his group are to be congratulated for organizing an excellent and stimulating meeting. The next annual meeting will be held in Pasadena, California, December 6–9, 1995, with G. McComb, MD, as the host.