The Art and Science of Pediatric Neurosurgery

Published in NeuroLogic - Summer 2016

Alan Cohen, new director of the Johns Hopkins Division of Pediatric Neurosurgery, recently gave the Presidential Address at the American Society of Pediatric Neurosurgeons annual meeting about the art of healing, which he condensed into three H’s: humility, humanity and humor. Throughout his career, he has tried to focus not only on treating the disease but also healing the child. This includes the empathetic care he tries to deliver to his patients and their families as well as donning sequined jackets and pants to sing karaoke with his patients as his alter ego, “Dr. Elvis.”

But along with the art of healing, he is also extremely focused on its science. In addition to furthering the excellent clinical care and training that has made the division among the best in the country, Cohen—who joins the division this spring along with his wife and fellow pediatric neurosurgeon, Shenandoah Robinson—plans to bring in new technologies that he and others have developed to make neurosurgery safer, particularly for the youngest patients.

One of these advances is three-dimensional printing. By creating models based on a patient’s own unique anatomy, Cohen says, surgeons can practice the procedures before the real surgery, where the stakes are much higher.

“Models enable surgeons to see the three-dimensional relationships among the blood vessels, cranial nerves and other neural structures to find the best possible approach,” he explains. “It’s like a batter taking a practice swing. By practicing the surgery before going into the operating room, we can make the procedure safer.”

Three-dimensional models will also revolutionize training for residents and fellows, he adds. Because of duty hour restrictions, trainees have less time to learn. But they still need to gain the same experience, and practicing on realistic models can help fill the learning gap.

Another area that Cohen hopes to focus on in his new role is minimally invasive surgery. As chief of pediatric neurosurgery at Rainbow Babies in Cleveland, and then at Boston Children’s Hospital, he developed a minimally invasive surgery research program, creating new techniques and microsurgical tools that allow significantly smaller exposures to access areas deep in the brain.

“With advances in optics, miniaturization and computerized guidance systems, we can get to difficult areas more safely, with less manipulation of the brain,” he says. “In many cases, that can reduce the morbidity and the potential for complications.”

In addition to launching a new minimally invasive surgery laboratory in Johns Hopkins’ Carnegie Building, Cohen says he’s looking forward to building on the collegial and multidisciplinary care approach already in place, working with experts in pediatric neurology, orthopaedics, oncology, physical medicine and rehabilitation, and other areas. 

“Working as a team enables us to do far more than anyone could do individually,” he says. “The sum is greater than any of the individual parts.”