Benjamin C. Warf, MD

Benjamin C. Warf, MD

Director, Neonatal and Congenital Anomaly Neurosurgery; Associate in Neurosurgery

Associate Professor of Neurosurgery, Harvard Medical School

"My experience as both a parent and a provider has deepened my understanding of treating children with disabilities and has particularly enriched my practice in the care of children with hydrocephalus and spina bifida and their families."

Medical Services

Specialties

  • Antenatal Evaluations
  • Congenital Malformations
  • Choroid Plexus Cauterization CPC
  • Endoscopic Third Ventriculostomy ETV
  • Endoscopy
  • Hydrocephalus
  • Minimally Invasive Surgery
  • Neonatal Neurosurgery
  • Neurosurgery
  • Spina Bifida

Departments

  • Neurosurgery

Languages

  • English

Programs

  • Advanced Fetal Care Center
  • Hydrocephalus Program
  • Neurosurgical Service
  • Spina Bifida Center
To schedule an appointment: Call 617-355-6008 or Request an Appointment
Benjamin C. Warf, MD

I am guided by my Christian conviction to use my skills as a surgeon and scientist for the good of others, and am an advocate for children who have complex medical needs and their families both here and in the developing world. 

My father, a pastor in the Appalachian Mountains of Eastern Kentucky, instilled these values in me through his ministry to the poor. I grew up in a family that was committed to service. I loved science, and became a doctor because I believed it would give me the greatest opportunity to use my gifts for the benefit of others.

This belief has shaped my career as a neurosurgeon. After medical school at Harvard and a post-residency fellowship at Boston Children's Hospital, I became chief of Pediatric Neurosurgery and director of Surgical Education at the University of Kentucky College of Medicine. In the 1990s, my commitment to global pediatric neurosurgery increased, and I sought a way to help children and train doctors in the developing world. In 2000, I found the right opportunity in Uganda with CURE International, where we had the opportunity to found the first pediatric neurosurgery facility in sub-Saharan Africa. My wife and I sold our farm in Kentucky and moved our family of six children to Africa.

I am also motivated personally by my children, one of whom was born with special needs. My experience as both a parent and a provider has deepened my understanding of treating children with disabilities and has particularly enriched my practice in the care of children with hydrocephalus and spina bifida and their families.

We returned to the U.S. in 2006, when our daughter needed surgery, and after I had successfully trained successors of African neurosurgeons to take over in Uganda. I feel honored at Boston Children's Hospital to have an international platform where I can continue to advance my work in global surgery and reach more children and families.

Experience and Education

Education

Undergraduate

Georgetown College, 1980

Georgetown, Kentucky

Medical School

Harvard Medical School, 1984

Cambridge, Massachusetts

Internship

Surgery - Case Western Reserve University/University Hospitals of Cleveland, 1984-1985

Cleveland, Ohio

Residency

Neurosurgery - Case Western Reserve University/University Hospitals of Cleveland, 1985-1991

Cleveland, Ohio

Fellowship

Neurosurgery - Boston Children's Hospital, 1991-1992

Boston, Massachusetts

Certifications

  • ABNS - American Board of Neurological Surgery

  • ABPNS - American Board of Pediatric Neurological Surgery

  • Neurological Surgery, Pediatric Neurological Surgery

Research

My research efforts have focused primarily on hydrocephalus in the developing world and in the United States, defining, validating, and reproducing a novel, low-cost method for treating this condition.

During my time as a neurosurgeon in Uganda, I was the first to identify neonatal infection as the most common cause of hydrocephalus in East Africa. I uncovered a correlation between the rainfall cycle and these infections. I pioneered and tested an alternative to shunts for this population, combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). Much of my research has focused on outcomes for this surgery.

Our work was the first to demonstrate equivalence in early childhood development between ETV/CPC and shunt treatment and the first to show the effect of previous ETV or CPC on subsequent shunt function.  My research analyzed the disease burden and economic impact for infant hydrocephalus in sub-Saharan Africa, and provided a detailed cost-benefit analysis of its treatment -- among the first studies to demonstrate cost-effectiveness for any surgical procedure in a setting with limited resources.

Clinical outcomes have been an important part of my research. I documented the 5-year survival rates and functional outcomes for Ugandan infants treated for myelomeningocele and for post-infectious-hydrocephalus. I have also reported equivalent outcomes between an inexpensive Indian shunt and an American shunt costing 20 times more.

In 2012, I was awarded a grant from the NIH to carry out a prospective randomized trial of developmental and brain volume outcomes for shunt placement versus ETV/CPC in Ugandan infants with post-infectious hydrocephalus. This work has now received additional NIH funding for its completion and extension through a grant that began in August 2015.

By invitation, I have presented our work at the CDC as well as the NIH. I have testified before the House Subcommittee on Africa, Global Health, and Human Rights, which resulted in the introduction of the International Hydrocephalus Treatment and Training Act (HR 3525) into the House of Representatives, and the subsequent introduction of HR 1468, the “Global Brain Health Act of 2015”.

My research, teaching, and leadership in both Africa and North America continue to inform and benefit one another with the ultimate goal of improving access to optimal, evidence-based, and sustainable treatment for children with hydrocephalus and spina bifida everywhere. Some key publications in these areas include:

Warf BC.  Hydrocephalus in Uganda:  predominance of infectious origin and primary management with endoscopic third ventriculostomy.  J Neurosurg (Pediatrics 1), 102:1-15, 2005.

Warf BC.  Comparison of One - Year Outcomes for the ChaabraTM and Codman Hakim Micro PrecisionTM shunt systems in Uganda:  A Prospective Study in 195 Children. J Neurosurg (Pediatrics 4), 102:358-362, 2005.

Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children.  J Neurosurg (6 Suppl Pediatrics), 103:475-481, 2005.

Warf BC, Campbell JW. Combined endoscopic third ventriculostomy and choroid plexus cauterization(ETV/CPC) as primary treatment of hydrocephalus for infants with myelomeningocele: Long-term results of a prospective intention to treat study in 115 African infants. J Neurosurg Pediatrics, 2:310-316, 2008.

Warf BC, Ondoma S, Kulkarni A, Donnelly R, Ampeire M, Akona J, Kabachelor C, Mulondo R, Nsubuga B. Neurocognitive outcome and ventricular volume in myelomeningocele children treated for hydrocephalus in Uganda. J Neurosurg Pediatrics 4:564-570, 2009.

Warf BC, Mugamba J, Kulkarni A. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatrics 5:143-148, 2010

Warf BC, Kulkarni A. Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. J Neurosurg Pediatrics 5:204-209, 2010

Li L, Padhi A, Ranjeva SL, Donaldson SC, Warf B, Mugamba J, Johnson J, Opio Z, Jayarao B, Kapur V, Poss M, Schiff S. Association of Bacteria with Hydrocephalus in Ugandan Infants. J Neurosurg Pediatrics 7:73-87, 2011

Warf BC, Stagno V, Mugamba J. Encephalocele in Uganda: Ethnic variation in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children. J Neurosurg Pediatrics 7:88-93, 2011

Warf BC, Wright EJ, Kulkarni AV. Factors affecting survival of infants with myelomeningocele in southeastern Uganda. J Neurosurg Pediatrics 7:127-133, 2011.

           

Warf BC, Dewan M, Mugamba J. Management of Dandy-Walker Complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). J Neurosurg Pediatrics 8:377-383, 2011

Warf BC, Alkire BC, Bhai S, Hughes C, Schiff S, Vincent J, Meara, JG. The costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatrics 8:509-521, 2011

Warf BC, Dagi AR, Nsbuga B, Schiff SJ. Five year survival and outcome of treatment for post-infectious hydrocephalus in Ugandan infants.  J Neurosurg Pediatrics 8:502-508, 2011

Warf BC, Bhai S, Kulkarni AV, Mugamba J. Shunt survival after failed endoscopic treatment for hydrocephalus. J Neurosurg Pediatrics 10:463-470, 2012

Schiff SJ, Ranjeva S, Sauer T, Warf BC. Rainfall drives hydrocephalus in East Africa. J Neurosurg Pediatrics  10:161-167, 2012 DOI -10.3171/2012.5.PEDS11557

Warf BC, Tracy S, Mugamba J. Long term outcome for combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV-CPC) compared to ETV alone for congenital aqueductal stenosis in African infants. J Neurosurg Pediatrics 10:108-111, 2012

Warf BC. Congenital idiopathic hydrocephalus of infancy: the results of treatment by endoscopic third ventriculostomy with or without choroid plexus cauterization and suggestions for how it works. Child’s Nervous System 29(6):935-940, 2013

Lane J, Mugamba J, Ssenyonga P, Warf BC. Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: A retrospective cohort study in 160 Ugandan children J Neurosurg Pediatr. 2014 Feb;13(2):140-4

Stone S, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr 14:439-446, 2014

Marano PJ, Stone SSD, Mugamba J, SSenyonga P, Warf EB, Warf BC. Reopening of obstructed third ventriculostomy. Long-term success and factors affecting outcome in 215 infants. J Neurosurg Pediatr 15:399-405, 2015

Kahle K, Kulkarne A, Limbrick D, Warf BC. Hydrocephalus in children. Lancet. 2015 Aug 6. pii: S0140 MJ-6736(15)60694-8. doi: 10.1016/S0140-6736(15)60694-8. [Epub ahead of print]

Boivin MJ, Kakooza AM, Warf BC, Davidson LL, Grigorenko EL. Reducing neurodevelopmental disorders and disability through research and intervention. Nature 527:S155-S160, 2015

Professional History

I am a pediatric neurosurgeon specializing in hydrocephalus, spina bifida and neuroendoscopy with a passion for training the next generation of surgeons and improving access to quality care both here and abroad.

I am the director of Neonatal and Congenital Neurosurgery and hold the chair in hydrocephalus and spina bifida at Boston Children's Hospital.  I founded the Global Hydrocephalus and Spina Bifida Program here and, in 2016, started the hospital's first global pediatric neurosurgery fellowship.

The Harvard community has played a major role in my development. I graduated from Harvard Medical School in 1984, was the first fellow in pediatric neurosurgery at Boston Children’s Hospital under emeritus chief, Dr. R. Michael Scott, and was a Harvard-Macy Scholar in Medical Education.

I felt strongly about using my expertise in parts of the world where medical resources are scarce. From 2000 to 2006, I served as chief of surgery and founding medical director at CURE Children’s Hospital of Uganda, the only pediatric neurosurgery hospital in sub-Saharan Africa. I remain the hospital's director of research and am a member of the CURE International Board of Trustees, for which I also act as senior medical advisor. I serve as the medical director of the CURE Hydrocephalus and Spina Bifida Program that trains and equips surgeons in developing countries to treat these conditions throughout the world.

While treating children with hydrocephalus in Uganda, I developed a novel treatment for hydrocephalus in infants by combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), which avoided the risk and expense of shunt dependence for the majority. To date, through CURE Hydrocephalus, surgeons in more than 20 countries have been trained and equipped in this technique, and more than 17,000 children have been treated for hydrocephalus, many of which would not have been treated otherwise.

Since joining Boston Children's Hospital in 2009, I have shown the efficacy of ETV/CPC for infant hydrocephalus in the United States, and have trained North American pediatric neurosurgeons across the country in the technique.

In 2007 I was presented with the Humanitarian Award of the American Association of Neurological Surgeons, and in 2012 I was honored to received a MacArthur “Genius” grant for improving access to care and standards of that care both at home and in the developing world.

To schedule an appointment: Call 617-355-6008 or Request an Appointment

Locations

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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