Together with my colleagues at Boston Children's Hospital, we have developed world-class programs to treat cerebrovascular disease and brain tumors through ongoing clinical innovation.

EDUCATION

Undergraduate Degree

  • Dartmouth College , 1992 , Hanover , NH

Medical School

  • Columbia University , 1996 , New York , NY

Internship

  • Massachusetts General Hospital , 1997 , Boston , MA

Residency

  • Massachusetts General Hospital , 2003 , Boston , MA

Fellowship

  • Boston Children's Hospital , 2004 , Boston , MA

Philosophy of Care

I was drawn to neurosurgery—and to Boston Children's Hospital and training with Emeritus Neurosurgeon-in-Chief R. Michael Scott in particular—when my good friend in high school was treated here for a brain tumor. That experience started me on my path to becoming a pediatric neurosurgeon.

PROFESSIONAL HISTORY

I focus my practice on treating patients with cerebrovascular disease and brain tumors, with a particular focus on moyamoya syndrome, arteriovenous malformations and skull base tumors. Together with my colleagues at Boston Children's Hospital, we have developed world-class programs to treat these conditions through ongoing clinical innovation.

I was reintroduced to Dr. Scott when I was a medical student at Columbia University. The neurosurgery department's chair there at the time, Ben Stein, was a former partner of Dr. Scott's and encouraged me to go and work with him. I completed a rotation here and then quickly followed that up with a fellowship under Dr. Scott's guidance. I have been at Boston Children's ever since, and am indebted to Dr. Scott for helping me to become a leader in the treatment of moyamoya syndrome, cerebrovascular disease and brain tumors.

Under the tutelage of Dr. R. Michael Scott, we have continued to refine a novel, cutting-edge surgery for children with moyamoya based on the procedure of pial synangiosis, pioneered by Dr. Scott here at Boston Children's. Surgery has proven to be the only effective long-term treatment for this disease and we are a global leader in treating children with this disorder. Our department heads one of the world's largest pediatric moyamoya programs, with 40 to 50 operations annually and more than 1,000 revascularization procedures performed overall. This high-volume international practice is mirrored throughout our department, particularly in regard to cerebrovascular malformations and brain tumors. This has enabled me and my colleagues to develop a number of important innovations, including advances in minimally invasive skull base endoscopic techniques in young children and new perioperative and surgical approaches for moyamoya and arteriovenous malformation patients. 

This clinical expertise has led to authoring a number of important guidelines and articles about these conditions. I have tried to work on a national level to drive research on pediatric neurosurgical diseases, including in my roles as former president of the Young Neurosurgeons Committee of the American Association of Neurological Surgery, the current chair of the national research committee for the pediatric section of neurological surgery and the ethics committee of the American Society of Pediatric Neurosurgery, while also lecturing and teaching nationally and internationally.

This work is equally focused here at home. In 2014, together with my colleague and friend Darren Orbach, we founded the Cerebrovascular Surgery and Intervention Center—a first-of-its-kind program that integrates translational research into clinical efforts. This center includes a dedicated translational research fellowship to train clinician-scientists and a series of funded seed grants awarded to foster research in this area. Our center is a pilot program sponsored by the hospital designed to innovate paradigms of medical care partnered with research. My colleagues and I in the Center have created 3-D models of patients' brains and blood vessels to rehearse neurointerventional procedures in advance, an innovation that has been shown to save resources and—importantly—improve patient outcomes. Our goal is for our center to serve as a national leader to transform the way that care is delivered to children.


I believe strongly in my role as a surgeon/scientist, and, in the laboratory, am lucky to have been mentored by Marsha A. Moses, a great scientist and the director of the Vascular Biology Program here at Boston Children's.  I'm a New Englander, having grown up in Dartmouth, MA, followed by my undergraduate years studying biology and rowing at Dartmouth College. My patients often give me joke books, which might be a reflection on my sense of (or lack of!) humor and desire to try to keep kids laughing if at all possible during difficult circumstances.

CERTIFICATIONS

  • American Board of Neurological Surgery
  • American Board of Pediatric Neurological Surgery

PUBLICATIONS

Publications powered by Harvard Catalyst Profiles

  1. A national analysis of 9655 pediatric cerebrovascular malformations: effect of hospital volume on outcomes. J Neurosurg Pediatr. 2019 Aug 02; 1-10. View abstract
  2. Noninvasive Thermal Evaluation of Ventriculoperitoneal Shunt Patency and Cerebrospinal Fluid Flow Using a Flow Enhancing Device. Neurosurgery. 2019 08 01; 85(2):240-249. View abstract
  3. Erratum. Results of more than 20 years of follow-up in pediatric patients with moyamoya disease undergoing pial synangiosis. J Neurosurg Pediatr. 2019 May 03; 24(2):215. View abstract
  4. ITGA2 as a potential nanotherapeutic target for glioblastoma. Sci Rep. 2019 04 17; 9(1):6195. View abstract
  5. General Principles for Preoperative Planning and Microsurgical Treatment of Pediatric Brain Arteriovenous Malformations: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019 Apr 01; 16(4):E114. View abstract
  6. Results of more than 20 years of follow-up in pediatric patients with moyamoya disease undergoing pial synangiosis. J Neurosurg Pediatr. 2019 Mar 01; 1-7. View abstract
  7. Letter to the Editor. Bypass and revascularization in young moyamoya patients. J Neurosurg Pediatr. 2019 Feb 08; 1-2. View abstract
  8. General Principles for Pial Synangiosis in Pediatric Moyamoya Patients: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019 Jan 01; 16(1):E14-E15. View abstract
  9. Acute fatal hemorrhage from previously undiagnosed cerebral arteriovenous malformations in children: a single-center experience. J Neurosurg Pediatr. 2018 09; 22(3):244-250. View abstract
  10. Whole Exome Sequencing Reveals a Monogenic Cause of Disease in ˜43% of 35 Families With Midaortic Syndrome. Hypertension. 2018 04; 71(4):691-699. View abstract
  11. Human genetics and molecular mechanisms of vein of Galen malformation. J Neurosurg Pediatr. 2018 04; 21(4):367-374. View abstract
  12. Multimodal treatment approach in a patient with multiple intracranial myxomatous aneurysms. J Neurosurg Pediatr. 2018 03; 21(3):315-321. View abstract
  13. Sickle Cell Disease. N Engl J Med. 2017 07 20; 377(3):304. View abstract
  14. Incidence, clinical features, and treatment of familial moyamoya in pediatric patients: a single-institution series. J Neurosurg Pediatr. 2017 May; 19(5):553-559. View abstract
  15. Real-Time Ultrasound-Guided Catheter Navigation for Approaching Deep-Seated Brain Lesions: Role of Intraoperative Neurosonography with and without Fusion with Magnetic Resonance Imaging. Pediatr Neurosurg. 2017; 52(2):80-86. View abstract
  16. Using urinary bFGF and TIMP3 levels to predict the presence of juvenile pilocytic astrocytoma and establish a distinct biomarker signature. J Neurosurg Pediatr. 2016 Oct; 18(4):396-407. View abstract
  17. National Analysis of 2454 Pediatric Moyamoya Admissions and the Effect of Hospital Volume on Outcomes. Stroke. 2016 05; 47(5):1303-11. View abstract
  18. Structural causes of ischemic and hemorrhagic stroke in children: moyamoya and arteriovenous malformations. Curr Opin Pediatr. 2015 Dec; 27(6):706-11. View abstract
  19. The natural history of cerebral cavernous malformations in children. J Neurosurg Pediatr. 2016 Feb; 17(2):123-128. View abstract
  20. Moyamoya Biomarkers. J Korean Neurosurg Soc. 2015 Jun; 57(6):415-21. View abstract
  21. Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients. J Neurosurg Pediatr. 2015 Oct; 16(4):432-8. View abstract
  22. Down syndrome and moyamoya: clinical presentation and surgical management. J Neurosurg Pediatr. 2015 Jul; 16(1):58-63. View abstract
  23. Intracranial aneurysms in the youngest patients: characteristics and treatment challenges. Pediatr Neurosurg. 2015; 50(1):18-25. View abstract
  24. Microsurgical treatment of arteriovenous malformations in pediatric patients: the Boston Children's Hospital experience. J Neurosurg Pediatr. 2015 Jan; 15(1):71-7. View abstract
  25. Moyamoya syndrome associated with Alagille syndrome: outcome after surgical revascularization. J Pediatr. 2015 Feb; 166(2):470-3. View abstract
  26. Benign triton tumor: multidisciplinary approach to diagnosis and treatment. Pediatr Dev Pathol. 2014 Sep-Oct; 17(5):400-5. View abstract
  27. Management of brain arteriovenous malformations. Lancet. 2014 May 10; 383(9929):1635. View abstract
  28. Spontaneous regression of an epidermoid cyst of the cavernous sinus. J Clin Neurosci. 2014 Aug; 21(8):1433-5. View abstract
  29. Occipital pial synangiosis. Acta Neurochir (Wien). 2014 Jul; 156(7):1297-300. View abstract
  30. Pial synangiosis in patients with moyamoya younger than 2 years of age. J Neurosurg Pediatr. 2014 Apr; 13(4):420-5. View abstract
  31. Treatment of Moyamoya disease in the adult population with pial synangiosis. J Neurosurg. 2014 Mar; 120(3):612-7. View abstract
  32. Resection of supratentorial lobar cavernous malformations in children: clinical article.. J Neurosurg Pediatr. 2013 Oct; 12(4):367-73. View abstract
  33. Imaging after direct and indirect extracranial-intracranial bypass surgery. AJR Am J Roentgenol. 2013 Jul; 201(1):W124-32. View abstract
  34. Cavernous malformations of the basal ganglia in children. J Neurosurg Pediatr. 2013 Aug; 12(2):171-4. View abstract
  35. Predictors of neoplastic disease in children with isolated pituitary stalk thickening. Pediatr Blood Cancer. 2013 Oct; 60(10):1630-5. View abstract
  36. Vascular collateralization along ventriculoperitoneal shunt catheters in moyamoya disease. J Neurosurg Pediatr. 2013 Jun; 11(6):710-2. View abstract
  37. Moyamoya disease with mesial temporal sclerosis. J Neurosurg Pediatr. 2013 Jun; 11(6):713-6. View abstract
  38. Moyamoya syndrome associated with neurofibromatosis Type 1: perioperative and long-term outcome after surgical revascularization. J Neurosurg Pediatr. 2013 Apr; 11(4):417-25. View abstract
  39. Chorea in the clinical presentation of moyamoya disease: results of surgical revascularization and a proposed clinicopathological correlation. J Neurosurg Pediatr. 2013 Mar; 11(3):313-9. View abstract
  40. Moyamoya arteriopathy. Curr Treat Options Neurol. 2012 Dec; 14(6):549-56. View abstract
  41. 168 Moyamoya Syndrome Associated with Neurofibromatosis Type 1 in Children. Neurosurgery. 2012 Aug 01; 71(2):E566. View abstract
  42. Spontaneous occlusion of the circle of Willis in children: pediatric moyamoya summary with proposed evidence-based practice guidelines. A review. J Neurosurg Pediatr. 2012 Apr; 9(4):353-60. View abstract
  43. Angioarchitectural features associated with hemorrhagic presentation in pediatric cerebral arteriovenous malformations. J Neurointerv Surg. 2013 May; 5(3):191-5. View abstract
  44. Intraoperative anaphylaxis induced by the gelatin component of thrombin-soaked gelfoam in a pediatric patient. Ann Allergy Asthma Immunol. 2012 Mar; 108(3):209-10. View abstract
  45. Dural arteriovenous fistulae in pediatric patients: associated conditions and treatment outcomes. J Neurointerv Surg. 2013 Jan 01; 5(1):6-9. View abstract
  46. Pial arteriovenous fistulae in pediatric patients: associated syndromes and treatment outcome. J Neurointerv Surg. 2013 Jan 01; 5(1):10-4. View abstract
  47. Incidentally discovered lesions. Neurosurg Focus. 2011 Dec; 31(6):1 p preceding E1. View abstract
  48. Discovery of asymptomatic moyamoya arteriopathy in pediatric syndromic populations: radiographic and clinical progression. Neurosurg Focus. 2011 Dec; 31(6):E6. View abstract
  49. Features of the lumbar spine on magnetic resonance images following sectioning of filum terminale. J Neurosurg Pediatr. 2011 Oct; 8(4):384-9. View abstract
  50. Moyamoya disease in children with congenital dwarfing conditions. Pediatr Neurosurg. 2010; 46(5):373-80. View abstract
  51. A rare case of psammomatoid ossifying fibroma in the sphenoid bone reconstructed using autologous particulate exchange cranioplasty. J Neurosurg Pediatr. 2011 Mar; 7(3):238-43. View abstract
  52. Dural scalp and intracranial hemangiomas causing hydrocephalus and venous sinus thrombosis in an infant. J Child Neurol. 2011 Jun; 26(6):777-81. View abstract
  53. Idiopathic syrinx in the pediatric population: a combined center experience. J Neurosurg Pediatr. 2011 Jan; 7(1):30-6. View abstract
  54. Cavernous malformations. Neurosurg Clin N Am. 2010 Jul; 21(3):483-90. View abstract
  55. Preface: introduction to pediatric vascular neurosurgery. Neurosurg Clin N Am. 2010 Jul; 21(3):xiii-xiv. View abstract
  56. Moyamoya: epidemiology, presentation, and diagnosis. Neurosurg Clin N Am. 2010 Jul; 21(3):543-51. View abstract
  57. Introduction: moyamoya disease. Neurosurg Focus. 2009 Apr; 26(4):E1. View abstract
  58. Seckel syndrome and moyamoya. J Neurosurg Pediatr. 2009 Apr; 3(4):320-4. View abstract
  59. Pial synangiosis in patients with moyamoya syndrome and sickle cell anemia: perioperative management and surgical outcome. Neurosurg Focus. 2009 Apr; 26(4):E10. View abstract
  60. Intracranial vasospasm with subsequent stroke after traumatic subarachnoid hemorrhage in a 22-month-old child. J Neurosurg Pediatr. 2009 Apr; 3(4):311-5. View abstract
  61. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009 Mar 19; 360(12):1226-37. View abstract
  62. Identification of an association between Robinow syndrome and moyamoya. Pediatr Neurosurg. 2009; 45(1):69-72. View abstract
  63. A novel TP53 germline mutation in a family with a history of multiple malignancies: case report and review of the literature. Pediatr Neurosurg. 2008; 44(6):501-8. View abstract
  64. Pediatric brain tumors. Adv Pediatr. 2009; 56:249-69. View abstract
  65. Foramen magnum stenosis from overgrowth of the opisthion in a child with achondroplasia. J Neurosurg Pediatr. 2008 Aug; 2(2):136-8. View abstract
  66. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008 Sep; 39(9):2644-91. View abstract
  67. Urinary biomarkers predict brain tumor presence and response to therapy. Clin Cancer Res. 2008 Apr 15; 14(8):2378-86. View abstract
  68. Progression of disease in unilateral moyamoya syndrome. Neurosurg Focus. 2008; 24(2):E17. View abstract
  69. Acute hydrocephalus secondary to obstruction of the foramen of monro and cerebral aqueduct caused by a choroid plexus cyst in the lateral ventricle. Case report. J Neurosurg. 2007 Sep; 107(3 Suppl):236-9. View abstract
  70. Tethered cord syndrome. Neurosurg Clin N Am. 2007 Jul; 18(3):531-47. View abstract
  71. A recurrent craniopharyngioma illustrates the potential usefulness of urinary matrix metalloproteinases as noninvasive biomarkers: case report. Neurosurgery. 2007 Jun; 60(6):E1148-9; discussion E1149. View abstract
  72. Multiple pilocytic astrocytomas of the cerebellum in a 17-year-old patient with neurofibromatosis type I. Childs Nerv Syst. 2007 Oct; 23(10):1191-4. View abstract
  73. Wound complications associated with the use of bovine serum albumin-glutaraldehyde surgical adhesive in pediatric patients. Neurosurgery. 2007 Apr; 60(4 Suppl 2):305-9; discussion 309. View abstract
  74. Is there a "July phenomenon" in pediatric neurosurgery at teaching hospitals? J Neurosurg. 2006 Sep; 105(3 Suppl):169-76. View abstract
  75. Lumbar intramedullary spinal schistosomiasis presenting as progressive paraparesis: case report. Neurosurgery. 2006 May; 58(5):E996; discussion E996. View abstract
  76. Moyamoya syndrome associated with Down syndrome: outcome after surgical revascularization. Pediatrics. 2005 Nov; 116(5):e694-701. View abstract
  77. 913 Moyamoya Associated with Down Syndrome: Outcome after Surgical Revascularization. Neurosurgery. 2005 Aug 01; 57(2):434-435. View abstract
  78. Surgical management of moyamoya syndrome. Skull Base. 2005 Feb; 15(1):15-26. View abstract
  79. Neurosurgical aspects of critical care neurology. Semin Pediatr Neurol. 2004 Jun; 11(2):169-78. View abstract
  80. Cerebral pathophysiology and critical care neurology: basic hemodynamic principles, cerebral perfusion, and intracranial pressure. Semin Pediatr Neurol. 2004 Jun; 11(2):89-104. View abstract
  81. Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery. 2004 Mar; 54(3):553-63; discussion 563-5. View abstract
  82. In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care. J Neurosurg. 2004 Feb; 100(2 Suppl Pediatrics):90-7. View abstract
  83. Far posterior subtemporal approach to the dorsolateral brainstem and tentorial ring: technique and clinical experience. Neurosurgery. 2003 Feb; 52(2):364-8; discussion 368-9. View abstract
  84. Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas. Neurosurgery. 2002 Jul; 51(1):117-24; discussion 124. View abstract
  85. Surgical approaches to vascular anomalies of the child's brain. Curr Opin Neurol. 2002 Apr; 15(2):165-71. View abstract
  86. Massive growth of a meningioma into the brachial plexus and thoracic cavity after intraspinal and supraclavicular resection. Case report and review of the literature. J Neurosurg. 2002 Jan; 96(1 Suppl):107-11. View abstract