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T M C » P U L S E | J U LY 2 0 1 8 31 of the brain was doing—you have to retrain the good side of your brain to take over," Lam said, adding that if one side of her own adult brain was removed, for example, the opposite side of her body would be paralyzed. "Umair was a case in which the affected side was dam- aged as a baby, and over the years, the seizures had already taken over, so functions from the affected, diseased, seizing side had already started to shift over to the healthy side—that's why he was able to walk and move his right arm and right leg after we disconnected the whole left side of his brain." For this reason, Lam said, the younger the patient, the better the candidate for this type of surgery. "Because of brain plasticity, younger patients are able to really retrain or relearn skills—a younger patient has more potential and plas- ticity than an older patient," Lam said. "We have to be very careful when we pick who to do this surgery on—that we plan to do no harm, and that we also plan for expected benefits in cognition and neurode- velopment, as well." Since Umair's groundbreak- ing surgery, Lam has performed endoscopic hemispherotomies on eight other pediatric patients. She has observed that not only has the minimally invasive technique cut down on recovery time, but, thus far, it seems very rare for patients to require a blood transfusion or a shunt—both of which are common with the typical "open" procedure. "Some of the children in need of this surgery are much smaller than Umair, and just cutting through the skin and cutting through the bone and really exposing all the areas of the brain that need to be visualized can result in enough blood loss to require a blood transfusion," Lam said. "We developed this more minimally invasive technique so that it would be easier for the patients to tolerate and so that they could go on with therapies and rehabilitation faster." Lam said that since the first surgery in November, her team has presented their initial findings in different forums around the world. They also submitted a write-up detailing the surgery for publication and have been invited to present the technique at the upcoming Congress of Neurological Surgeons and at the annual meeting of the International Society for Pediatric Neurosurgery. Colleagues from hospitals across the country are eager for opportunities to observe the surgery and learn the technique for their own patients. "It's definitely something that has a learning curve. We are very conscious about the big responsibil- ity in how we develop and dissem- inate this new technique, because it's a quite complex procedure," Lam said. "The families and kids don't realize that they've actually just had one of the biggest surgeries that we do in pediatric neurosurgery." The Majeed family considers Umair's surgery a resounding success. "The miraculous outcome of this technique is the quick recovery— the very quick recovery," Ashif said, looking at his son. We developed this more minimally invasive technique so that it would be easier for the patients to tolerate and so that they could go on with therapies and rehabilitation faster. — SANDI LAM, M.D. Pediatric neurosurgeon at Texas Children's Hospital • Houston area's only MPH program in healthcare management • One of only !ve MPH programs in healthcare management in the nation accredited by the Commission on Accreditation of Healthcare Management Education (CAHME) • Located in the heart of the Texas Medical Center • Diverse faculty includes researchers, consultants, former executives and current administrators of major healthcare organizations • Offers degree and certi!cate programs in the fast-growing !eld of healthcare management Housed in UTHealth School of Public Health, the George McMillan Fleming Center for Healthcare Management provides rigorous training in healthcare management paired with a one-of-a-kind focus on population health. Learn more about our programs go.uth.edu/!emingcenter L E A R N F R O M L E A D E R S I N H E A LT H C A R E M A N A G E M E N T

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