Our ongoing pursuit of excellence continues to pay dividends. I have cut the shunt infection rate at Arnold Palmer Hospital in half in the last 2 years and my shunt infection rate is now <1%, the lowest in the state. This compares to the historical Central Florida ventriculo-peritoneal shunt infection rate of 12%. Our surgical epilepsy program has continued to forge ahead, focusing primarily on vagus nerve stimulators(VNS). With intra-operative and programming improvements, the failure rate is <11% in our VNS, compared with the original FDA data failure rate of 46%.

We have truly been blessed with wonderful patients. I have endeavored to correspond frequently with all my patients, either by telephone or e-mail. I average >5 e-mails/day from patients, all of which I answer personally. The model we continue to use is a physician centered care model. None of my patients are seen and evaluated by anyone other than me. That means, the patients don’t feel as though the PA or other physician-extender is their care-giver. If the referral is to a pediatric neurosurgeon, it should be a board-certified pediatric neurosurgeon who sees the patient. I am willing to overbook patients any time you or the patient feel it is necessary. I have been able to keep my average wait for an appointment to <2 weeks, by flexing the hours of clinic as needed.

We are always looking for ways to minimize surgical trauma. One way to do that is shown to the right.

The incidence of elevated intracranial pressure with single suture synostosis has been documented to be >20%. Therefore, repair of craniosynostosis is indicated from a medical necessity standpoint. Open craniofacial reconstruction has been the standard of care for many years and allows for a more complete reconstruction. In those patients with less severe cosmetic anomalies, endoscopic repair allows for reduced blood loss, hospital stay, and incision length/scarring, while still obtaining the benefit of return to normal intracranial pressure and release of stenosis. I began performing endoscopic craniofacial reconstruction in late 2005. The picture below is from a recent case of metopic synostosis, in which a 2.5cm incision over the anterior fontanelle allowed for complete resection of the stenotic metopic suture and barrel staving parallel to the coronal sutures bilaterally. Hospital stay was 2 days and no transfusion was needed.