Bill Klaproth (Voice over): Welcome to Pediatric Insights, advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. Today's episode is a special edition featuring our In The Know series, a new edition to our podcast lineup that brings you insightful conversations with our Chief Medical Executive, Dr. Dai Chung, and expert physicians from across Children's Health. We'll be sharing these special episodes regularly to keep you informed on emerging trends and advancements in pediatric care straight from the leaders who are shaping it.

In this episode, Dr. Chung is joined by Dr. Raphael Sillero, pediatric neurosurgeon at Children's Health and Assistant Professor of Neurological Surgery at UT Southwestern. Together, they'll discuss the Interventional Neurosurgery Program and how it's helping children with complex neurovascular conditions.

Dr. Dai Chung (Host): I'm Dai Chung. Welcome to the In the Know Video series. We're here today with Dr. Raphael Sillero. He's an Assistant Professor of Neurological Surgery and also Co-director of Cerebrovascular Disease, and many other multitude of programs at Children's Health. Welcome, Rafael.

Dr. Rafael Sillero: Thanks, Dr. Chung, for having me today.

Host: Yeah. I've been looking very much forward to this time. We're excited to learn more about what you do, your program.

Dr. Rafael Sillero: Our program is a very unique program, because we have three service lines, stroke, neurology, endovascular neurosurgery, and cerebrovascular neurosurgery.

Host: When you name all of those, I know for a fact that you are very uniquely experienced and trained individual. There are not many of you with multiple credentials in not only a neurosurgery, cerebrovascular disease, IR, et cetera. Isn't that right?

Dr. Rafael Sillero: It's a long training, because you have to do specific fellowships for each specialty. Few people can do this long training and be able to really do this comprehensive treatment.

Host: Great. So, I want to kind of probe that a little bit, because obviously in adult patient population, stroke or cerebrovascular disease is a lot more prevalent. So in pediatric patient cohort, what kind of conditions are we managing?

Dr. Rafael Sillero: The conditions are similar. But in pediatric, it tends to be more complex and that's one of the reasons that attracted me so much to do the pediatric space, because it's more exciting. At same time, you need really a team culture because, for example, some processes, we need neonatal care, we need a cardiologist to help. This is, to me, the most important part of the work.

Host: When it comes to infants and children, I certainly will admit I don't think of like often as neuro or cerebrovascular disease. Can you kind of elaborate on one or two examples of conditions?

Dr. Rafael Sillero: The common conditions that we see is stroke. And the stroke can be because of a large vessel occlusion. Something we do now is thrombectomy. We can go there with the microcatheter and remove the clot. Children can have the stroke because they may have a trauma, for example, and they have a dissection of a large vessel of the neck and they have a clot in the foramen can cause a stroke. But the most common cause for stroke in children, large vessel occlusion, is really a cardiac problem. A lot of the common conditions that we see is the brain aneurysm that can rupture. So, treatment for this condition can be open or endovascular.

Dr. Dai Chung (Host): So, we have now the capability of being able to intervene when a child suffers such a condition.

Dr. Rafael Sillero: Right. We have the capability to do thrombectomy, which means the clot removal. We have 24/7 coverage for that, which is very important because the problem with the stroke intervention is delay. You don't want to have a delay because time is brain.

Host: That's fascinating and fabulous. So, surely not many centers have the capability like ours.

Dr. Rafael Sillero: Not many centers, because you need coordination, you need anesthesia, you have to be fast, you need equipment available as well, and good equipment because the vessels in children, they're smaller, so you need to access the groin sometimes in smaller children, which can be a challenge. And then, of course, the image technology to navigate those little vessels, you need that good image to do that.

Host: So speaking of technology, what are some advances in this field that we should look forward to?

Dr. Rafael Sillero: The quality of the image now that we navigate those catheters are very different from the past. But also, we have more devices to remove the clot, for example. And also, in the future, we may have a robot.

Host: Well, great, because as you know, we have a robot program here at Children's. So, it would be great to have possible neurosurgical procedures to be considered. What are some advances that are just right on the corner?

Dr. Rafael Sillero: The game-changer to me was the hybrid room. You have the capability now to do open surgery, but also interventional procedure.

Host: Tell us more about that. It's in the second floor in the main OR. How has that impacted your patients or your program?

Dr. Rafael Sillero: Number one, you have less procedures because you're in the single room. You can do both. The other advantage is because you can do everything more efficiently, in less time. The other thing is to really reduce complications.

Host: There's a whole host of disease or conditions that you're taking care of. Can you share with us the vision of neurosurgery?

Dr. Rafael Sillero: The vision that we have is really improved outcomes for the patients and evolve from a regional hub to a national hub. We're doing well. And in increasing volume and the reputation and doing more cases, improving the outcomes, I think we're doing great.

Host: So, with all that, and obviously, we're going to have a new hospital soon.

Dr. Rafael Sillero: I think it's going to be very, very helpful. The collaboration with UT Southwestern and the research capability is also going to help us to develop the program. And actually, we've been working with a new pediatric cerebrovascular catheter.

Host: Well, I want to hear more about it.

Dr. Rafael Sillero: The truth is there are no specific pediatric devices for this kind of work. Some of the challenge are the size of the vessel.

Host: Right.

Dr. Rafael Sillero: And the anatomy. And then, came up the idea to do a catheter that you can use in any age. It is a very small catheter that can go through any kind of vessel size. But at the same time, it is braided. So, it can give you support for an intervention.

Host: Tell us a bit more about your 3D printing, how it's useful in your practice.

Dr. Rafael Sillero: Yes. So, it's very u useful to understand the complex anatomy of some of the problems. And I have here today, one of the cases we did recently, which is the vein of Galen malformation.

So, this helps me to understand the anatomy and plan the procedures. It's safer for the patient and more efficient because if you don't have this, you have to do a complete angiographic study to understand this. We can do 3D print for spine for any kind of vascular anatomy for complex craniosynostosis.

Host: That's fabulous. Well, it's really amazing work that you're doing. I can't thank you enough for being here and sharing all the great work that you do. You are an incredible neurosurgeon with multitude of skill sets. So, thank you for all the great work that you do.

Dr. Rafael Sillero: Thanks so much. Thanks for having me.

Host: Great.

Bill Klaproth (Voice over): Thanks for listening to Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. We'll be back soon with another special edition featuring our In the Know Series with Chief Medical Executive, Dr. Dai Chung, where he interviews expert physicians from across Children's Health. You can find out more at childrens.com. And if you found this podcast helpful, please rate and review or share this episode. And please follow Children's Health on your social channels.