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Advanced Care for Pediatric Tumors at Children’s Hospital of Georgia

Wi t h t h i s m i s s i o n i n mind, Dr. Heger and the pediatric neurosurgery team offer comprehensive

regional care for pediatric brain tumors, including access to innovative clinical trials and stereotactic radiosurgery.

Having earned his medical degree and served his internship at State University of New York (SUNY) Downstate Medical Center, Dr. Heger completed his residency in neurosurgery at the same institution, followed by a fellowship in pediatric neurosurgery at Children’s Hospital, Philadelphia, PA. He holds board certification in general and pediatric neu-rosurgery and has published a number of scholarly articles in his areas of expertise.

Dr. Heger has served at various institu-tions in academic and professional capacities since 1996 and brings an atypi-cal breadth of knowledge and abilities to bear in his practice. Among other areas, he has years of experience treating adult and pediatric patients for aneurysms, arterial venous malformations (AVM), brain and other central nervous system tumors, spasticity related to conditions such as cerebral palsy, and spinal condi-tions. Dr. Heger’s expertise has been recognized by U.S. News & World Report, which included him on its 2008, 2009 and 2012 lists of America’s Top Surgeons.

A holistic ApproachLed by Dr. Heger, providers at

Children’s Hospital of Georgia recognize the importance of not only treating the whole patient, but also of understanding the patient’s presenting condition before establishing a diagnosis. As Dr. Heger explains, observing signs of brain tumors may be relatively easy in older children who are able to vocalize discomfort. However, classic brain tumor symptoms,

such as headaches (especially in the morning and accompanied by nausea), double vision, loss of appetite, dragging one side of the body, and lethargy, may fly under the radar for infants and children too young to articulate their distress. In infants, many classic signs of brain tumors present similarly to the common cold, Dr. Heger notes. He recommends early referral to physicians at Children’s Hospital of Georgia for evaluation of any symptomatic children or those suspected of having brain tumors.

Once patients enter the system, Dr. Heger says, all prospective partici-pants are brought into the treatment plan from the start. He incorporates members of neurosurgery and oncology teams as well as physical and occupational therapists to provide the best possible out-comes and innovative treatment options.

Breaking the tumor’s DefensesResearch conducted by Dr. Heger and

his colleagues on the effects of medicinally blocking indoleamine 2, 3-dioxygenase (IDO) presents one potential breakthrough from which patients at Georgia Regents Health System may soon benefit.

Dr. Heger explains that brain tumors utilize several methods to effectively shield themselves from the body’s immune system. IDO is an enzyme that brain tumors produce to prevent T cells, the body’s cancer-fighting immune response, from attacking. Clinical trials studying the effects of blocking this enzyme in systemic cancers are under way, and Dr. Heger says Phase I clinical trials to study 1-methyl-d-tryptophan (1-MT), a drug that inhibits the IDO enzyme in pediatric and adult brain tumors, will soon come to Georgia Regents.

Current 1-MT trials sponsored by the National Cancer Institute are exploring the drug’s efficacy in enabling the body to identify and effectively attack tumors, possibly negating the need for aggressive treatments and limiting harsh side effects. Along with standard treatments, it offers the hope of prolonging survival with a better quality of life. Initial tests suggest that 1-MT can achieve both stated goals, and in a few months, Dr. Heger plans to begin safety trials to observe 1-MT’s effects in tandem with standard chemotherapy and radiation therapy.

“To effecTively TreaT cancer, physicians have To TreaT The enTire paTienT.” ThaT is The philosophy of ian heger, M.D., faans, faap, facs, assisTanT professor aT georgia regenTs UniversiTy anD The new chief of peDiaTric neUrosUrgery aT chilDren’s hospiTal of georgia.

Advanced Care for Pediatric Tumors at Children’s Hospital of Georgia

Lighting Up the ProblemAnother potential development that

excites Dr. Heger is associated with ongoing clinical trials studying 5-ami-nolevulinic acid (ALA). Researchers hope to use the compound to introduce better means of visualizing brain tumors, which may lead to more complete resections and reduced chances of recurrence.

“The idea behind this method is that, as good as we are at differentiating tumor from brain matter, sometimes it can be difficult,” notes Dr. Heger. “It is expected that fluorescent guiding methods will help us remove more of the tumor at the first resection. Additionally, for patients coming to us from outside the region for follow-up surgeries, this method will help differentiate scar tissue from previous operations, allowing for better resection.”

Authors of a 2008 study published in Clinical Neurosurgery note that ALA is naturally produced by the body and absorbed by malignant tumor cells, which convert it into fluorescent porphy-rins — chemicals that form hemoglobin and oxygen-carrying protein in red blood cells. The study examines ALA’s role in

causing tumors to fluoresce, defining the tumor’s boundaries and helping surgeons resect the entire tumor.

Using surgical microscopes with specially designed fluorescent imaging equipment, surgeons observe normal brain tissue aglow with a blue coloration contrasted with a vivid red glow emitted by tumor tissue.

Collaborative DesignDr. Heger’s broad experience treating

children and adults equips him to address even the more obscure conditions with which children may present. But he applies his skill set in tandem with the abilities and experience of other readily accessible specialists. Georgia Regents Health System locates its physicians in close proximity to foster a collaborative atmosphere. Its campus provides the advantage of a freestanding hospital with convenient access to the entire neurosurgery and surgical oncology teams whenever another opinion or skill set may be beneficial.

“My colleagues from the adult hospital are only 100 yards away,” Dr. Heger notes. “There are some techniques they use on adults on a daily basis that I don’t. The campus is structured in a way that facilitates easy collaboration with my colleagues who concentrate on adult neurosurgery.”

Dr. Heger treats pediatric cases of AVM, cavernous malformation and moyamoya, but colleagues who more routinely treat these conditions — which

arise with greater frequency in adults — may provide insight or an extra pair of hands to produce better outcomes for patients. For children suffering from these conditions, Dr. Heger has at his disposal the skills of his neurosurgical colleagues, Cargill H. Alleyne Jr., M.D.; Scott Y. Rahimi, M.D.; and Haroon Choudhri, M.D.

“My collaboration with Dr. Rahimi and Dr. Alleyne is unique because they are uniquely trained neurosurgeons special-izing in vascular problems, which means they are trained in catheter endovascular techniques,” Dr. Heger says. “I may call upon their expertise for workups with angiograms. Sometimes we’ll plan the surgeries as a team, and, if the surgery requires one of their areas of expertise, they’ll perform the procedure.”

Dr. Choudhri lends his abilities to spine reconstruction and spine tumor resec-tion, which he performs on a regular basis on adult patients. When a child requires spinal reconstruction, Dr. Choudhri may be called upon.

Superior results flow from the collab-orative approach that guides the pediatric neurosurgery team at Children’s Hospital of Georgia, Dr. Heger says.

“I have gathered experience and expertise throughout my career for deal-ing with problems unique to children,” he notes. “When dealing with issues more frequently seen in adults, I am also able to consult surgeons who do these operations on a daily basis. When you combine the two, you get better outcomes.”

“We’re happy to evaluate children who

present with symptoms their pediatricians

suspect may indicate neurological problems

— even if it’s only to put the physicians’ or the

parents’ minds at ease. We want to provide the

best possible care for children, and anytime

pediatricians are not comfortable with what

they see, we’re available for a second opinion.”— Ian Heger, M.D., FAANS, FAAP,

FACS, assistant professor at Georgia Regents University and Chief of Pediatric Neurosurgery at Children’s Hospital of Georgia

Reprinted from md news Augusta

stereotactic RadiosurgeryCole Giller, M.D., Ph.D., M.B.A., FACS,

is another member of the neurosurgery team with whom Dr. Heger collabo-rates. Dr. Giller, Director of Functional and Stereotactic Neurosurgery, has experience performing stereotactic radio-surgery on infants. Although radiation therapy is a valuable treatment modality, X-ray beams must be very carefully directed through the brain to avoid radiating still-developing areas.

“Many treatment protocols call for radiation therapy, but we know there are significant risks to that in the developing brain,” Dr. Heger says. “Fortunately, we have options and skilled physicians, like Dr. Giller, with experience using radia-tion in the safest ways possible.”

Stereotactic radiosurgery performed in the Gamma Knife Center at Georgia Regents Medical Center beams low-dose X-rays from multiple sources to a focal point, at which the power of the coalesc-ing beams destroys tumor cells without

harming brain tissue. Dr. Heger explains that this is particularly useful for tumors in areas of the brain that are difficult to operate on, such as those forming near the optic nerves and the pituitary gland.

“Pediatric brain tumors are so unusual, and there’s such diversity to them,” he says. “Children’s Hospital of Georgia will have access to innovative treatments that aren’t going to be available elsewhere, and we have a full array of treatments avail-able for any child with any sort of tumor. There really isn’t anything we wouldn’t be prepared to take care of here.”

Those state-of-the-art treatment options, coupled with the expansive exper-tise of its physicians, make Children’s Hospital of Georgia a destination of choice for the treatment of pediatric brain tumors.

To speak with Dr. Heger or to refer a patient, please call (706) 721-9386. To learn more about pediatric neurosurgery, visit www.gru.edu/neuro. ■

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