A few years ago, Craig Kilburg, MD, a vascular neurosurgeon, assumed leadership of the pediatric neurovascular program from his old mentor, Phil Taussky, MD. “When Dr. Taussky left, I was hesitant to take on the role,” Dr. Kilburg admitted. “It’s difficult to see kids suffering, but ever since I started, I’ve really grown to love the program and the relationships with the patients and their families that have come from it.” Dr. Kilburg has been working closely with Lisa Pabst, MD, the director of pediatric stroke in neurology, to build on the existing program, increase the case volume, and help as many families as possible.
“Our diagnostic angiography volume has increased, and we are also one of the highest volume pediatric thrombectomy centers in the country.” Dr. Kilburg said. While Dr. Kilburg has been improving the neurosurgery side of the pediatric vascular team, Dr. Pabst has also been making strides on the neurology side, including the recent implementation of a pediatric telestroke network within the Intermountain region. “It’s a big network that will hopefully help us increase and improve the acute use of reperfusion therapies and treatment of kids with stroke,” Dr. Pabst said.
The collaborative partnership between Drs. Kilburg and Pabst, and the two departments in general, has allowed them to accomplish several initiatives in a short period of time, and they have extensive plans for the future. “We’ve established a monthly pediatric neurovascular conference—which includes pediatric neurology, the pediatric intensive care unit, pediatric neurosurgery, and trainees—where we discuss complex patient cases to learn from each other and develop consensus treatment recommendations,” Dr. Kilburg said. “It’s been really beneficial to have such an easy forum to collaborate with other the specialties involved in the care of these patients as we build out the program.”
Dr. Kilburg has also partnered with pediatric interventional radiology, pediatric oncology, and pediatric ophthalmology to develop a new method of delivering intra-arterial chemotherapy for children with retinoblastoma. “The administration of intra-arterial chemotherapy into the ophthalmic artery has been a long-standing treatment of retinoblastoma in infants. Together, we’ve refined a method for accessing the ophthalmic artery that was previously only used as a rescue technique,” Dr. Kilburg said. “This allows us to administer the chemotherapy more effectively and efficiently. We plan to publish our initial treatment results with the alternate pathway soon, as well as a method we have developed that helps to reduce access site complications in infants.” The team is also prioritizing pediatric stroke advocacy as a group. The pediatric stroke team, including Drs. Kilburg and Pabst, attended the 2024 Utah Heart & Stroke Walk with one of their patients, Lucy Merrell, and her family. Lucy is a 14-year-old who experienced a stroke this past year and has made an amazing recovery after undergoing mechanical thrombectomy. She has now become an advocate for other pediatric stroke patients.
Another important move forward in the program is protocol development for the treatment of different pathologies. The team has already rolled out protocols for thrombolysis, thrombectomy, blunt cerebrovascular injuries, and cerebral venous sinus thrombosis and are currently developing several other multidisciplinary vascular protocols.
Dr. Kilburg is also part of the Vein of Galen Malformation Genetics Research Consortium that aims to understand the genetic basis of Vein of Galen malformation. “We’re going to start sampling cells from our patients with Vein of Galen malformation and sending them to a central site for analysis, so we can better understand and treat these malformations,” Dr. Kilburg said. The pediatric stroke program is also a site in the Focal Cerebral Arteriopathy Steroid Trial, a study that is researching whether early corticosteroid treatment in children with focal cerebral arteriopathy leads to better outcomes. The Utah program is currently the highest enrolling site in the country.
Overall, the team has made a number of enhancements to the program so far, and there’s even more to come in the future. The team plans to set up a comprehensive pediatric vascular clinic that will include therapies, physical medicine and rehabilitation, hematology, neurosurgery, and neurology to create an all-in-one clinic where children with cerebrovascular diseases can see multiple specialists at once. “Dr. Kilburg has been instrumental in the building of all these programs and initiatives,” Dr. Pabst shared. “So often pediatric neurology and neurosurgery and other specialties keep themselves separated, so it’s been great to bring them together and see how patient care gets better and more cohesive.”