21F Clinical Conversations Recap #7

November 2nd, 2021 by Patrick Howard

Dr. Howard (top left) presenting to Dartmouth students on Calvarial Sutures

Dr. Peter Morgenstern spoke to Dartmouth students as part of the seventh installment of Clinical Conversations for Fall 2021. Dr. Morgenstern is an accomplished pediatric neurosurgeon who spent his undergraduate years as a music major at Dartmouth, earned his MD at Weill Cornell Medical College, completed his neurosurgical residency at New York Presbyterian Hospital, and finished his pediatric neurosurgery fellowship at Seattle Children’s Hospital. He is an expert in pediatric brain tumors, spinal and cranial malformations, hydrocephalus, Chiari malformation, and other complex pediatric neural problems that require neurosurgical intervention. After sharing some of his Dartmouth experiences and the decisions that led him to a career in pediatric neurosurgery, Dr. Morgenstern shared some of the fascinating cases he has worked on during his time at Mount Sinai. 

The first presented case was a fetal patient with a myelomeningocele, or an opening of the spinal cord that is fused to the outside of the skin. As he worked through the progression of the case, Dr. Morgenstern gave some insight into the challenges that come with surgery on pediatric patients, like a low circulating blood volume, smaller anatomy that is harder to navigate, and the need for special anesthetic expertise. He explained the development of the condition through an embryonic lens, and how that progression informed the plan he developed for surgery after the fetus’s birth. The presentation included footage of this surgery and how he applied the anatomy and pathology he had shown the audience to his surgical repairs. After sharing some of the advanced tools he works with to complete surgeries like this, he closed by sharing newer treatments for myelomeningocele like in-utero repairs. 

The second case Dr. Morgenstern presented was of a patient with a germ cell tumor that was compressing their optical nerves as well as diabetes insipidus and hypernatremia. In this case, he walked the audience through different ways of accessing a deep brain tumor and why he in this case chose to make an opening deep in the nasal cavity rather than a typical craniotomy. He also gave an example of the decision making that happens when something unexpected happens during a surgery; in this case, he spotted extra tumor tissue that he did not anticipate, and made the decision to explore further and resected more of the tumor. The result was improved patient outcomes (from 20:250 left-eye vision and right-eye blindness to 20:40 left-eye vision and right eye light detection). The patient of his third case, an infant with an early closure of the sagittal cranial suture, also had a positive outcome after Dr. Morgenstern and a plastic surgeon removed excess skull tissue and reshaped the head to a healthy structure. That patient is now developing normally. 

Finally, Dr. Morgenstern shared advice on balancing work and life as a pre-medical student and as a physician in a competitive medical field. Students were able to converse with him about his career decisions, applying to medical school, and making the most out of their time at Dartmouth. The Nathan Smith Society is extremely grateful for Dr. Morgenstern’s generous donation of his time and expertise, and wish him the best in his future work.