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Faculty Focus

Ann-Christine Duhaime, M.D.: Brain trust

By Jennifer Durgin

The surgeon threads her slender fingers through the patient's hair, gathering it together in her hands. Gently, she parts the black strands and, using small blue elastics, forms tiny ponytails on either side of the part. The patient, who is lying face down, asleep, on the operating table, will probably never know the care with which Ann-Christine Duhaime, M.D., prepared her for surgery.

For Duhaime, the director of pediatric neurosurgery at the Children's Hospital at Dartmouth (CHaD), getting her patients' hair ready for surgery is one part compassion and one part making sure things are done the way she wants. "If I don't do it myself, it doesn't get done the way I like it," says Duhaime, as she shaves a thick band along the length of the girl's part. "It's also a time when you think about what you are going to do."

Not all surgeons take such an active role in prepping their patients for surgery, but Duhaime is "very particular," says Martha Irvine, the scrub tech who will hand Duhaime scissors, clips, scalpels, and the other instruments needed for the operation. Irvine is still setting up her own workstation. She would usually be done by now, but Duhaime insists that the bag of sterilized instruments not be opened until the patient is in the operating room and the flow of traffic in and out of the room has diminished. "She likes things a certain way," says Irvine, "and she's very nice, so we try to accommodate."

Duhaime (pronounced "dew-HAME") has earned the right to be exacting. She became CHaD's first pediatric neurosurgeon in 2001, after 15 years at the Children's Hospital of Philadelphia—ranked the nation's best children's hospital by U.S. News & World Report—and 12 years on the faculty at the University of Pennsylvania. "I came to DMS because I thought that it was a wonderful environment to do innovative work both clinically and in research," she explains. A professor of neurosurgery and of pediatrics at DMS, Duhaime has helped double Dartmouth's pediatric neurosurgery patient volume. "CHaD is going through a growth phase," she says. "Right now, we're on, in my mind, the small end of the bell curve of what's ideal. There are some children's hospitals that in my opinion have gotten too big. They get too big and too cumbersome and they lose their collegiality. . . . Here, I have found that collaboration is very easy."

Perching on the head of a stuffed frog is all in a day's work for pediatric neurosurgeon Tina Duhaime—but so, too, is probing delicately deep into children's brains.

Duhaime, who has written more than 60 papers for such journals as Brain Research, Pediatrics, and the Journal of Neurosurgery, also heads up CHaD's pediatric neuroscience research program. She is currently the principal investigator for a $1.2-million study, funded by the National Institutes of Health, that's looking at the physiological effects of trauma to immature brains, as well as treatments for such injuries.

In her clinical work, Duhaime specializes in epilepsy, a disorder characterized by recurrent seizures. "Seizures are basically an electrical storm" in the brain, she explains. "About 80% of kids who have epilepsy can be treated successfully with medication, but that leaves one in five that no matter what you give them they still have seizures or they have unacceptable side effects from the medication. And those are the kids that may be candidates for surgery."

Duhaime is known nationally for her expertise in performing corpus callosotomies—in which the two hemispheres of the brain are disconnected in order to prevent seizures originating on one side from affecting the other side. If the "good" side of the brain

is "constantly bombarded with electrical storms [from the seizureprone side], it can't get a breath in edgewise," she explains. But if the "bad" side is isolated, the good side has a chance to develop while it's still young and adaptable. "Many centers have become less comfortable with offering corpus callosotomy," says Duhaime, "because they don't do it very often and have little experience." But because the procedure has been done at Dartmouth for decades, and Duhaime has treated a larger-than-average number of such patients, families considering the procedure are often referred to CHaD from afar.

Duhaime is only five feet, four inches tall, but her stature belies her brisk stride and commanding presence. When she burst through the operating-room doors earlier in the afternoon to prep for the procedure, it's clear she's the one in charge. "Everybody get some lunch?" she calls out to Irvine and the others in the room—an operating room nurse, a certified nurse anesthetist, and general surgery resident Tarek Radwan, M.D. "Everybody happy?"

She then focuses on grilling Radwan, who will assist in the operation; as a resident,

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Jennifer Durgin is Dartmouth Medicine magazine's senior writer. Certain identifying details in this article have been changed to preserve patient confidentiality.

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