My experience as both a parent and a provider has deepened my understanding of treating children with disabilities and has particularly enriched my practice in the care of children with hydrocephalus and spina bifida and their families.


Undergraduate Degree

  • Georgetown College , 1980 , Georgetown , KY

Medical School

  • Harvard Medical School , 1984 , Boston , MA


  • Case Western Reserve University/University Hospitals of Cleveland , 1985 , Cleveland , OH


  • Case Western Reserve University/University Hospitals of Cleveland , 1991 , Cleveland , OH


  • Boston Children's Hospital , 1992 , Boston , MA

Philosophy of Care

I am motivated personally by my children, one of whom was born with special needs. My experience as both a parent and a provider has deepened my understanding of treating children with disabilities and has particularly enriched my practice in the care of children with hydrocephalus and spina bifida and their families.


I am a pediatric neurosurgeon specializing in hydrocephalus, spina bifida and neuroendoscopy with a passion for training the next generation of surgeons and improving access to quality care both here and abroad.

I am the director of Neonatal and Congenital Neurosurgery and hold the chair in hydrocephalus and spina bifida at Boston Children's Hospital.  I founded the Global Hydrocephalus and Spina Bifida Program here and, in 2016, started the hospital's first global pediatric neurosurgery fellowship.

The Harvard community has played a major role in my development. I graduated from Harvard Medical School in 1984, was the first fellow in pediatric neurosurgery at Boston Children’s Hospital under emeritus chief, Dr. R. Michael Scott, and was a Harvard-Macy Scholar in Medical Education.

I felt strongly about using my expertise in parts of the world where medical resources are scarce. From 2000 to 2006, I served as chief of surgery and founding medical director at CURE Children’s Hospital of Uganda, the only pediatric neurosurgery hospital in sub-Saharan Africa. I remain the hospital's director of research and am a member of the CURE International Board of Trustees, for which I also act as senior medical advisor. I serve as the medical director of the CURE Hydrocephalus and Spina Bifida Program that trains and equips surgeons in developing countries to treat these conditions throughout the world.

While treating children with hydrocephalus in Uganda, I developed a novel treatment for hydrocephalus in infants by combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), which avoided the risk and expense of shunt dependence for the majority. To date, through CURE Hydrocephalus, surgeons in more than 20 countries have been trained and equipped in this technique, and more than 17,000 children have been treated for hydrocephalus, many of which would not have been treated otherwise.

Since joining Boston Children's Hospital in 2009, I have shown the efficacy of ETV/CPC for infant hydrocephalus in the United States, and have trained North American pediatric neurosurgeons across the country in the technique.

In 2007 I was presented with the Humanitarian Award of the American Association of Neurological Surgeons, and in 2012 I was honored to received a MacArthur “Genius” grant for improving access to care and standards of that care both at home and in the developing world.


  • American Board of Neurological Surgery
  • American Board of Pediatric Neurological Surgery


Publications powered by Harvard Catalyst Profiles

  1. Assessing the utility of low resolution brain imaging: treatment of infant hydrocephalus. Neuroimage Clin. 2021; 32:102896. View abstract
  2. The low utility of routine cranial imaging after pediatric shunt revision. J Neurosurg Pediatr. 2021 Nov 19; 1-7. View abstract
  3. Preoperative risk and postoperative outcome from subdural fluid collections in African infants with postinfectious hydrocephalus. J Neurosurg Pediatr. 2022 Jan 01; 29(1):31-39. View abstract
  4. Parental metal exposures as potential risk factors for spina bifida in Bangladesh. Environ Int. 2021 12; 157:106800. View abstract
  5. Normal childhood brain growth and a universal sex and anthropomorphic relationship to cerebrospinal fluid. J Neurosurg Pediatr. 2021 Jul 09; 28(4):458-468. View abstract
  6. Brain growth after surgical treatment for infant postinfectious hydrocephalus in Sub-Saharan Africa: 2-year results of a randomized trial. J Neurosurg Pediatr. 2021 Jul 09; 1-9. View abstract
  7. Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study. BMC Anesthesiol. 2021 04 21; 21(1):124. View abstract
  8. Immune activation during Paenibacillus brain infection in African infants with frequent cytomegalovirus co-infection. iScience. 2021 Apr 23; 24(4):102351. View abstract
  9. Choroid plexus NKCC1 mediates cerebrospinal fluid clearance during mouse early postnatal development. Nat Commun. 2021 01 19; 12(1):447. View abstract
  10. Safety of delayed surgical repair of omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex in infants with significant comorbidities. Pediatr Surg Int. 2021 Jan; 37(1):93-99. View abstract
  11. Exome sequencing implicates genetic disruption of prenatal neuro-gliogenesis in sporadic congenital hydrocephalus. Nat Med. 2020 11; 26(11):1754-1765. View abstract
  12. Paenibacillus infection with frequent viral coinfection contributes to postinfectious hydrocephalus in Ugandan infants. Sci Transl Med. 2020 09 30; 12(563). View abstract
  13. Geospatial Mapping of International Neurosurgical Partnerships and Evaluation of Extent of Training and Engagement. World Neurosurg. 2020 12; 144:e898-e907. View abstract
  14. Management of Post-hemorrhagic Ventricular Dilatation in the Infant Born Preterm. J Pediatr. 2020 11; 226:16-27.e3. View abstract
  15. Complex Management of Hydrocephalus Secondary To Choroid Plexus Hyperplasia. World Neurosurg. 2020 09; 141:101-109. View abstract
  16. Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets. Nat Rev Neurol. 2020 05; 16(5):285-296. View abstract
  17. The CURE Protocol: evaluation and external validation of a new public health strategy for treating paediatric hydrocephalus in low-resource settings. BMJ Glob Health. 2020; 5(2):e002100. View abstract
  18. Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study. J Neurosurg Pediatr. 2019 Oct 18; 1-9. View abstract
  19. The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants: A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial. Neurosurgery. 2019 10 01; 85(4):E714-E721. View abstract
  20. Noninvasive Thermal Evaluation of Ventriculoperitoneal Shunt Patency and Cerebrospinal Fluid Flow Using a Flow Enhancing Device. Neurosurgery. 2019 08 01; 85(2):240-249. View abstract
  21. Infection risk for Bactiseal Universal Shunts versus Chhabra shunts in Ugandan infants: a randomized controlled trial. J Neurosurg Pediatr. 2019 01 04; 23(3):397-406. View abstract
  22. Reversible intracranial hypertension following treatment of an extracranial vascular malformation: case report. J Neurosurg Pediatr. 2019 01 04; 23(3):369-373. View abstract
  23. Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems. Neurosurg Focus. 2018 10; 45(4):E2. View abstract
  24. Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide. Neurosurg Focus. 2018 10; 45(4):E13. View abstract
  25. Patterns of Hydrocephalus in Rural Haiti: A Computed Tomography-Based Study. World Neurosurg. 2018 Nov; 119:257-261. View abstract
  26. Renal Outcomes in Children with Operated Spina Bifida in Uganda. Int J Nephrol. 2018; 2018:6278616. View abstract
  27. De Novo Mutation in Genes Regulating Neural Stem Cell Fate in Human Congenital Hydrocephalus. Neuron. 2018 07 25; 99(2):302-314.e4. View abstract
  28. Children with spina bifida in Eastern Uganda report a reasonable quality of life relative to their healthy school-attending peers. Arch Dis Child. 2019 01; 104(1):101-102. View abstract
  29. Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective. J Neurosurg. 2018 May 01; 1-9. View abstract
  30. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg. 2018 04 01; 1-10. View abstract
  31. Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. 2018 Apr 01; 1-15. View abstract
  32. Normative human brain volume growth. J Neurosurg Pediatr. 2018 05; 21(5):478-485. View abstract
  33. Economic burden of neonatal sepsis in sub-Saharan Africa. BMJ Glob Health. 2018; 3(1):e000347. View abstract
  34. Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda. N Engl J Med. 2017 12 21; 377(25):2456-2464. View abstract
  35. Learning Based Segmentation of CT Brain Images: Application to Postoperative Hydrocephalic Scans. IEEE Trans Biomed Eng. 2018 08; 65(8):1871-1884. View abstract
  36. Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg. 2017 10; 41(10):2426-2434. View abstract
  37. Erratum to: Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg. 2017 10; 41(10):2423-2425. View abstract
  38. Growing Brains: How Adapting to Africa Advanced the Treatment of Infant Hydrocephalus. Neurosurgery. 2017 Sep 01; 64(CN_suppl_1):37-39. View abstract
  39. Quality of life among children with spina bifida in Uganda. Arch Dis Child. 2017 11; 102(11):1057-1061. View abstract
  40. Past, Present, and Future of Neurosurgery in Uganda. Neurosurgery. 2017 04 01; 80(4):656-661. View abstract
  41. Comparative effectiveness of flexible versus rigid neuroendoscopy for endoscopic third ventriculostomy and choroid plexus cauterization: a propensity score-matched cohort and survival analysis. J Neurosurg Pediatr. 2017 May; 19(5):585-591. View abstract
  42. Scorecard for spina bifida research, prevention, and policy - A development process. Prev Med. 2017 Jun; 99:13-20. View abstract
  43. Neuroimaging of Children With Surgically Treated Hydrocephalus: A Practical Approach. AJR Am J Roentgenol. 2017 Feb; 208(2):413-419. View abstract
  44. Introduction: Pediatric hydrocephalus: a continuing evolution in our understanding and management. Neurosurg Focus. 2016 Nov; 41(5):E1. View abstract
  45. Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions. Neurosurg Focus. 2016 Nov; 41(5):E11. View abstract
  46. Ten-year survival of Ugandan infants after myelomeningocele closure. J Neurosurg Pediatr. 2017 Jan; 19(1):70-76. View abstract
  47. Surgery for epilepsy: the need for global acceptance and access. Lancet Neurol. 2016 08; 15(9):898-899. View abstract
  48. Prenatal diagnosis and assessment of congenital spinal anomalies: Review for prenatal counseling. World J Orthop. 2016 Jul 18; 7(7):406-17. View abstract
  49. Separating Putative Pathogens from Background Contamination with Principal Orthogonal Decomposition: Evidence for Leptospira in the Ugandan Neonatal Septisome. Front Med (Lausanne). 2016; 3:22. View abstract
  50. Teaching NeuroImages: Interhemispheric multiloculated cyst with callosal dysgenesis in an infant. Neurology. 2016 Jan 05; 86(1):e10-1. View abstract
  51. Reducing neurodevelopmental disorders and disability through research and interventions. Nature. 2015 Nov 19; 527(7578):S155-60. View abstract
  52. "Who Is My Neighbor?" Global Neurosurgery in a Non-Zero-Sum World. World Neurosurg. 2015 Dec; 84(6):1547-9. View abstract
  53. Hydrocephalus in children. Lancet. 2016 Feb 20; 387(10020):788-99. View abstract
  54. Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants. J Neurosurg Pediatr. 2015 Apr; 15(4):399-405. View abstract
  55. Volumetric brain analysis in neurosurgery: Part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus. J Neurosurg Pediatr. 2015 Feb; 15(2):125-32. View abstract
  56. Volumetric brain analysis in neurosurgery: Part 3. Volumetric CT analysis as a predictor of seizure outcome following temporal lobectomy. J Neurosurg Pediatr. 2015 Feb; 15(2):133-43. View abstract
  57. The role of simulation in neurosurgery. Childs Nerv Syst. 2014 Dec; 30(12):1997-2000. View abstract
  58. Anatomical pediatric model for craniosynostosis surgical training. Childs Nerv Syst. 2014 Dec; 30(12):2009-14. View abstract
  59. New anatomical simulator for pediatric neuroendoscopic practice. Childs Nerv Syst. 2015 Feb; 31(2):213-9. View abstract
  60. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr. 2014 Nov; 14(5):439-46. View abstract
  61. Three steps forward and 2 steps back: the Echternach procession toward optimal hydrocephalus treatment. Neurosurgery. 2014 Aug; 61 Suppl 1:105-10. View abstract
  62. 183 Intracranial arachnoid cysts and hemorrhage. Neurosurgery. 2014 Aug; 61 Suppl 1:220. View abstract
  63. Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children. J Neurosurg Pediatr. 2014 Feb; 13(2):140-4. View abstract
  64. Presentation, pathology, and treatment outcome of brain tumors in 172 consecutive children at CURE Children's Hospital of Uganda. The predominance of the visible diagnosis and the uncertainties of epidemiology in sub-Saharan Africa. Childs Nerv Syst. 2014 Jan; 30(1):137-46. View abstract
  65. Position statement on fetal myelomeningocele repair. Am J Obstet Gynecol. 2014 Feb; 210(2):107-11. View abstract
  66. The microbial spectrum of neonatal sepsis in Uganda: recovery of culturable bacteria in mother-infant pairs. PLoS One. 2013; 8(8):e72775. View abstract
  67. Congenital idiopathic hydrocephalus of infancy: the results of treatment by endoscopic third ventriculostomy with or without choroid plexus cauterization and suggestions for how it works. Childs Nerv Syst. 2013 Jun; 29(6):935-40. View abstract
  68. Shunt survival after failed endoscopic treatment of hydrocephalus. J Neurosurg Pediatr. 2012 Dec; 10(6):463-70. View abstract
  69. Dysplastic-reactive choroid plexus presenting as an intramedullary tumor of the cervicomedullary junction in a patient with myelomeningocele. J Neurosurg Pediatr. 2012 Nov; 10(5):406-10. View abstract
  70. Rainfall drives hydrocephalus in East Africa. J Neurosurg Pediatr. 2012 Sep; 10(3):161-7. View abstract
  71. Long-term outcome for endoscopic third ventriculostomy alone or in combination with choroid plexus cauterization for congenital aqueductal stenosis in African infants. J Neurosurg Pediatr. 2012 Aug; 10(2):108-11. View abstract
  72. Educate one to save a few. Educate a few to save many. World Neurosurg. 2013 Feb; 79(2 Suppl):S15.e15-8. View abstract
  73. Extradural myelomeningocele reconstruction using local turnover fascial flaps and midline linear skin closure. J Plast Reconstr Aesthet Surg. 2012 Nov; 65(11):1569-72. View abstract
  74. Risk factors of sudden death in young adult patients with myelomeningocele. J Neurosurg Pediatr. 2012 Feb; 9(2):149-55. View abstract
  75. The impact of combined endoscopic third ventriculostomy and choroid plexus cauterization on the management of pediatric hydrocephalus in developing countries. World Neurosurg. 2013 Feb; 79(2 Suppl):S23.e13-5. View abstract
  76. Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatr. 2011 Nov; 8(5):509-21. View abstract
  77. Five-year survival and outcome of treatment for postinfectious hydrocephalus in Ugandan infants. J Neurosurg Pediatr. 2011 Nov; 8(5):502-8. View abstract
  78. Management of Dandy-Walker complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization. J Neurosurg Pediatr. 2011 Oct; 8(4):377-83. View abstract
  79. Hydrocephalus associated with neural tube defects: characteristics, management, and outcome in sub-Saharan Africa. Childs Nerv Syst. 2011 Oct; 27(10):1589-94. View abstract
  80. Initial experience with combined endoscopic third ventriculostomy and choroid plexus cauterization for post-hemorrhagic hydrocephalus of prematurity: the importance of prepontine cistern status and the predictive value of FIESTA MRI imaging. Childs Nerv Syst. 2011 Jul; 27(7):1063-71. View abstract
  81. Factors affecting survival of infants with myelomeningocele in southeastern Uganda. J Neurosurg Pediatr. 2011 Feb; 7(2):127-33. View abstract
  82. Association of bacteria with hydrocephalus in Ugandan infants. J Neurosurg Pediatr. 2011 Jan; 7(1):73-87. View abstract
  83. Encephalocele in Uganda: ethnic distinctions in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children. J Neurosurg Pediatr. 2011 Jan; 7(1):88-93. View abstract
  84. Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome. Childs Nerv Syst. 2010 Dec; 26(12):1711-7. View abstract
  85. Pediatric hydrocephalus in East Africa: prevalence, causes, treatments, and strategies for the future. World Neurosurg. 2010 Apr; 73(4):296-300. View abstract
  86. Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. J Neurosurg Pediatr. 2010 Feb; 5(2):204-9. View abstract
  87. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatr. 2010 Feb; 5(2):143-8. View abstract
  88. Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. J Neurosurg Pediatr. 2009 Dec; 4(6):564-70. View abstract
  89. Neurosurgical humanitarian aid. J Neurosurg Pediatr. 2009 Jul; 4(1):1-2; discussion 2-3. View abstract
  90. Surgery for pharmacoresistant epilepsy in the developing world: A pilot study. Epilepsia. 2009 May; 50(5):1256-61. View abstract
  91. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 East African infants. J Neurosurg Pediatr. 2008 Nov; 2(5):310-6. View abstract
  92. Application of neuroendoscopy to intraventricular lesions. Neurosurgery. 2008 Feb; 62 Suppl 2:575-97; discussion 597-8. View abstract
  93. Endoscopic third ventriculostomy and choroid plexus cauterization for pediatric hydrocephalus. Clin Neurosurg. 2007; 54:78-82. View abstract
  94. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg. 2005 Dec; 103(6 Suppl):475-81. View abstract
  95. Comparison of 1-year outcomes for the Chhabra and Codman-Hakim Micro Precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg. 2005 May; 102(4 Suppl):358-62. View abstract
  96. Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg. 2005 Jan; 102(1 Suppl):1-15. View abstract
  97. Nonselective partial dorsal rhizotomy: a clinical experience with 1-year follow-Up. Pediatr Neurosurg. 2000 Mar; 32(3):114-8. View abstract
  98. Interpreting the judgment of surgical faculty regarding resident competence. J Surg Res. 1999 Sep; 86(1):29-35. View abstract
  99. The relative contributions of interpersonal and specific clinical skills to the perception of global clinical competence. J Surg Res. 1999 Sep; 86(1):17-23. View abstract
  100. Separation of complex pygopagus conjoined twins. J Pediatr Surg. 1999 Apr; 34(4):619-22. View abstract
  101. Intracavernous teratoma in a school-aged child. Pediatr Neurosurg. 1999 Mar; 30(3):135-9. View abstract
  102. Dorsal tethering bands of the meningocele manque: sonographic findings. AJR Am J Roentgenol. 1996 Nov; 167(5):1293-4. View abstract
  103. Cavernous sinus thrombophlebitis: case report. Neurosurgery. 1996 Aug; 39(2):385-9. View abstract
  104. The electromyographic responses to dorsal rootlet stimulation during partial dorsal rhizotomy are inconsistent. Pediatr Neurosurg. 1996 Jul; 25(1):13-9. View abstract
  105. Occult spinal dysraphism in the infant. Clin Pediatr (Phila). 1995 Dec; 34(12):650-4. View abstract
  106. Recurrent meningitis: the search for the dermoid or epidermoid tumor. Pediatr Infect Dis J. 1995 Aug; 14(8):697-700. View abstract
  107. Cervical paraspinous desmoid tumor in a child: case report. Neurosurgery. 1994 Nov; 35(5):956-9; discussion 959. View abstract
  108. Tethered spinal cord in patients with anorectal and urogenital malformations. Pediatr Neurosurg. 1993; 19(1):25-30. View abstract
  109. Evidence for the ventral origin of oligodendrocyte precursors in the rat spinal cord. J Neurosci. 1991 Aug; 11(8):2477-88. View abstract
  110. Intracranial tumor in infants: characteristics, management, and outcome of a contemporary series. Neurosurgery. 1991 Mar; 28(3):343-8. View abstract
  111. Ventral brain-stem compression from a subarachnoid ependymal cyst. Childs Nerv Syst. 1990 Jun; 6(4):225-7. View abstract
  112. Maternal intracranial hemorrhage complicating severe superimposed preeclampsia. A case report. J Reprod Med. 1989 Oct; 34(10):857-60. View abstract
  113. Neocarzinostatin chromophore binds to deoxyribonucleic acid by intercalation. Biochemistry. 1981 Jul 07; 20(14):4007-14. View abstract