Pediatric Neurosurgery

Carilion Clinic features surgeons with comprehensive pediatric neurosurgery experience and expertise. We can handle the full spectrum of pediatric neurosurgical conditions at Carilion. All Neurosurgeons at Carilion are well versed at pediatric emergencies. Two members of our team, Dr. Lisa Apfel and Dr. Gary Simonds specialize in pediatric neurosurgery.

Dr. Apfel trained at SUNY Buffalo and has focused almost exclusively on pediatric neurosurgery. She has performed a breadth pediatric procedures of the highest complexity at Carilion. Her interests include brain tumors, hydrocephalus, vascular malformations, craniosynostosis, spina bifida, trauma, and endoscopic neurosurgery. She is instrumental in the planning of a future Spina Bifida Clinic at Carilion.

Dr. Simonds trained at Walter Reed Army Medical Center and has worked with national leaders in pediatric neurosurgery throughout his career. Through the care of thousands of pediatric neurosurgical patients over the years, Dr Simonds has become one of the most experienced surgeons in the Virginias in pediatric neurosurgery. His interests include brain tumors, uncontrollable epilepsy, and tethered spinal cord.

Both Dr. Apfel and Dr. Simonds are well respected in Pediatric Neurosurgery and are highly regarded in their interactions with children and their parents.

The Carilion Neurosurgery Team includes 7 surgeons, 7 resident surgeons, 5 mid-level providers (four physician assistants and one nurse practitioner) and many specialized nurses and support personnel. All forms of pediatric neurosurgical disorders are treated at Carilion every day. Conditions treated at Carilion include but are not limited to:

  • Brain and spinal cord tumors. Unfortunately, children can be afflicted by many types of brain tumors, both malignant and benign. Some can be completely removed, some can only be partially removed, and some are located in sensitive areas and can only be biopsied. Some brain tumors require further treatment, which may include chemotherapy, radiation therapy or radiosurgery. All types of brain tumors are routinely treated at Carilion. Results from brain tumor surgery at Carilion have been exceptional.


  • Brachial plexus and peripheral nerve injuries, referring to damage to the network of nerves originating in the neck and extending through the armpit. These nerves can be injured directly or through violent stretching.
  • Chiari malformations. These involve a portion of the brain projecting through the major opening at the bottom of the skull. Too much tissue here can cause a back up of spinal fluid (hydrocephalus), fluid-filled cavitation of the spinal cord (syrinx), and/or too much pressure against the brainstem. They are often associated with bad headaches. Carilion Neurosurgeons use the latest techniques to successfully repair these brain malformations.
  • Craniofacial disorders. Some children are born with or develop premature closing of parts of their skull (normally, the skull is designed to expand with the growth of the brain). Lack of appropriate expansion leads to very oddly shaped heads (and faces) and occasional developmental delay. Carilion Neurosurgeons are well versed at the correction of all forms of “craniosynostosis.”
  • Intractable Epilepsy. Most forms of seizures can be controlled with medicines. Seizures that cannot be controlled are called “intractable.” Patients with this can experience up to hundreds of seizures in a day. We perform procedures which help reduce seizure frequency and duration. These include placing nagal nerve stimulators and cranial procedures which involve the removal, or disconnection, of the sections of the brain causing the seizures. Dr. Simonds has been instrumental in creating Epilepsy Surgery Centers at two other institutions and now plans to create such a center at Carilion.

  • Hydrocephalus, a buildup of fluid inside the brain that can be caused by genetic conditions, birth injury, infections, tumors, injury or trauma. Carilion surgeons treat this condition with either “shunting,” or opening up regions of the brain fluid system with tv scopes (endoscopes).
  • Spina bifida. Spina Bifida comes in many sizes and shapes but can involve severe spinal deformities in children. Care for severely affected spina bifida children involves multi-specialty care and support personnel. Carilion Neurosurgeons are some of the most experienced surgeons in the country treating this disease.

  • Syringomyelia. Also known as syrinx or hydromyelia, involves a fluid-filled cavitation of the spinal cord, potentially resulting in gradual paralysis. This condition can be treated successfully with various techniques.
  • Tethered cord syndrome. Often related to spina bifida, this condition involves the scarring down of the spinal cord resulting in stretching with growth or bending. Persistent stretching may result in paralysis, scoliosis, limb deformities. Often the spinal cord will require release from its “tethering”. We perform such procedures with some frequency and have excellent results.
  • Trauma to brain and spinal cord. Carilion Clinic is a “ Level 1” trauma center (one of only five in the state of Virginia). Unfortunately, this makes Carilion Neurosurgeons all too familiar with, yet extremely experienced with severe injuries to the backs and heads of children. Carilion features a state of the art pediatric intensive care unit where these patients are cared for. Neurosurgeons provide coverage of all types of pediatric neurosurgery trauma.
  • Non-accidental head injury. Sadly this refers to the scourge of child abuse. Carilion neurosurgeons are vastly experienced with this dreadful phenomenon and are dedicated to the care of these traumatized children.
  • Minor head injuries/concussions. Neurosurgeons are the ultimate experts on brain injuries. Sometimes simple appearing head injuries hide more serious problems within the brain.
  • Low back pain, neck pain, disc herniations. Less common in children, these spinal ailments can still afflict children. Carilion neurosurgery cares for thousands of patients every year with back and neck disorders.
  • Vascular disorders of the brain. Carilion neurosurgeons are very experienced in the care of patients with aneurysms, arteriovenous malformations, and cavernomas. These lesions can cause bleeding in the brain suddenly and “out of the blue.” Fortunately these are uncommon in children.

Our mission is to provide the highest quality care with compassion, dedication and attention to children and their families. In addition to our expert physicians and state-of-the-art facility, you will find our clinic offers a warm, welcoming staff experienced at easing the anxieties associated with medical treatment.