Prof. Dr. med. Martina Messing-Jünger enjoys an international reputation as Head of Pediatric Neurosurgery at the Asklepios Children’s Hospital in St. Augustin. This renowned specialist is familiar with the entire spectrum of neurosurgical conditions affecting the brain and spinal cord in children and adolescents – and has thus earned a worldwide reputation as an outstanding physician when it comes to pediatric neurosurgical conditions. One of her areas of specialization is the treatment of hydrocephalus, commonly known as water on the brain. Pediatric neurosurgeon Prof. Messing-Jünger is a doctor with a passion and a great deal of empathy for her young patients and their families. This empathetic commitment also characterizes the entire team, on whom she can rely completely.
Leading Medicine Guide: Prof. Messing-Jünger, you are an internationally renowned and recognized pediatric neurosurgeon – yet you practice in Sankt Augustin, which is rather in the provinces. How do your patients find their way to you?
Prof. Dr. med. Martina Messing-Jünger: Young patients come to me from all over the world. The Asklepios Children’s Hospital in Sankt Augustin is a specialist clinic renowned far beyond our borders; word gets around. And pediatric neurosurgeons form a special international community: I am regarded as a well-known and recognized specialist within it. I was also President of the European Society for Pediatric Neurosurgery (ESPN) for two years.
Leading Medicine Guide: How on earth did you end up becoming a pediatric neurosurgeon?
Prof. Dr. med. Martina Messing-Jünger: There is no specific specialist training for this field. I worked in general neurosurgery for twenty years and performed all surgical procedures within our speciality at Düsseldorf University Hospital. But I’ve always been particularly interested in pediatrics, and I felt that children simply received poorer surgical care than adult patients. Surgical disciplines are geared toward adults. Bringing about change in this area was, and remains, very close to my heart. At major neurosurgical conferences and within our professional association, I always advocate that children are not just small adults and should be treated by specialists in a child- and family-friendly environment.
Leading Medicine Guide: You have been Head of Pediatric Neurosurgery at the Asklepios Children’s Hospital in Sankt Augustin since 2007. What led to the move from Düsseldorf University Hospital to the Asklepios Children’s Hospital?
Prof. Dr. med. Martina Messing-Jünger: Professionally, I had reached a point where I wanted to do something on my own. I had been asked several times to take over a clinic and had applied to two or three large hospitals – but I wasn’t entirely convinced yet. I am a doctor driven by passion and conviction, and not everything in our healthcare system runs smoothly. There are also many so-called ‘misincentives’ within the framework of hospital funding. Not every operation is truly indicated, but the economic pressure is very strong. You have to make compromises from time to time. It’s different in pediatric medicine. If I’m going to develop a niche within neurosurgery, then it has to be pediatric neurosurgery. Yes, and during that decision-making process, I actually received a proactive call from the Asklepios Children’s Hospital in Sankt Augustin. I didn’t have to think twice and made up my mind straight away. The business plan I had drawn up to establish the pediatric neurosurgery department was implemented exactly as written, and its further development has also gone perfectly.
Leading Medicine Guide: What a blessing for the many young patients who can be treated in the pediatric neurosurgery department at the Asklepios Children’s Hospital. Which conditions do you treat most frequently?
Prof. Dr. med. Martina Messing-Jünger: We see disorders of the cerebrospinal fluid circulation, such as hydrocephalus, almost every day. We also see large numbers of children with spinal cord and spinal column malformations. In addition, we treat all types of skull deformities and brain tumors. Functional neurosurgery is also part of our range of services. Children suffering from spastic cerebral palsy can be helped by the implantation of a baclofen pump or the targeted severing of nerve fibers. In cases of epilepsy that cannot be treated with medication, surgical interventions can, in certain instances, help to stop the seizures. We are currently in the process of establishing an epilepsy center in collaboration with our pediatric neurologists. Our young patients come to us from all over Germany and from around the world, as the interdisciplinary care we provide – which is our top priority – is a unique feature of our service.
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Leading Medicine Guide: The children are very, very small when you operate on them. For many conditions, surgery at the age of six months is the optimal medical solution. How do you go about operating on such small children?
Prof. Dr. med. Martina Messing-Jünger: You mustn’t be afraid of operating on young children. Of course, you have to be able to handle tiny structures, but there are also many advantages from the surgeon’s perspective. Although it is riskier to operate on a brain that is still developing and on other very delicate structures, children often have fewer comorbidities than adults that could negatively affect the operation.
Leading Medicine Guide: When you see children with rare conditions, do you always know what to do?
Prof. Dr. med. Martina Messing-Jünger: Every malformation is unique and presents a wide variety of challenges during training. But if you have a lot of experience and have performed the procedure so many times, you know the basics and have developed strategies to deal with the variations. I pass on my wealth of experience in many training sessions. We offer work shadowing and a fellowship, run courses, and advise colleagues both at home and abroad. Providing good training is a difficult area, as you cannot immediately expose young graduates to delicate operations on children.
Leading Medicine Guide: What needs to be different in a pediatric clinic?
Prof. Dr. med. Martina Messing-Jünger: Oh, quite a lot. It starts with the different bed sizes; we have beds in four sizes. Then we need different tube sizes, cannulas, syringes, implants – everything must be adapted to the different age groups. And of course, we have extensive experience here with medications and dosages. As I said, children are not just small adults. Our anaesthetists must be specially trained and also have a great deal of experience. Without an experienced, interdisciplinary team, particularly in the operating theater and on the intensive care unit, we cannot perform our neurosurgical operations on children of all age groups with a clear conscience.
Leading Medicine Guide: It’s not just the medical setting that’s different; the psychological aspect is more complex too, isn’t it?
Prof. Dr. med. Martina Messing-Jünger: Yes, that is a very important point. Anyone working in my team must take the concerns of patients and their families very seriously. Without this particular empathy, one would be out of place. The conversations with the parents, the conversations with the children, are much more time-consuming compared to adult medicine. And I always say to my team: please imagine you were in the father’s or mother’s shoes. You would be very afraid, so you need to be able to put yourselves in their position. Our nursing staff are also different in their approach and show a great deal of dedication. And what’s particularly lovely is that everyone is always in good spirits and spreads optimism and confidence.
Leading Medicine Guide: Do you always want the parents to be present?
Prof. Dr. med. Martina Messing-Jünger: Yes, that’s important to us, and it also has an enormous impact on the children’s well-being and recovery. Thankfully, there has been a paradigm shift in the wards and in treatment approaches. The parents also sleep alongside their children. If the children have to go to the intensive care unit, the parents – and, if necessary, the siblings too – stay at the Ronald McDonald House nearby. We also have a team of chaplains and psychologists who look after the family. This is of immense importance, particularly in oncology.
Leading Medicine Guide: The Asklepios Children’s Hospital in Sankt Augustin moved into a beautiful new building some time ago.
Prof. Dr. med. Martina Messing-Jünger: We’ve been very lucky in that respect. We were able to move into the former Heart Center and now have spacious patient and ward rooms, as well as state-of-the-art operating theaters. Up to 80,000 young patients are treated at our clinic each year, both as outpatients and inpatients.
Acoustic neuroma – a tumor in the brain
Leading Medicine Guide: Surely this leads to long-term doctor-patient relationships?
Prof. Dr. med. Martina Messing-Jünger: In neurosurgery, these are actually lifelong relationships, because we continue to treat many patients even as adults, as we are the only ones with the expertise for certain conditions. And our patients are very loyal; we always receive lots and lots of letters at Christmas. Recently, I met a young woman in the orthopedics department whom I had treated as a little girl. She had undergone orthopedic surgery back then and didn’t wake up from the anesthetic. During imaging, we then saw that she had a very large acoustic neuroma in her head. I removed it during a ten-hour operation. Yes, and this young woman came up to me and said: ‘You saved my life back then. And then she handed me a book; she had since gone on to earn a PhD in history. “This is for you,” she said, opening the book: “I’ve dedicated it to you.” That’s when you realize why you do this demanding job!
Professor, thank you very much for the informative conversation. You can get in direct contact with our expert via her profile page on the Leading Medicine Guide.
