Pediatric Neurosurgery | Specialists and Information

Main areas of treatment in pediatric neurosurgery

Pediatric neurosurgery deals with the diagnosis and surgical treatment of injuries, diseases and malformations of the

• Central nervous system (and its envelope structures) and
• Peripheral nervous system

The most common disease in the field of pediatric neurosurgery is infantile hydrocephalus, also known as hydrocephalus.

This is a pathological change in the cerebrospinal fluid in the brain that arises from various causes.

Another frequently encountered condition in pediatric neurosurgery is craniocerebral trauma. It is often caused by an external force in an accident or by excessive shaking of the child (shaking trauma).

Brain tumors are the most common tumors in children. An experienced pediatric neurosurgery team usually operates on these tumors.

Other clinical pictures treated by pediatric neurosurgery are, for example

• Microcephaly (reduced head circumference)
• Encephaloceles (gaps in the skull, for example, through which brain tissue can bulge outwards)
• Tethered cord (attached spinal cord)
• Cysts in the spinal cord
• Spina bifida (clefts in the spinal column, neural tube malformation, so-called open spine)

Spina bifida occulta is a spinal malformation that cannot be detected by imaging. It can be an incomplete closure of the posterior vertebral arches without clinical significance.

Complex malformations in the area of the spinal cord are also possible, such as

• Chiari malformations (displacement of cerebellar tissue into the spinal canal of the spinal cord)
• Craniosynostosis (premature closure of the cranial sutures)
• Malformations of brain and spinal cord vessels
• Tumors in the spinal cord
• epilepsy
• spasticity
• Dystonic movement disorders
• Peripheral nerve injuries
• Nerve damage due to birth
• Infections of the central nervous system and surrounding structures

In around 1 in 1000 cases, a baby is born with hydrocephalus @ Pepermpron /AdobeStock

Diagnostic procedures in pediatric neurosurgery

Precise diagnosis is essential for the optimal treatment of children with neurosurgical diseases.

Neurosurgeons work closely with radiologists to make a diagnosis and then plan treatment. Depending on the type of illness, they may also involve other specialists.

Specialties with which pediatric neurosurgery often works together are

• Pediatrics
• Pediatric surgeons
• Oral and maxillofacial surgeons
• Pediatric orthopedists
• Pediatric oncologists

The examinations and consultations are carried out

• endocrinological (hormone measurements)
• microbiological (examination for bacteria, yeasts and viruses)
• virological (clarification of a virological infection)
• histological (examination for tissue changes under the microscope)

Numerous imaging procedures are also available:

• Radiography (conventional X-ray)
• Ultrasound examinations (sonography)
• Angiography (X-ray procedure for examining arteries and veins using contrast media)
• CT(computer tomography)
• MRI(magnetic resonance imaging), functional MRI
• MRA (magnetic resonance angiography)

The following procedures are also part of the diagnostic repertoire of a pediatric neurosurgeon:

• EEG (electroencephalography)
• Neurological examinations (e.g. motor and sensitivity tests) and
• Neurophysiological procedures (e.g. recording of evoked potentials, determination of nerve conduction velocities, electromyography)

The EEG is an examination method for recording the brain waveform @ ShunTerra /AdobeStock

Treatment options for neurosurgical diseases in children

Neurosurgery in general and pediatric neurosurgery in particular is a modern medical specialty. Due to the anatomical conditions and the immense importance of nerve tissue for humans, surgeons must meet high professional standards.

Neurosurgeons are supported by the latest techniques, such as

• Surgical microscopy
• neuronavigation
• Intraoperative neuromonitoring and
• Intraoperative ultrasound

The operating theaters are equipped with the latest technology. The combination of minimally invasive endoscopic techniques means that healthy nerve tissue can be spared during the procedure. The risk of surgery-related functional deficits is reduced.

Surgery for vascular malformations, malformations or tumors is performed microsurgically.

Surgical treatment is followed by close aftercare. This is usually carried out in collaboration with the affiliated pediatric clinic and other specialists.

Neurosurgeons for children - what training do they need?

There is no such thing as a "specialist in pediatric neurosurgery". Paediatric neurosurgery is mostly carried out by neurosurgeons who specialize in the treatment of infants, children and adolescents.

To be able to work as a specialist in neurosurgery, you need to have completed a degree in medicine. After studying medicine, further training takes place, which lasts 72 months.

This further training leads to the attainment of specialist competence. The prospective neurosurgeon must carry out a specified number of diagnostic procedures and therapies.

Further training to become a neurosurgeon involves acquiring knowledge, experience and skills in the following areas

• Diagnosis
• Surgical, perioperative and conservative treatment options
• Aftercare and rehabilitation of diseases, injuries and their consequences
• Neurosurgical interventions

Neurosurgical interventions include

• Interventions on peripheral and autonomic nerves (relocation and suturing of nerves, tumor removal)
• Interventions on the spine (e.g. treatment of spinal injuries)
• Interventions for craniocerebral injuries
• Surgery for brain and spinal cord tumors
• Interventions for cranial, brain and spinal cord malformations
• Interventions for pain syndromes

Working with children requires sensitivity and empathy for the children themselves. But also for the worries and fears of the parents.