Pediatric Neurosurgery
While
some neurological conditions can be managed effectively with medical
(drug) therapy, others are best suited to surgical intervention.
Our team of pediatric neurosurgeons routinely works in concert with
pediatric specialists throughout the hospital to provide optimal
therapies for children with minimal risk to their physical and neurological
development. Using the latest diagnostic and surgical techniques,
NewYork-Presbyterian offers effective surgical options for children
and babies with neurological and muskuloskeletal conditions that
were once difficult to treat, such as:
Hydrocephalus
Definition
Hydrocephalus
is an imbalance between the rate at which cerebrospinal fluid
(CSF) is produced and reabsorbed ' is of the most common reasons
for the intervention of a pediatric neurosurgeon. Normally, CSF
is produced in the brain, where it circulates and protects brain
tissue. CSF eventually drains into certain passageways in the
brain, called ventricles, where it is reabsorbed into the blood
vessels. Hydrocephalus occurs when conditions such as congenital
malformations, neural tube defects, tumors, and blood clots obstruct
CSF circulation and absorption.
Diagnosis
Now,
such blockages can be located with the aid of diagnostic methods
such as computed tomography (CAT) scanning and magnetic resonance
imaging (MRI). Once the cause of hydrocephalus has been identified,
a physician can determine whether the head will eventually grow
enough to accommodate the imbalance of CSF on its own, or whether
surgical intervention is needed. Surgery often involves the placement
of a device called a shunt, which drains excess CSF away from
the brain.
Tumors
of the brain and spine
Definition
Brain
tumors are the most common solid tumor in children and adolescents.
In children, brain tumors usually are benign (non-cancerous) and
remain confined within the boundaries of a specific area of the
brain. Although not as common as brain tumors, spinal tumors in
children are almost always benign. Depending on their location
and type, some brain and spinal tumors may be surgically removed.
Diagnosis
The
goal of the pediatric neurosurgeon is to remove as much of the
tumor as possible to prevent it from causing neurological impairment
or increasing pressure within the skull. Prior to surgery, diagnostic
imaging techniques such as computed tomography (CAT) scanning
and magnetic resonance imaging (MRI) are used to identify the
location, size, and other visual characteristics of the tumor.
If the tumor cannot be removed without causing serious injury
to the brain or spinal cord, a biopsy may be performed to determine
other types of treatment (e.g., chemotherapy or radiation therapy)
may be most effective.
Congenital
malformations of the head and spine
Pediatric
neurosurgeons can correct a variety of malformations of the bone
and soft tissue of the head and spine, including neural tube defects
such as spina bifida. Each year, one in a thousand babies
are born with spina bifida (meningomyelocele), a malformation
of the bones (vertebrae) and/or skin surrounding the spine that
can lead to serious infections, problems with bladder and bowel
function, hydrocephalus, and paralysis. In most cases, surgical
correction of the neural tube defect can prevent such complications.
Other
congenital problems that may be treated by a pediatric neurosurgeon
include:
- Chiari
malformation, a condition in which portions of the base
of the spine protrude into the upper spine, where they may compress
the brain or spinal cord. Left untreated, this condition can
lead to neck pain, hoarseness, upper-respiratory tract infections,
and progressive weakness of the arms and legs. Chiari malformation
also may block the flow of cerebrospinal fluid (CSF), leading
to hydrocephalus. Treatments often focus on removing portions
of the bone and soft tissue to relieve pressure on the spinal
cord and brain, as well as providing new pathways to drain CSF.
- Encephaloceles,
a condition similar to chiari malformation that affects the
passageway between the nose and the front or back of the head.
Encephaloceles can lead to infections and hydrocephalus. Surgical
treatment of this condition involves removing bone and soft
tissue or drainage of CSF.
- Tethered
spinal cord, the attachment of the spinal cord to surrounding
tissue. Failure to detect a tethered spinal cord can lead to
a sudden catastrophic injury during childhood or adolescence,
such as paralysis. Tethered spinal cord can be diagnosed through
the detection of certain skin abnormalities along the midline
of the back. Diagnosis may be confirmed by magnetic resonance
imaging (MRI), and surgery is usually indicated to prevent neurological
damage.
Epilepsy
An
estimated 2.5 million Americans, including many children, have
epilepsy -- recurrent seizures caused by brief electrical disturbances
in the brain. Seizures typically cause a variety of symptoms,
including strange sensations, changes in behavior or emotions,
muscle spasms, convulsions, and a sudden loss of awareness or
consciousness.
In
most cases, epilepsy can be controlled with anti-seizure medications.
When drug therapy is insufficient, surgery may be considered.
Candidates for epilepsy surgery may undergo a variety of specialized
diagnostic tests ' with or without the aid of anesthesia -- to
pinpoint the exact cause and location of the seizure within the
brain. These tests help the surgical team determine whether major
functional areas of the brain, such as those guiding speech and
movement, might be affected by surgery. Following is a description
of the diagnostic tests frequently performed at NewYork-Presbyterian's
Epilepsy Centers:
- Intraoperative
electrocorticography maps seizure location with electrodes
placed on the surface, or within, the brain.
- Intraoperative
somatosensory evoked potentials locates areas of the brain
that should be avoided during surgery, such as those responsible
for touch and movement.
- Intraoperative
cortical stimulation for brain mapping confirms the location
of certain major functional centers of the brain, including
those responsible for movement and speech.
Once
the seizure area has been identified, the lesions that cause seizures
may be surgically removed. Depending on the location and severity
of the lesions, epilepsy surgery can improve patient quality of
life, and in some cases, eliminate seizures.
Columbia
Comprehensive Epilepsy Center http://cpmcnet.columbia.edu/dept/epilepsycenter/index.html
NewYork
Weill's Comprehensive Epilepsy Center:
http://neuro.med.cornell.edu/NYH-CMC/n-epilepsy.html
Trauma
Trauma
from accidental injury to the head and spinal cord is the leading
cause of death in children. Each year, an estimated 4,000 children
die from head injuries caused by falls, automobile accidents,
and even child abuse. Pediatric neurosurgeons treat a variety
of head injuries, ranging from skull fractures to intracranial
bleeding. The goal of treatment is to remove blood clots caused
by these injuries or close open wounds that can lead to infection.
Craniofacial
abnormalities
It
is not uncommon for infants to be born with a skull or facial
abnormality. While many of these abnormalities are minor, and
can be treated cosmetically, some can increase pressure within
the skull as the child grows.
Cynostosis
' premature closure of the skull bones ' is the most common craniofacial
abnormality. A pediatric neurosurgeon, often in conjunction with
a plastic surgeon, can correct this condition. Other common abnormalities
include benign developmental cysts, which can be surgically removed,
and posterior plagiocephaly, a flattening of the skull in infants
who sleep on their backs. Occasionally, orthotic devices such
as specially designed helmets are recommended to improve the shape
of the skull.
Functional
neurosurgery
Surgery
is now an option for many children with debilitating spasticity
or impaired movement and balance. Cerebral palsy, a movement disorder
that can cause severe spasticity, occurs in up to 5 per 1,000
infants. Other causes of spasticity may include head injuries,
a cutoff of oxygen to the brain, stroke, malnutrition, and heavy
metal ingestion. When oral medication fails, spasticity may be
reduced through the use of an implantable pump that delivers an
antispasmodic medication directly to the spinal cord. In some
cases, balance may be improved with a surgical technique called
rhizotomy, which removes the damaged motor/reflex nerve roots
located at the base of the spine.
Movement
also may be impaired by injury to the brachial plexus, a network
of nerves located in the neck and shoulder. Brachial plexus injuries
usually occur during birth, affecting up to 2 out of 1,000 babies.
Diagnostic tests using EMG (electromyelogram), which records muscle
movement, and high-definition MRI (magnetic resonance imaging)
are often used to diagnose this type of injury. While some brachial
plexus injuries may heal on their own, surgical repair may be
needed to prevent permanent neurological damage.
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