Pediatric neurosurgery is a medical specialty that focuses on conditions affecting the head, spine, or nervous system in children. Many of the issues treated by surgeons within this field are similar to conditions seen in adults. However, the approach to diagnosis and treatment is often very different. Some conditions are unique to newborns, infants, children, adolescents, and teens.
Diagnostic Efforts and Delayed Symptoms
An important part of pediatric neurosurgery is determining the specific problem that is causing issues with the brain, spinal cord, or nervous system. Making a positive diagnosis isn’t always easy with some childhood neurological conditions. This is because children go through growth spurts and development stages that can have an impact on how symptoms are presented.
Children also aren’t able to verbalize symptoms the same way adult patients can when asked to describe what they’re experiencing. Some neurologic disorders or infections passed from mother to baby during pregnancy may be detectable during prenatal testing and others are diagnosed later when:
- Deformities or abnormalities affect development
- Development milestones are missed, as may be the case with autism
- Unexplained or unusual infections like meningitis develop
Another essential task for a pediatric neurosurgeon is to determine when surgical intervention is necessary. Some neurologic conditions are present at birth (congenital), some are acquired, and others have no known cause (idiopathic). For instance, a structural problem with the cerebellum that blocks spinal fluid flow (Chiari malformation) often requires corrective surgery before serious symptoms develop.
Minimally invasive techniques may be used to treat cerebrospinal fluid-filled sacs (arachnoid cysts) located in the space between the spinal cord and brain and similar conditions that may produce life-threatening symptoms. Surgery for some conditions may be delayed until later stages of development to reduce the risk of injury to growing bones.
Traumatic Brain Injuries
Any type of substantial blow to the head in children should be treated seriously. Referral may be made to a pediatric neurosurgeon for a more accurate diagnosis or to determine an appropriate treatment. Such injuries may be contained within the head (closed head injuries) or involve an open wound.
Spinal Cord Injuries
Unexpected falls, hard impacts, and infections may affect the developing spinal cord in children. A pediatric neurosurgeon will determine the extent of the damage to the spinal cord and make an appropriate treatment recommendation. Non-surgical remedies are usually preferred to avoid surgery on a growing and developing spine, if possible. The majority (60 to 75 percent) of spinal cord injuries in children occur in the neck rather than the lumber (lower) spine, as is common in adults.
Abnormal masses (tumors) sometimes develop in children. Tumors may be located in the brain or spinal cord while others may appear in the throat or abdomen. If a tumor is detected, tests must be done to determine if it is benign (non-cancerous) or malignant (cancerous). Even tumors that are benign may cause issues with development in children if located along certain parts of the spine or in the brain.
Some children have defects that may develop due to a combination of genetic issues and environmental factors. Such malformations can affect the brain, spine, and vital organs throughout the body. These abnormalities need to be detected and treated as early as possible to minimize the risk of developing learning difficulties and issues with growth and mental and physical development.
Exposure to Toxins
If children are exposed to certain toxins, neurologic impairments may development over time. Diagnosis can be difficult since some symptoms can be vague or possible signs of other conditions.
Coordinated and Comprehensive Care
Pediatric neurosurgery often involves the coordination of care efforts with a child’s regular doctor. This may be necessary for conditions that will likely require periodic monitoring. A pediatric neurosurgeon may also work with other specialists to put together a comprehensive long-term care plan, as may be necessary for:
- Neuromuscular diseases
- Craniofacial anomalies
- Complex seizure disorders
- Orthopedic anomalies and conditions
Neurological disorders affecting children have many potential causes and just as many possible treatment options. Some conditions like scoliosis may require minor treatment such as bracing and periodic monitoring while cerebral palsy typically requires continued care into adulthood. For this reason, pediatric neurosurgery is a dynamic and diverse field that includes a unique and personalized approach to patient care.