Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
As a brain and nerve surgeon, there is a fact I frequently emphasize: children are not “small adults.” A developing brain, a skull that has not yet fused, and a nervous system that continues to grow require an entirely separate approach specific to children. Pediatric neurosurgery is precisely the specialized field that arose from this very need, focusing on the brain and nervous system diseases of children. In this article, I want to explain in plain language what pediatric neurosurgery is, which diseases it deals with, why it differs from adult surgery, and what families should pay attention to.
What Is Pediatric Neurosurgery?
Pediatric neurosurgery (children’s brain and nerve surgery) is a specialty that deals with the diagnosis, follow-up, and surgical treatment of the brain, spinal cord, spine, and nervous system diseases of children from the period in the womb to the end of adolescence — that is, up to approximately 18 years of age. Nervous system problems that arise before birth, during birth, or afterward fall within the scope of this field.
The main aim of this field is to detect diseases at the earliest possible stage and to ensure that the child’s brain and nervous system can continue their development in a healthy way.
Children Are Not “Small Adults”: The Difference from Adult Neurosurgery
It is important to understand why pediatric neurosurgery requires a separate specialty. Because a child’s body differs in many respects from that of an adult:
- The skull has not yet fully fused: In infants, the regions between the skull bones called “fontanelles” (soft spots) are open, and the sutures (bone junction lines) are flexible.
- The brain tissue is developing: In children, the water content of the brain tissue is higher, and the blood-brain barrier has different properties.
- The spectrum of diseases is different: In children, congenital anomalies and distinctive tumor types are more prominent.
- Neuroplasticity (the brain’s capacity to adapt) is high: With appropriate and timely intervention, the child’s brain has a higher capacity than an adult’s to repair itself and establish new connections. This makes early diagnosis much more valuable.
Because of all these differences, the surgical techniques, the instruments used, the anesthesia protocols, and the post-operative intensive care must be planned entirely according to pediatric standards. For this reason, it is of great importance that children be evaluated by teams experienced in this field.
Which Diseases Does Pediatric Neurosurgery Deal With?
The scope of pediatric neurosurgery is very broad, ranging from emergency traumas to complex congenital syndromes. The most commonly encountered situations are:
Hydrocephalus (Fluid Accumulation in the Brain)
Hydrocephalus, known colloquially as “fluid accumulation in the brain,” is the excessive accumulation of fluid in the brain ventricles as a result of a disorder in the circulation of the cerebrospinal fluid (CSF). This situation increases intracranial pressure. Especially in small infants, symptoms such as the rapid growth of the head circumference, vomiting, and, in the later period, headache and vision impairments can be seen. In treatment, a shunt that drains the CSF in a controlled manner into the abdominal cavity can be placed, or, in suitable cases, a new pathway for the circulation of the fluid can be opened with endoscopic third ventriculostomy (ETV).
Congenital Anomalies and Spina Bifida
Nervous system disorders that arise at birth are among the most commonly encountered subjects of this field. Foremost among these is spina bifida (split spine). In this condition, known as meningocele or myelomeningocele, the spinal cord and the nerve sac have herniated outward from the baby’s back. In such cases, intervention is often needed within the first hours after birth to eliminate the risk of infection and to protect the nerve tissues. The use of folic acid during pregnancy has an important place in preventing such neural tube defects.
Craniosynostosis (Skull Shape Deformities)
Craniosynostosis is a head shape deformity that develops due to the premature closure of one or more of the sutures (bone junction lines) in the skull. The prematurely closed suture can impede the growth of the brain and increase intracranial pressure. The aim of surgical treatment is to lower the high pressure, make room for the brain to grow, and, by reshaping the skull, prevent possible damage to the brain and cognitive development. The timing of the surgery varies according to the type of synostosis.
Childhood Brain and Spinal Cord Tumors
Brain tumors are among the most commonly seen solid tumors in childhood. These tumors can be both benign and malignant and generally require surgical intervention. The tumor types seen in children differ significantly from those in adults; for this reason, diagnosis and treatment are a multidisciplinary process carried out together with pediatric oncology and radiation oncology.
Cerebral Palsy and Spasticity
Cerebral palsy (CP) is a condition commonly seen in children that arises due to damage that develops in the brain before, during, or after birth. In these children, spasticity (excessive tightness in the arm and leg muscles) often develops. In suitable cases, neurosurgery can contribute to this process with interventions such as selective dorsal rhizotomy or a baclofen pump aimed at reducing spasticity.
Epilepsy Surgery and Other Conditions
Surgery can also be an option in some cases of epilepsy that do not respond to medication (drug-resistant). In addition to these, Chiari malformation (cerebellar herniation), arachnoid cysts, tethered cord syndrome, head and spinal cord traumas, and vascular diseases seen in children (such as AVM, cavernoma, aneurysm, Moya-Moya) also fall within the scope of pediatric neurosurgery.
Prenatal (Before Birth) Diagnosis and Fetal Surgery
One of the developing and exciting subfields of pediatric neurosurgery is prenatal (fetal) surgery. Some cases of spina bifida (myelomeningocele) detected at certain weeks of pregnancy can be treated with surgery performed while the baby is still in the womb (intrauterine). Such an approach can reduce the risk of neurological problems after birth, decrease the need for a shunt, and contribute to the child’s walking functions. This is a promising field that shows how far medicine has advanced for the sake of children’s health.
The Importance of Early Diagnosis and the Multidisciplinary Approach
I would like to state once more a point I have emphasized again and again throughout this article: in childhood brain and nervous system diseases, early diagnosis and timely intervention are among the most important factors determining the outcome. Thanks to the high adaptive capacity of the child’s brain, steps taken at the right time often yield much better results.
Furthermore, pediatric neurosurgery is never the work of a single physician or a single branch. It is a teamwork carried out together with pediatric neurology, pediatric oncology, neonatology specialists, genetics, and physical therapy and rehabilitation teams, in which the family, too, is at the center of the process. Attending not only to the child’s disease but also to the child’s development and to the emotional needs of the entire family during this process is an inseparable part of treatment.
Symptoms Families Should Pay Attention To
If one of the following symptoms is noticed, it is important for the child to be evaluated by a physician. Most of these symptoms can also stem from far more common and innocent causes; however, it is worthwhile to be attentive:
- In infants: Rapid growth of the head circumference compared with peers, a fontanelle (soft spot) that is noticeably bulging and tense, eyes that constantly appear to look downward (a “sunset” appearance), and frequent, projectile-type vomiting.
- A sac or an abnormal opening on the back, hair growth, or a change in color.
- A marked asymmetry or abnormality in the shape of the head.
- In older children: A headache that occurs especially in the mornings, is accompanied by vomiting, and progressively increases.
- Regression in developmental milestones or a delay in expected development (such as sitting, walking, speaking).
- Having a seizure (convulsion).
- Impairment of balance and gait, frequent falls, or loss of hand-and-arm skills.
- Deterioration in vision or abnormality in eye movements.
Frequently Asked Questions
Below, I have gathered the most frequently asked questions about pediatric neurosurgery along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the physician who evaluates your child.
What is pediatric neurosurgery?
Pediatric neurosurgery is a specialty that deals with the diagnosis and surgical treatment of the brain, spinal cord, spine, and nervous system diseases of children from the period in the womb to approximately 18 years of age. It is also known as children’s brain and nerve surgery.
Which diseases does a children’s brain surgeon deal with?
Most commonly, it deals with hydrocephalus, congenital anomalies such as spina bifida, craniosynostosis, brain and spinal cord tumors, spasticity due to cerebral palsy, drug-resistant epilepsy, head traumas, and various cysts and vascular diseases.
Why is pediatric neurosurgery different from adult neurosurgery?
Because children have a developing nervous system, a skull that has not yet fused, and a physiology that differs from that of an adult. For this reason, the surgical techniques, instruments, anesthesia, and intensive care are planned entirely according to standards specific to children. In addition, the child’s brain has a higher capacity for adaptation (neuroplasticity).
How is hydrocephalus (fluid accumulation in the brain) treated?
In treatment, a shunt that drains the cerebrospinal fluid in a controlled manner into the abdominal cavity can be placed, or, in suitable cases, a new pathway for the circulation of the fluid can be opened with endoscopic third ventriculostomy (ETV). Which method is appropriate is evaluated separately for each child.
Does craniosynostosis resolve without surgery?
The treatment of craniosynostosis is generally surgical; its aim is to make room for the brain to grow, lower intracranial pressure, and prevent possible developmental damage. The type and timing of the surgery are determined by the physician who evaluates the child, according to the type of synostosis.
My child’s head looks large; should I worry?
If there are symptoms such as rapid growth of the head circumference compared with peers, a bulging fontanelle, or accompanying vomiting, it is important for the child to be evaluated by a physician. However, head size alone does not always mean a problem; this can only be understood with an examination and, if deemed necessary, imaging.
Do childhood brain tumors heal?
Some childhood brain tumors are benign, and good results can be obtained with appropriate treatment. The course varies according to the type and location of the tumor and the child’s general condition. Treatment is generally a multidisciplinary process in which surgery, oncology, and radiation oncology work together.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The diagnosis, course, and treatment of childhood brain and nervous system diseases vary from person to person according to the type of disease, the child’s age, and general state of health, and can only be determined by a physician who evaluates your child. If you have any concern about your child or if the symptoms mentioned above are present, go to a physician experienced in this field or the nearest healthcare facility without delay.