Paediatric Neurosurgery

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What is Paediatric Neurosurgery?

Paediatric Neurosurgery refers to the treatment and management of nervous system disorders and deformities in the brain and spinal cord in children. This includes a wide range of medical issues, including congenital defects of the brain and spine, brain tumours and nerve trauma. These medical issues often require treatment from a paediatric neurosurgeon to prevent developmental delays or cognitive impairments.

Common Causes of Paediatric Neurosurgical Conditions

1. Congenital Anomalies

Congenital anomalies refer to abnormal structures of the brain, skull, spine, and spinal cord that occur from birth. Most of the time, these arise from a disruption of the normal growth process in the womb. Paediatric neurosurgery can help to correct these congenital anomalies through reconstructive surgery to restore the normal anatomy of these structures.

2. Brain and Spine Tumours

Tumours that arise within the central nervous system (i.e. the brain and spinal cord) can be removed and treated by neurosurgeons. Aside from surgery to remove the tumour, other treatment options include chemotherapy, radiotherapy, and medical therapy such as steroids. The prognosis of the tumour often varies from child to child and also in the type of tumour, the stage at which it is diagnosed, and the medical background and overall health of the child.

3. Paediatric Hydrocephalus

Hydrocephalus refers to extra cerebrospinal fluid in and around your baby’s brain. This can cause increased pressure in the baby’s head, causing the bones in the skull to expand and separate. Hydrocephalus is dangerous because increased pressures can compress and squash the brain within the skull. If areas of the brain controlling breathing, consciousness, blood pressure, and heart rate are affected, this can lead to death.

In addition, hydrocephalus, if left untreated for a long time, may also disrupt the normal formation of the brain and other structures within the skull, leading to potential developmental issues as your baby grows up.

4. Spasticity

Spasticity occurs when there is an injury to the brain that results in the death of neurons within the brain. Spasticity is a type of neurological disorder that results in stiff limbs, gait abnormalities, and abnormal posturing of the body. There are many ways to treat the defects that arise from spasticity, depending on the areas of the brain that are affected.

In particular, neurosurgery can help manage spasticity through oral medications and neurotoxin injections (e.g., botulinum toxin A), which can relax muscles. Newer modalities to treat spasticity include rhizotomies, which are minimally invasive surgeries that can help remove nerve fibres that cause pain and stiffness.

Paediatric neurosurgeons can also inject baclofen into the patient’s muscles. Baclofen is a skeletal muscle relaxant and can be used to help reduce stiffness in spastic muscles. Deep brain stimulation can also be done for children to help revive and stimulate parts of the brain that are damaged. This can help improve stiff muscle tone as well as help reduce tremors.

5. Craniosynostosis

Craniosynostosis occurs when one or more sutures of a child’s skull close prematurely, preventing full brain development. Usually, these sutures remain open during infancy to allow the skull to expand as much as it can as the brain grows. Premature closure of the skull can lead to abnormal skull shapes, increased intracranial pressure, and potential developmental delays.

Common Symptoms of Paediatric Neurosurgical Conditions

Depending on the disorder, paediatric neurosurgical conditions can present with a wide range of symptoms.

Physical Deformities: Visible deformities such as an enlarged head circumference or abnormal skull shape may be an indication of neurosurgical disorder.
Cognitive and Behavioural Changes: Children may exhibit developmental delays, difficulty concentrating, irritability, or personality changes.
Pain and Discomfort: Persistent headaches, along with vomiting or neck pain.
Neurological Deficits: Weakness, numbness, poor coordination, or seizures may indicate that the child is suffering from underlying conditions affecting the brain.
Sensory Impairments: Double vision, hearing loss, or difficulty swallowing may be signs of increased intracranial pressure or structural abnormalities affecting the nervous system.

Surgical Treatment Options Available

Neurovascular Surgery

Neurovascular surgery refers to surgery of the blood vessels and nerves within the brain and spinal cord. Depending on the underlying conditions, what happens during a neurovascular surgery may be different. Some things that can be done include the repair of vascular malformations (e.g. aneurysms), removal of clots, removal of abnormal nerve fibres, and the repair of broken or disjointed anatomical structures within the brain and its blood vessels and nerves.

Neuro-endoscopic Surgery

Neuro-endoscopic surgery is a type of minimally invasive surgery (MIS) that refers to the use of small incisions over the skin, through which thin surgical instruments may be inserted. Video cameras and surgical tools may be affixed to these surgical arms, and a surgeon will control these tools from outside the body. MIS is beneficial as it causes less soft tissue damage and can lead to faster recovery times in patients. MIS neurosurgery is a developing field now and can be used for many procedures that were previously only done via traditional open surgery.

Craniofacial Surgery

Craniofacial surgery refers to surgery for the brain, skull, and face. Structures that are worked on include the skull bone, blood vessels, nerves, and organs within the face, such as the eyes, brain, and dental system.

Craniofacial surgery may be done for conditions such as tumours, trauma, and the repair of congenital anomalies.

Functional Neurosurgery

Functional neurosurgery involves the use of surgery to target anatomical structures in order to modulate neurological function. The aim of functional neurosurgery is to help improve symptoms and quality of life in those with chronic neurological conditions such as epilepsy, gait abnormalities, and hyperhidrosis. Specific areas within the central nervous system will be worked on to help provide relief of symptoms from the conditions.

Stereotactic Biopsies

A stereotactic biopsy is a surgical procedure done to obtain tissues from the brain. This is done to help diagnose an abnormality seen on brain imaging such as on a CT scan and MRI. A thin needle is inserted into the brain during the procedure, and a small piece of tissue is extracted to be examined in a lab, under a microscope by a doctor called a pathologist.

Biopsies are useful to help determine the exact type of cells that a brain mass has, including cancer cells and infection. Identifying the exact tissue can help guide further management.

How do Paediatric Brain Tumours differ from Adults?

Paediatric brain tumours are usually primary brain tumours where it originates from the brain and are found mostly in the lower parts of the brain, such as the brainstem and cerebellum. The most common types of brain tumours in children are medulloblastomas and gliomas.

Compared to adults, paediatric brain tumours are more sensitive to treatment with chemotherapy and radiotherapy.

When to Consult a Paediatric Neurosurgeon in Singapore?

There are some warning signs that there may be something wrong with the central nervous system in your child. Symptoms include:

Headache
Nausea and vomiting
New onset of weakness and/or numbness
Abnormal gait
Having problems with walking and balance
Blurring of vision
Problems with memory
Seizures

Seeking medical attention as soon as your child is unwell will be useful as this means that prompt diagnosis can be made, and management can be instituted as early as possible.

Dr Sein Lwin is an experienced Senior Consultant Neuro & Spine Surgeon and the Neurosurgical Director at the Advanced Brain and Spine Surgical Centre.

He is experienced in spine surgery and in minimally invasive approaches for spinal cord tumours and degenerative spine surgery. His specialised interests lie in endoscopic endonasal and open skull base surgery, pituitary tumours, vascular surgery, cranial nerve disorders and peripheral nerve conditions.

Urgent Care

Many neurological conditions may require urgent attention. If you require immediate care, please contact us.