Pediatric neurosurgery

When something goes wrong in a child’s brain or spine, the situation can quickly become overwhelming. There is often no warning, no safety net, and certainly no manual to guide the way.  What happens next depends on how quickly the right specialists intervene and how accurately they assess the problem. 

At Biruni Hospital, the approach is straightforward and focused. It is not about embellishing or overexplaining, but about understanding the issue and determining what can be done safely and effectively. While Turkey provides access to advanced care, the success of the treatment relies on precise coordination, structural expertise, and the judgment to avoid intervening unnecessarily.

What is pediatric neurosurgery?

Pediatric neurosurgery involves treating the brains, spines, and nerves of children, whose nervous systems are continually growing and changing, unlike adults where structures are more stable. 

This dynamic nature increases risks and makes decision-making more complex. Surgeons cannot simply repair what is damaged; they must carefully consider how their interventions will impact the child’s future growth and neurological function. This specialty requires a highly calculated, individualized approach that incorporates collaboration with neurologists, oncologists, rehabilitation specialists, and other experts to ensure comprehensive care.

Key aspects of pediatric neurosurgery include:

• Operating on a nervous system that is constantly developing and evolving
• Adapting surgical techniques specifically for children’s anatomy, rather than treating them as smaller adults
• Collaborating closely with other medical specialists to address all aspects of the child’s health
• Utilizing precision tools designed to minimize tissue damage and reduce surgical disruption
• Determining the optimal timing for surgery, balancing immediate needs with long-term growth considerations
• Managing a wide range of conditions, from congenital malformations to injuries and tumors, with tailored treatment plans
• Judging when urgent intervention is necessary and when a cautious, watchful approach is appropriate
  

What are the main types of pediatric neurosurgery procedures?

Pediatric neurosurgery involves complex challenges due to the dynamic nature of the developing brain, spine, and nervous system. Each case presents unique variables influenced by the child’s growth and development.

Selective dorsal rhizotomy

Selective dorsal rhizotomy is a specialized surgery that cuts certain sensory nerve roots in the spinal cord to reduce muscle spasticity, mainly in children with cerebral palsy. It interrupts abnormal signals causing stiffness while preserving motor function. Precision nerve identification with intraoperative monitoring is crucial to avoid side effects.

 Steps and aspects include:

• Thorough preoperative neurological evaluation
• Imaging to plan the surgical approach
• Intraoperative electrical stimulation to distinguish sensory roots
• Selective cutting of overactive sensory roots
• Avoiding damage to motor nerves
• Postoperative monitoring of muscle tone and strength
• Early physical therapy to improve mobility
• Long-term assessment of spasticity reduction
• Collaboration with multidisciplinary rehabilitation teams
  
  

Brain tumor surgery

Brain tumor surgery involves removing abnormal tissue, but it requires careful navigation due to the tumor’s shape and location. The goal is to remove as much as safely possible without harming healthy brain functions. Risks like swelling, bleeding, and side effects remain after surgery, and follow-up treatments may be necessary.

Steps and aspects include:

• Obtaining clear imaging to identify the tumor
• Assessing brain function before surgery
• Planning the safest route to the tumor
• Using real-time tools during surgery to avoid surprises
• Avoiding critical brain areas
• Sometimes performing surgery while the child is awake for brain mapping
• Close monitoring for postoperative complications
• Post-surgery scans to check residual tumor
• Planning additional treatments if needed
• Supporting recovery of affected functions
  

Hydrocephalus treatment

Hydrocephalus is excess fluid buildup causing pressure in the brain. Surgery creates a new drainage route, usually by inserting a shunt system that diverts fluid, but managing complications like malfunctions and infections is ongoing. Sometimes internal drainage is preferred depending on the case.

Steps and aspects include:

• Confirming diagnosis with imaging
• Monitoring symptoms which may be subtle
• Choosing between shunt placement or internal drainage procedures
• Inserting a catheter into brain fluid spaces
• Connecting catheter to a valve that regulates fluid flow
• Draining fluid to the abdomen or another body cavity
• Monitoring for infections or blockages
• Adjusting valve settings when possible
• Regular follow-ups for shunt function and brain health
• Supporting growth and development after surgery
  

Epilepsy surgery

Epilepsy surgery aims to remove or disconnect brain areas causing seizures when medication fails. Detailed testing is required to pinpoint seizure origins. Success depends on targeting the right area without impairing other functions, often requiring multiple evaluations.

Steps and aspects include:

• Long-term seizure monitoring
• Using EEG and imaging to localize seizure focus
• Multidisciplinary case discussions
• Deciding extent of brain tissue removal or disconnection
• Performing surgery with strict brain monitoring
• Tracking seizure control and adjusting medications postoperatively
• Managing side effects and complications
• Long-term follow-up for seizure management
• Considering additional surgeries if needed
  

Craniosynostosis surgery

Craniosynostosis is premature fusion of skull bones that restricts brain growth and alters head shape. Surgery releases fused sutures and reshapes the skull, usually before one year of age. Techniques vary from open surgery to less invasive endoscopic methods based on complexity.

 Steps and aspects include:

• Diagnosis through clinical exam and imaging
• Choosing surgical approach depending on sutures involved and child’s age
• Releasing fused sutures to enable brain growth
• Reshaping skull bones for normal head form
• Using molding helmets post-surgery in some cases
• Monitoring intracranial pressure during recovery
• Managing pain and infection risks
• Regular follow-ups to assess head growth
• Coordination with craniofacial specialists for ongoing care

What preparations are necessary before undergoing pediatric neurosurgery ?

Getting ready for pediatric neurosurgery is rarely straightforward. It takes coordination between doctors, parents, and sometimes the child. Every step matters because mistakes before surgery can cause problems later.

1. Medical Evaluation

Before surgery the child goes through a detailed medical review. This covers past illnesses, current medications, allergies, and previous operations. Doctors run physical exams and may order blood tests or scans like MRI or CT to check the overall health. This helps spot anything that could complicate surgery and guides how it should be done.

2. Neurological assessment

The child’s nervous system is examined closely to understand muscle strength, reflexes, sensation, and mental function. This gives a baseline picture before surgery and helps identify exactly where problems lie. Neurologists and neurosurgeons use this to decide how to approach the operation safely and what risks might be involved.

3. Imaging studies

Scans like MRI or CT are done to map the brain, spine, or nerves in detail. These images let surgeons see what they are dealing with beyond what exams reveal. Precise images are essential to plan the operation and avoid surprises during surgery.

4. Anesthesia consultation

Meeting the anesthesiologist beforehand is necessary to talk through how anesthesia will be managed. The anesthesiologist reviews the child’s health and figures out the safest plan. Factors like age, weight, and existing conditions all influence anesthesia choices.

5. Psychological preparation

Depending on the child’s age some mental preparation might be needed. Explaining what will happen and addressing fears can help the child cooperate better and recover more smoothly. Specialists like child life workers or psychologists sometimes assist families in this process.

6. Preoperative instructions

Parents get clear instructions about when the child must stop eating or drinking, how to handle medications, and hygiene rules before surgery. These are not just formalities but steps that reduce risks like choking under anesthesia or infections.

7. Logistical planning

Arranging practical matters such as how to get to the hospital, how long the stay might be, and what care is needed after surgery is part of preparation. Families are advised to be ready for ICU stays and rehab if required. Having these details sorted early reduces stress and avoids last minute issues.

What happens during the post-operative period after pediatric neurosurgery ?

The time after pediatric neurosurgery isn’t simple or predictable. It stretches from the moments right after surgery to months or even years later. Recovery takes shape in stages and each one brings its own challenges.

Short term healing period

The short term healing phase starts right after surgery and lasts days to weeks. It’s about keeping the child stable, managing pain, and watching closely for problems. This time demands constant attention and quick responses because complications can appear fast.

What happens during the short term healing period includes

• Checking heart rate, breathing, and blood pressure frequently
• Giving pain medicine that fits the child’s age and condition
• Looking for infections at the surgical site or elsewhere
• Testing how awake and aware the child is
• Watching muscle strength and feeling carefully
• Managing brain or spine swelling or bleeding
• Helping the child breathe properly if a breathing tube was used
• Controlling fluids and nutrition often through IV or tubes
• Preventing blood clots with movement or medicine
• Starting small movements to avoid stiffness and help circulation
• Keeping family informed on every change and concern

Long term healing period

The long term healing phase can last weeks, months, or years depending on the surgery and child. It focuses on rebuilding abilities, avoiding setbacks, and adapting to changes. Some problems show up late and rehab becomes a daily routine.

What happens during the long term healing period includes

• Regular checks on neurological function to catch new issues
• Physical, occupational, and speech therapies customized for the child
• Watching for late problems like fluid buildup or seizures
• Adjusting medicines to control symptoms or side effects
• Supporting thinking and emotional growth with specialists
• Tackling nutrition and growth issues that appear during recovery
• Doing scans to see how the brain or spine is healing
• Planning more surgery if problems come up later
• Helping the child get back to school and social life
• Teaching families how to handle care at home and what to watch for

Final thoughts on pediatric neurosurgery

Pediatric neurosurgery is complicated and requires more than just technical skill. Each child presents challenges that need careful thought and ongoing attention. The path through treatment and recovery isn’t smooth or predictable. It needs steady planning, expert hands, and continuous follow up. Biruni Hospital focuses on practical care that aims for real outcomes rather than empty assurances.