The scope of Pediatric Neurosurgery is from the preterm infant through adolescence. The pathological entities include: Brain and Spinal Cord tumors, Cranial and Spinal Trauma, Hydrocephalus, Spina Bifida, Craniosynostosis Craniofacial anomalies, Chiari malformations, Spinal Cord abnormalities requiring surgical treatment and Vascular malformations of brain or spinal cord and uncontrolled Epilepsy requiring surgical treatment.
The Pediatric Neurosurgery team, works closely with members of Pediatrics, Pediatric Neuro-Oncology, Pediatric Neurology, Pediatric Rehabilitation Medicine, Pediatric Endocrinology, Plastic Surgery/Craniofacial Surgery, Pediatric Ophthalmology, Orthopedic Surgery, Nursing, Social Work, and Genetics to provide children and their families with integrated, multidisciplinary treatment programs tailored to their individual needs.
The service utilizes state-of-the-art surgical technology, including Microsurgery, minimally invasive Neuro-Endoscopy, frameless/image-guided and frame-based Stereotaxy, intra-operative MRI, and Stereotactic Radiosurgery.
150 children are operated on annually.
Pediatric Neurosurgery is concerned with the evaluation and treatment of cranial, spinal, and peripheral nerve disorders in infants, children, and adolescents. Common problems treated include hydrocephalus, brain and spinal cord tumors, intractable Epilepsy, Spina Bifida, craniofacial disorders vascular disorders such as Moyamoya Disease, and brain or spine Trauma.
Congenital Conditions
Spina Bifida is the most common of a class of congenital conditions known as neural tube defects. It occurs very early in fetal development often before a woman even knows she is pregnant. Infants with Spina Bifida should be delivered by cesarean section at a medical center such as Sheba Medical; Center equipped with a neonatal intensive care unit and staffed by a specialized neurosurgical team to repair the opening shortly after birth.
All of the pediatric subspecialties involved in the comprehensive care plan, which might include orthopedists, urologists, physical therapists, occupational therapists and social workers, collaborate closely with the neurosurgical department Sheba.
Hydrocephalus
Hydrocephalus, which affects about one in every 500 children, is a build-up of fluid inside the brain. Congenital Hydrocephalus is caused by a complex interaction of genetic and environmental factors. Acquired Hydrocephalus may result from Spina Bifida, intraventricular Hemorrhage, Meningitis, head Trauma, tumors and cysts.
It is typically treated with a shunt, a small flexible tube that allows the blocked fluid to drain safely into the abdomen. Since the advent of shunting, the outcome for most children with Hydrocephalus is very good, but some children will have complications. Shunt malfunctions and infections, developmental delays, learning disabilities and visual problems are not uncommon. Families need to be aware of the life-long complexities of Hydrocephalus to ensure their children receive comprehensive on-going care and appropriate intervention services and therapies.
Sheba pediatric neurosurgeons use the endoscopes to treat Hydrocephalus surgically. Endoscopes provide a clear picture of the ventricles within the brain, so surgeons are able to cut an opening in the ventricle, making it possible to bypass the obstruction and restore normal fluid flow. The procedure, called Endoscopic Third Ventriculostomy, is a safe and effective treatment for some children.
Craniosynostosis and Craniofacial Reconstruction
There are a large number of conditions that can affect the shape of a childs head. When a baby is born, the skull is composed of a collection of small bones that abut one another along areas known as sutures. The sutures make it possible for the skull to grow to accommodate it.
If one or more of the sutures close too quickly, the brain is forced to grow in a direction where the bones are not resisting it. This condition, known as Craniosynostosis, may be congenital, but it is usually not associated with any developmental abnormalities. It can be disfiguring, however, and since the most rapid head growth occurs during a babys first year, it is most often treated during that time.
Pediatric Tumors
Children with both malignant and benign tumors of the central nervous system benefit from evaluation by a multidisciplinary team of pediatric specialists at Sheba that may include a neurosurgeon, neurologist, radiation oncologist, neuropathologist and an oncologist. Once a tumor has been identified, most children will undergo a biopsy and/or surgical removal of the tumor.
Vascular Abnormalities
There are several rare problems that affect the blood vessels in the brain of newborns, infants and growing children. While very frightening and potentially lethal, many if not most of these conditions can be treated successfully. At Sheba, the pediatric neurosurgeon works in collaboration with the neurovascular service aided by state of the art imaging technology, including Magnetic Resonance Imaging (MRI) and interventional Neuroradiology. We specialize in the treatment of Moyamoya disease, which may cause ischemic stroke or blood clots in the brain.
Surgical Management of Medically Intractable Epilepsy
The Sheba Epilepsy Surgery program provides promising options for children whose Epilepsy has not been managed successfully with medication. Close collaboration between the pediatric neurosurgeon and the pediatric neurology team provides new hope for children with intractable Epilepsy.
Head and Spinal Cord Trauma
The Sheba Medical Center is a Level One Trauma Center and a Spinal Cord Injury Center, and as a result, receives either directly or in transfer, many infants and children with extensive and often life threatening brain and central nervous system injuries.
Emergency Division physicians are fully equipped to take care of the most severely traumatized patient. After initial assessment and diagnostic studies, the patient is either transferred to our fully equipped pediatric ICU or to the operating room as indicated.
The Sheba Epilepsy Surgery program provides promising options for children and adults whose Epilepsy has not been managed successfully with medication.
The department's pediatric neurosurgeon works in close concert with the pediatric and adult neurologists to ensure the best outcome for these children.
