Mending of the Tiny Brains - Pediatric Neurosurgery

Children need a lot of care and understanding in their growing years. When it comes to dealing with a kid facing neurological challenges, a much more compassionate and trustful environment needs to be developed to understand the condition and treat them and offer specialized care. These challenges are usually the abnormalities, disorders, and tumours related to the head, face and spine regions in children.

The commonly found neurosurgical disorders in children are:

Arachnoid cysts and Hydrocephalus - Due to a split in the arachnoid membrane (one of the membranes in the lining of the brain) and subsequent fill up with fluids, an arachnoid cyst is created. These cysts occur, either at birth (congenital) or due to trauma at a later point in time. Symptoms such as headache, seizures, hydrocephalus (fluid build-up in the head), problems related to vision are noticed. CT or MRI is used to detect the location and treatments involve surgery and/or placing a tube to drain the fluid. 

Congenital Abnormalities of the spine - Spinal disorders developing in children much before their birth I.e., at the time of foetal development are called congenital spine conditions. These conditions mainly cause alignment abnormalities in the spinal cord and also affect nerves reflecting in pain and complexities in the movement of hands and legs.

  1. Spina Bifida - When a baby is born with certain defects of the backbone where the skin on the spinal cord has not formed properly and the spinal nerves get exposed it is referred to as Spina bifida. 

  2. Tethered Spinal Cord - In this condition, a rubber-band a stretch of the spinal cord is seen and its movements are restricted because of the attachment of tissues abnormally to the spinal cord. The factors that cause tethered spinal cord include spina bifida and the presence of unusual fat in a spine or lipomyelomeningocele etc.  

  3. Abnormal spinal alignment - When the formation of the backbone is affected in the developing foetus it results in alignment issues like

  • Kyphosis: Forward bending of the spinal cord

  • Lordosis:  Backwards bending of the spinal cord

  • Scoliosis: Sideways bending of the spinal cord

The main symptoms of spinal abnormalities are pain, loss of function and difficulties in breathing. The diagnosis of these congenital abnormalities of the spinal cord requires imaging tests such as CT or MRI and treatment is mainly focused on the reduction of pain and surgery to correct the abnormalities and restore functions.

Cerebral palsy: If the region in the brain that controls the motor functions is damaged or does not develop properly, it can cause musculoskeletal and neurological problems resulting in a condition called cerebral palsy. Approximately three out of a thousand children are the victims of this disease. These children end up having various orthopaedic issues, sensory and motor problems, seizures, etc. Treatment therapies involve muscle relaxants, therapeutic electrical stimulation (to increase blood flow to weak muscles) as well as surgery.

Brain and spinal cord tumours: The brain is responsible for controlling the thoughts and other sensory organs in the body. The spinal cord acts as a messenger to relay messages between the brain and other parts of the body. Certain genetic conditions and exposure to radiations can cause tumour formation in the brain and spinal cord. The presence of these tumours can interfere with the basic functions carried out by these organs in the body. Based on their location and size of tumours variety of symptoms are observed such as:

  • Headache and nausea

  • Abnormality in vision, hearing, and other senses

  • improper movement or balance and personality change

  • Seizures

Radiation and chemotherapies and surgery are used in the treatment of tumours.

Brachial plexus injury - In our body brachial plexus refers to a knotty network of nerves that control the sensory and motor functions of muscles in the upper limbs. These nerves help to carry signals between the spinal cord and the upper limbs. In case of difficult labour, these nerves may get stretched or torn and the function of the upper limbs may be compromised. Both surgical and non-surgical treatments are available for treating the condition.
 

Chiari malformations: Cerebellum is the control centre in the brain for factors related to the maintenance of balance. In the body, the cerebellum is positioned at a point where the skull opens to allow the spinal cord to pass through. In case of a Chiari malformation, a part of cerebellum extends over through the opening into the upper region of the spinal cord. This malformation may be caused during the structural development issues of the baby in the foetus or due to trauma. Symptoms may include headaches associated with sneezing and coughing, pain in the neck, balance-related issues, dizziness and blurred vision. Medications and surgeries to alleviate pressure on the spine, are used in the treatment of Chiari malformations. 

Craniosynostosis – In an infant, the skull bones are not completely hardened. As the baby grows, the plates of soft bones fuse to form the skull. Due to certain birth defects, the skull bone joints close prematurely much before the brain is fully formed leading to a condition called Craniosynostosis. The appearance of the baby and eyesight alterations are caused in craniosynostosis due to the buildup of pressure on the brain as it grows.  

Traumatic brain and spinal injuries – In case of trauma or injury to the brain and spinal cord in a child, early diagnosis and proper treatment either with medication or surgery can save lives and give a better quality of life. 

FAQs:

1. What does Pediatric Neurosurgery mean?

Pediatric Neurosurgery is a sub-speciality in surgical medicine that relates to the treatment of any abnormal condition occurring in the brain, and spinal cord through a surgical procedure in children. Some of these abnormal conditions are injury, trauma, tumour, congenital abnormalities, etc.

2. What causes epilepsy?

Certain genetic conditions, structural abnormalities of brain e.g. medial temporal sclerosis, infections of the brain, trauma, brain tumours are some of the known associations. However, in a large group of the case, the exact cause is difficult to ascertain. 

3. What is the meaning of Skeletal dysplasia?

Skeletal dysplasia is more commonly called as dwarfism. It is a collective term for the numerous conditions that affect the growth of bone and cartilage in children.

 

Dr. Anurag Saxena

HOD & Consultant - Department of Neurosurgery

Manipal Hospitals, Dwarka, Delhi

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