Children are not small adults, and paediatric neurosurgery is a distinct speciality within neurosurgery for reasons that are both technical and clinical. On the technical side, children's anatomical structures are smaller, their blood volume is substantially lower - meaning even modest blood loss during surgery can be haemodynamically significant - and their anaesthetic requirements differ from adults in ways that affect both safety and brain physiology during the procedure. Instruments are sized and techniques adapted accordingly. On the clinical side, the conditions that bring children to a neurosurgeon are often different from those affecting adults. Hydrocephalus in newborns and infants is a leading indication for paediatric neurosurgery, as are congenital brain and spine malformations, paediatric brain tumours with histological types not commonly seen in adults (medulloblastoma, ependymoma, choroid plexus tumours), and Moyamoya disease, a rare cerebrovascular condition of childhood causing progressive stroke that can be treated with indirect bypass surgery. Epilepsy surgery in children also requires assessment of developmental considerations that do not apply to adults. There is also a dimension specific to treating children that goes beyond technique: the developmental implications of both the condition and the treatment must inform every decision, because a deficit acquired in a young brain affects a lifetime of learning, independence, and quality of life in a way that the same deficit in an elderly patient does not. My paediatric neurosurgery fellowship at Jikei University School of Medicine, Tokyo, under Professor Oi - one of the world leaders in paediatric hydrocephalus and neuroendoscopy - gave me specific training in this area.
Written by Dr. Nigel Peter Symss, MBBS, DNB (Neurosurgery), Fellowship in Paediatric Neurosurgery (Jikei University School of Medicine, Tokyo, Japan - Oi-Sami Fellowship), Fellowship in Spinal Surgery, Functional Neurosurgery and Microneurosurgery (Flinders Medical Centre, Adelaide, Australia), HOD and Senior Consultant Neurosurgeon and Functional Neurosurgeon, Gleneagles Fortis Hospital, Perumbakkam, Chennai. 30+ years. 50,000+ patients.
