pediatric neurosurgery training using simulator: A Compassionate Journey to Healing

Pediatric Neurosurgery: A Compassionate Journey to Healing

When a child faces a neurological condition or disorder, it’s a journey that requires exceptional care and understanding. Pediatric neurosurgery is the realm of medicine that focuses on diagnosing, treating, and managing these conditions in children. In this article, let’s accompany UpSurgeOn to explore the intricate world of pediatric neurosurgery, from common conditions to unique challenges, and how compassionate specialists work to bring healing and hope to young patients.

1. The Compassionate Care of Pediatric Neurosurgery

Pediatric neurosurgery is a highly specialized field where dedicated professionals navigate the complex world of children’s neurological health. It involves surgical interventions on the brain, spinal cord, and peripheral nerves of infants, children, and adolescents. Compassionate pediatric neurosurgeons are integral members of multidisciplinary teams, providing comprehensive care to children with conditions such as brain tumors, hydrocephalus, spina bifida, epilepsy, craniofacial abnormalities, and traumatic brain injuries.

Over the years, the field of pediatric neurosurgery has evolved significantly. Advancements in surgical techniques, imaging technology, and collaborative efforts have led to remarkable progress in the treatment of young patients.

2. The Unique Challenges of Pediatric Neurosurgery

Pediatric neurosurgery training with UpSurgeOn’s Pediatric simulator. Source: UpSurgeOn
  • Anatomical differences: Children’s brains are not yet fully formed and are continually growing,  which differs from those of adults. which means that pediatric neurosurgeons must take into account the anatomical differences between children and adults when performing surgery and be skilled in managing the delicate structures and adapting surgical techniques to accommodate the unique anatomy of pediatric patients. Children have developing brains and skulls, which differ from those of adults.To overcome this challenge, neurosurgeons must be skilled in managing the delicate structures and adapting surgical techniques to accommodate the unique anatomy of pediatric patients [1].
  • Growing up: Pediatric neurosurgeons must consider the long-term effects of surgery on a child’s developing brain. They must also consider the child’s future growth and development when planning treatment. To overcome this challenge, pediatric neurosurgeons must work closely with other healthcare professionals, including pediatricians, physical therapists, and occupational therapists, to ensure that the child receives comprehensive care [1].
  • Planning: Pediatric neurosurgeons must plan for the future when treating children. They must consider the child’s future growth and development when planning treatment. They must also consider the long-term effects of surgery on a child’s developing brain. To overcome this challenge, pediatric neurosurgeons must have a thorough understanding of the child’s condition and work closely with other healthcare professionals to develop a comprehensive treatment plan [1].
  • Training: Pediatric neurosurgeons must undergo rigorous training, including medical school, residency, and general surgery training. They also receive specialized training in pediatric diseases as they relate to pediatric neurosurgical diseases. To overcome this challenge, pediatric neurosurgeons must stay up-to-date with the latest research and techniques in pediatric neurosurgery [2].
  • Patient care: Pediatric neurosurgical patients often require long-term follow-up care due to the chronic nature of their conditions. Children with nervous system problems frequently require ongoing and close follow-up throughout childhood and adolescence. Pediatric neurosurgeons have a special and longstanding relationship with their patients and know how to examine and treat children in a way that makes them relaxed and cooperative. To overcome the challenge of transitioning from childhood to adulthood, pediatric neurosurgeons must consider the neurological, functional, and social outcomes of these patients. They must also have excellent communication skills and be able to work closely with the child and their family to provide comprehensive care [3] [4].
  • Ethical and Emotional Considerations: Pediatric neurosurgeons develop deep and enduring bonds with their patients and their families. They experience both joy and pleasure in these relationships but also face emotional challenges when patients do not fare well. Communicating bad news and managing the emotional impact on families require sensitivity and empathy. Training programs should address the relational and emotional dimensions of pediatric neurosurgery [5].
  • Limited Resources: There may be a mismatch between the supply of and demand for pediatric neurosurgeons. Pediatric neurosurgery may face challenges related to limited resources, inadequate infrastructure, and lower reimbursement for pediatric care compared to adult care, particularly in low- and middle-income countries. Limited training opportunities and the need for specialized expertise in pediatric neurosurgery may pose challenges in meeting the healthcare needs of pediatric patients and may affect the availability and quality of pediatric neurosurgical services. [2] [6] To overcome these challenges, providing training opportunities for pediatric neurosurgeons can help increase the number of qualified professionals in this field. This can be done through fellowships, workshops, and other educational programs [2].

3. Common Pediatric Neurosurgical Conditions

Pediatric neurosurgery on pediatric surgical simulator
Cranial fixation on a pediatric simulator. Source: UpSurgeOn

Some of the frequently encountered pediatric neurosurgical conditions are:

  • Hydrocephalus: This is a condition characterized by the accumulation of cerebrospinal fluid in the brain, leading to increased pressure. It often requires surgical intervention to place a shunt or perform an endoscopic procedure.
  • Brain tumors: Tumors can develop in the brain or spinal cord of children, and they can be benign or malignant. Surgical removal or other treatments may be necessary, depending on the type and location of the tumor.
  • Spina bifida: This is a birth defect in which the spinal column does not fully close, leading to potential damage to the spinal cord and nerves. Surgery is often performed to repair the defect and prevent complications.
  • Craniosynostosis: This condition involves the premature fusion of the skull bones, leading to an abnormal head shape. Surgery is typically performed to reshape the skull and allow for normal brain growth.
  • Chiari malformation: This is a structural defect in which the lower part of the brain extends into the spinal canal. Surgery may be needed to relieve pressure on the brain and spinal cord.
  • Epilepsy: Pediatric neurosurgery may be necessary for children with epilepsy that does not respond to medication. Surgical procedures such as resection or implantation of devices like vagus nerve stimulators may be performed. [714]

4. Cranial Approaches for Pediatric Patients

Pediatric neurosurgery is geared toward children’s brains, which are not yet fully formed and continually growing. The choice of cranial approach for pediatric patients depends on the location and type of pathology, as well as the surgeon’s experience and preference. Here are some of the most common cranial approaches used for pediatric patients:

  • Frontal craniotomy with transfacial exposure: This approach is commonly used for pediatric skull base surgery. It combines frontal craniotomy with some form of transfacial exposure, including transoral or transpalatal approach, lateral skull base approaches, and endoscopic endonasal approaches [15] [16] [17].
  • Endoscopic endonasal approach: This approach is a less invasive option that may be preferable to craniotomy, especially in children. It involves the use of an endoscope to access the skull base through the nose and sinuses. It is used for the treatment of pituitary tumors, craniopharyngiomas, and other lesions in the skull base [16].
  • Lateral skull base approaches: These approaches are used to access the lateral skull base and are suitable for accessing the parasellar, parachiasmatic, and intrasylvian spaces. They allow minimal brain retraction, an important consideration for reaching deep lesions, especially pathologies underneath the dominant hemisphere. Approaches described for use in pediatric lateral skull base surgery include subtotal petrosectomy, translabyrinthine approach (TLA), and supraorbital craniotomy [17] [18].

It is important to note that the choice of approach depends on the location and type of pathology, as well as the surgeon’s experience and preference. Surgeons should carefully consider the anatomical differences between pediatric and adult patients when selecting a surgical approach [18].

Conclusion

Pediatric neurosurgery is a field where compassion and expertise intersect to provide the best possible care for children facing neurological conditions. Every case is a unique journey, and the ability to adapt to the ever-changing needs of pediatric patients is paramount. With ongoing research and collaboration, pediatric neurosurgery will continue to evolve and offer hope to families seeking healing and a brighter future for their children. As a surgical simulation start-up that has developed state-of-the-art simulation technologies, UpSurgeOn is your trusted partner in this transformative journey. Our goal is to provide aspiring neurosurgeons with the ultimate bridge to mastering surgical skills. With our simulation technologies,  we not only enhance the safety and effectiveness of training but also enable trainees to conquer the challenges in this field. Do not hesitate to visit UpSurgeOn.com to explore the possibilities of simulation technologies and take your surgical career to a new level! 


References: 

  1. Rao, & Rao. (2023, May 19). The Pediatric Neurosurgery treatment is at Dr Raos Guntur. Dr Raos Hospital. The best Neurosurgeon and Spine surgeon at the best neurosurgery hospital in India. https://drraoshospitals.com/pediatric-neurosurgery-navigating-the-challenges-of-treating-children-with-neurological-disorders/?utm_campaign=pediatric-neurosurgery-navigating-the-challenges-of-treating-children-with-neurological-disorders&utm_medium=rss&utm_source=rss
  2. Davis, M. C., Rocque, B. G., Singhal, A., Ridder, T., Pattisapu, J. V., & Johnston, J. M. (2017). State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee. Journal of Neurosurgery, 20(2), 204–210. https://doi.org/10.3171/2017.3.peds16433
  3. Vinchon, M., & Dhellemmes, P. (2007). The transition from child to adult in neurosurgery. In Advances and technical standards in neurosurgery (pp. 3–24). https://doi.org/10.1007/978-3-211-47423-5_1
  4. Gerald, B. K. R., Brice, K. B. S., Brieux, E. M. H., Diogène, B. O. P., Léon, B., Patricia, M. N. K. F., & Robert, M. B. J. (2022). Practice of Pediatric Neurosurgery at the “Hôpital Spécialisé Mère-Enfant Blanche Gomes” in the Republic of the Congo. Open Journal of Modern Neurosurgery, 13(1), 41-50.
  5. Granek, L., Shapira, S., Constantini, S., & Roth, J. (2022). ‘Every patient is like my child’: pediatric neurosurgeons’ relational and emotional bonds with their patients and families. British Journal of Neurosurgery, 36(1), 70-74.
  6. Gandy, K., Castillo, H., Rocque, B. G., Bradko, V., Whitehead, W., & Castillo, J. (2020). Neurosurgical training and global health education: systematic review of challenges and benefits of in-country programs in the care of neural tube defects. Neurosurgical Focus, 48(3), E14.
  7. McGee, S., & Burkett, K. W. (2000). Identifying common pediatric neurosurgical conditions in the primary care setting. Nursing Clinics of North America, 35(1), 61-85.
  8. Silva, A. H., & Aquilina, K. (2019). Surgical approaches in pediatric neuro-oncology. Cancer and Metastasis Reviews, 38, 723-747.
  9. Mekitarian Filho, E., Carvalho, W. B. D., & Cavalheiro, S. (2012). Perioperative patient management in pediatric neurosurgery. Revista da Associação Médica Brasileira, 58, 388-396.
  10. Aldana, P. R., & Steinbok, P. (2009). Prioritizing neurosurgical education for pediatricians: results of a survey of pediatric neurosurgeons. Journal of Neurosurgery: Pediatrics, 4(4), 309-316.
  11. Drake, J. M., Riva-Cambrin, J., Jea, A., Auguste, K., Tamber, M., & Lamberti-Pasculli, M. (2010). Prospective surveillance of complications in a pediatric neurosurgery unit. Journal of Neurosurgery: Pediatrics, 5(6), 544-548.
  12. Garcia, M., Daugherty, C., Khallouq, B. B., & Maugans, T. (2018). Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet. Journal of Neurosurgery: Pediatrics, 21(5), 535-541.
  13. Dewan, M. C., Onen, J., Bow, H., Ssenyonga, P., Howard, C., & Warf, B. C. (2018). Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems. Neurosurgical focus, 45(4), E2.
  14. Themistocleous, M. S., Giakoumettis, D., Margetis, K., Alexiou, G. A., & Stranjalis, G. (2017). The use of antiepileptic drugs in paediatric neurosurgical conditions. Current Pharmaceutical Design, 23(42), 6488-6504.
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  16. London Jr, N. R., Rangel, G. G., & Walz, P. C. (2020). The expanded endonasal approach in pediatric skull base surgery: A review. Laryngoscope investigative otolaryngology, 5(2), 313-325.
  17. Kazahaya, K. (2018). Lateral skull base approaches in pediatric skull base surgery. Journal of Neurological Surgery Part B: Skull Base, 79(01), 047-057.
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