Neurosurgery Conditions & Treatments Brain and Spinal Cord Tumors The neurosurgeons at Connecticut Children’s Medical Center are experienced in operating on children with both benign and malignant tumors of the brain and spinal cord. Brain tumors can produce symptoms over several weeks or months that may include seizures, severe headaches accompanied by double vision or nausea, and the gradual loss of vision, movement or balance. An MRI or CT scan is used to localize the tumor mass. Using a multidisciplinary team approach, our neurosurgeons work closely with Connecticut Children’s neuro-oncology program to design an optimal treatment plan for each child. When surgery is required, resections are assisted by Connecticut’s only intra-operative CT scanner to maximize patient safety. Our collaborative team offers advanced therapeutics to include endovascular embolization, endoscopic anterior skull base approaches, and radiosurgery for selected cases. As a member of the Children’s Oncology Group, we offer leading-edge therapeutics to patients. Craniofacial Disorders In partnership with Connecticut Children’s multidisciplinary craniofacial clinic, we provide comprehensive treatment of craniofacial abnormalities. Services include evaluation and treatment of positional plagiocephaly as well as both open and minimally-invasive surgical approaches to craniosynostosis. Cerebral Palsy and Spasticity Cerebral palsy and spasticity are both conditions of the nervous system that cause motor disabilities. While orthopaedic specialists, physical therapists and occupational therapists offer excellent non-surgical therapies to improve movement in children with cerebral palsy, neurosurgeons at Connecticut Children’s offer surgical treatments to lessen the severity of impairments to movement caused by the conditions. To reduce spasticity, our skilled neurosurgeons can surgically implant a small pump into a child’s abdomen, a drug delivery system that continuously delivers muscle relaxing medication. The pump delivers medicine directly into the fluid surrounding the spine. Connecticut Children’s is the only hospital in Connecticut to provide this leading therapy to pediatric patients. Chiari Malformation Chiari malformation (Type 1) is a malformation of the brain. A small portion of the cerebellum protrudes into the cervical spinal canal blocking spinal fluid circulation. It can cause headaches, dizziness, nausea, impaired coordination, and difficulty walking. Chiari malformations are most common at the base of the skull and are diagnosed after an MRI of the brain and spine. This condition is surgically treated by decompressing the skull base for the release and restoration of spinal fluid circulation. Most children are hospitalized for a few days, with headaches subsiding about a month after surgery. Hydrocephalus Hydrocephalus is a condition that occurs when cerebrospinal fluid builds up in the brain, caused by abnormal formation of the brain before birth, head injury, hemorrhage, brain tumor, or infection. This build up puts pressure on your child’s brain, which can cause problems with neurodevelopment and lead to cognitive dysfunction if left untreated. Our neurosurgeons use several advanced techniques to treat hydrocephalus: A shunt, the most common method for treating hydrocephalus, is surgically implanted to drain excess cerebrospinal fluid from the ventricles of the brain to another area of the body—the abdomen, typically—where it will be absorbed by your child’s body. Endoscopic third ventriculostomy (ETV) surgery eliminates the need for a shunt in children who have a normal cerebrospinal fluid drainage channel that is narrow or blocked. ETV is a rigid endoscopic procedure in which the neurosurgeon makes a small hole in the bottom of the brain’s third ventricle so the fluid can flow out and be absorbed. Choroid plexus cauterization (CPC) is sometimes performed in combination with ETV. This endoscopic procedure decreases the amount of cerebrospinal fluid produced in your child’s brain by using a small electric current to burn some of the choroid plexus tissues which produce the fluid. While shunt infection is a common problem, particularly among children because they have not yet built immunities to many diseases, Connecticut Children’s has North America’s lowest risk for shunt infections. Alternative treatments for hydrocephalus, like ETV and CPC, are options which avoid complications that arise with shunts. Spinal Cord Malformations Spinal cord abnormalities occur in about one in every 4,000 births. The spine is nearly always skin covered, but with associated skin pits, dimples, lipoma mass, or unusual hair patterns. Spine malformation is suspected based on skin changes or the presence of neurological deficits. Many children are diagnosed at older ages after complaining of back pain, changes in their walking or problems urinating. About 1,500 babies are born each year with spina bifida, however, exposure of the cord through a skin defect, is rare. Coordinated through our Tethered Cord/Spina Bifida Program, Connecticut Children’s neurosurgeons work closely with a team of multidisciplinary specialists from urology, orthopedics and physical therapy to provide highly specialized care for children affected byspinal cord malformations. An MRI of the spine confirms the malformation and the degree of restriction on spinal cord mobility. Surgery relieves the tension on the spinal cord and preserves neurological function. Most children are discharged within a few days of surgery, yet have regular follow up for months or years, depending on the severity of the condition. Spinal Deformity Connecticut Children’s Division of Neurosurgery includes a unique and specialized program in spinal deformity. Jonathan Martin, MD, oversees the program for children and teenagers with traumatic and congenital deformity of the cervical spine. In collaboration with our colleagues in orthopaedic surgery, we use advanced surgical techniques along with neuro-physiological monitoring and intra-operative imaging to enhance patient safety and to maximize stability and correction of these deformities with instrumentation and spine fusions. Vascular Abnormalities Abnormalities in blood vessels of the brain, such as aneurysms, arteriovenous malformations and cavernous malformations, may cause bleeding in the brain. Neurosurgeons treat these conditions based on the severity and threat to the life of the child. Connecticut Children’s Medical Center is equipped with a highly skilled staff and state-of-the-art critical care facilities to treat your child quickly and safely when he or she becomes ill from bleeding in the brain. Neuroradiologists use embolization to block the blood supply to the blood vessel where bleeding is occurring, causing it to clot. Or, stereotactic radiosurgery is used to deliver high doses of radiation to abnormal blood vessels. Following these procedures, a neurosurgeon operates to physically remove the abnormal area. Epilepsy Connecticut Children’s neurosurgeons collaborative with our partners in pediatric neurology to deliver surgical options to patients with epilepsy to include vagal nerve stimulation, tailored surgical resection, and hemispherectomy. Our inpatient epilepsy monitoring unit allows for in-depth analysis of potential surgical candidates.