Pediatric Neurosurgery

History

From ancient times until the Harvey Cushing period, neurosurgery was occasionally performed on children. Cushing provided the first comprehensive description of the more common tumours of the posterior fossa in children, particularly cerebellar astrocytomas and medulloblastomas. He published three major papers in the final years of his surgical practise summarising the characteristics, clinical picture, and treatment of the more common paediatric brain tumours. He was able to achieve a surgical mortality rate of only 4% in pediatruc brain tumor surgery due to his exceptional surgical skill and innovations. In 1929,  Franc Ingrahm was a student of Cushing and did his practice at Petre Bent Brigham Hospital (Children’s Hospital). Ingraham spent his whole career working to advance pediatric neurosurgery. He had a key role in identifying and creating surgical procedures for conditions such as craniosynostosis, diastematomyelia, hydrocephalus, infantile subdural hematoma and effusion, and different types of spina bifida. He was successful in drawing in and nurturing a number of talented students who would advance pediatric neurosurgery. If Cushing was the father of neurosurgery, Ingraham was undoubtedly the pioneer in fostering the expansion and advancement of pediatric neurosurgery. Donald Matson was also one of the students who was guided by Cushing. Together with Ingraham, he co-authored the remarkable article on an infantile subdural hematoma in 1944 and the first pediatric neurosurgery textbook in 1954. Matson made a substantial contribution to the treatment of intraspinal tumors, cerebellar astrocytoma, craniopharyngioma, and brain abscesses. The first successful, long-term therapy for communicating and obstructive hydrocephalus in children was made possible by Matson's lumboureteral and ventriculoureteral shunts, which were developed in 1949 and 1951, respectively. He was an excellent surgeon and teacher. Before his tragic passing in 1969, Neurosurgery of Infancy and Childhood was revised and rewritten by Matson.

 A conference of 37 neurosurgeons was conducted in New York in September 1969 to establish the first pediatric neurosurgical association. After the meeting, it was decided to establish Pediatric Neurosurgery. In the majority of the main cities in the United States and Canada, pediatric neurosurgery has developed. The American Society for Pediatric Neurosurgery was founded in 1978.

Present status

Pediatric neurosurgery is a subspecialty of neurosurgery that focuses on the treatment of neurological conditions and disorders in infants, children, and adolescents. This procedure is one of the newest forms of surgery. It was first created in the early 1900s. But now modern technology is being used in the field. It is regarded as a cutting-edge procedure in surgery. There have been several recent developments in pediatric neurosurgery that are likewise true of other neurosurgical subspecialties. Despite the fact that many more recent technological developments have had an impact on the field of neurosurgery as a whole, innovations like the intraoperative MRI scan, neuroendoscopy, and new intraoperative imaging and instrumentation appear to have particular applications in pediatric neurosurgical disorders. Pediatric neurosurgery involves treating Congenital brain and spinal cord malformations, hydrocephalus, cerebral palsy, epilepsy, traumatic brain injury, and other neurological disorders. But the most common reasons for pediatric neurosurgery would be brain tumors and Spina Bifida. Pediatric Neurosurgery is an evolving branch so many neurosurgeons do 6-12 months fellowship in this field but all countries don't provide pediatric neurosurgery fellowship programs so, neurosurgeons most commonly go to North America, Europe, and Australia to obtain experience.

Due to the absence of a formal referral mechanism, pediatric neurosurgeons may not always be referred cases by pediatricians and family doctors. Additionally, general neurosurgeons could choose to do "straightforward" pediatric surgeries, referring patients to specialists only when difficulties emerge. This might further reduce the number of instances that are brought to a specialist's attention.

Future of Pediatric Neurosurgery

There will be a lot of new advances in pediatric surgery, but the major focus should be on three fundamental elements that will be primarily responsible for these occurrences: technical advancements, professional innovation, and the use of new equipment in clinical training.

Imaging is a field that is ever-evolving and growing. Robotic surgery might be considered the future of surgery. This kind of surgery combines the use of robotic equipment, imaging technologies, and surgical techniques. It has greater precision and less complication.

Also, Hospitals in the twenty-first century will need to undergo significant modifications to meet the demands of the new period and be able to address various societal requirements. Pediatric hospitals will need to modify their organizational structures as well.

There is a need for the Centralization of specialized treatment to allow pediatric neurosurgeons to gain plenty of operating room experience if a referral mechanism is in place. So that they can gain expertise in ailments specific to kids that are consequently less prevalent in general practice, such as pediatric epilepsy and syndromic craniosynostosis.

A new branch of medical education called simulation-based medical education (SBME) is expanding quickly all around the world. Medical professionals, residents, nurses, and students have the chance to study and train individually or in groups in unexpected circumstances through simulation-based medical education. So this can be a powerful tool for learning pediatric neurosurgery.

There are still numerous obstacles to overcome. It is just the beginning. In upcoming years there will be more advancement. All this will be done by young and enthusiastic doctors who will be passionate about pediatric surgery.