Pediatric Neurosurgery
What the candidate must own
Know the embryology of neural tube closure and the spectrum of congenital malformations: myelomeningocele, Chiari malformations, Dandy-Walker spectrum, arachnoid cysts, and tethered cord. Understand hydrocephalus - communicating versus non-communicating - and the treatment options: endoscopic third ventriculostomy, ventriculoperitoneal shunt, and the complications of each (shunt malfunction, infection, overdrainage, slit ventricle syndrome). Know the paediatric tumours: medulloblastoma, pilocytic astrocytoma, ependymoma, craniopharyngioma, and germ cell tumours, with their typical locations and imaging. Understand craniosynostosis and the timing of surgical correction, and the management of paediatric head injury and abusive head trauma.
Traps that appear in questions
- Assuming a Chiari I malformation always needs surgery - asymptomatic patients may be observed.
- Confusing communicating with non-communicating hydrocephalus when choosing ETV versus shunt.
- Forgetting that shunt infection usually requires removal and external drainage, not just antibiotics.
- Missing the red flags of abusive head trauma (retinal haemorrhages, metaphyseal fractures, inconsistent history).
Rule of thumb
In a child with hydrocephalus, find the level of obstruction first: if the obstruction is at the aqueduct or fourth ventricle outlet, ETV is an option; if it is at the arachnoid granulations (communicating), a shunt is usually needed. Worked example: an infant with an enlarging head, sunset eyes, and triventricular hydrocephalus with a normal fourth ventricle has aqueductal stenosis - ETV is a reasonable first-line treatment in an appropriate candidate.