Pediatric Neurosurgery
Core concepts
Understand the unique physiology of the pediatric patient: open fontanelles and sutures, higher brain water content, and different injury patterns. Know the common pediatric neurosurgical conditions: hydrocephalus (congenital and acquired), myelomeningocele, Chiari malformation, craniosynostosis, tethered cord, and pediatric brain tumors (medulloblastoma, ependymoma, pilocytic astrocytoma, craniopharyngioma). Learn the principles of shunt management and the signs of shunt malfunction. Also cover abusive head trauma and its imaging features.
Traps
- Assuming a large head is always hydrocephalus; macrocephaly can be familial or due to other causes.
- Missing shunt malfunction because symptoms are nonspecific (headache, vomiting, lethargy).
- Confusing medulloblastoma (midline cerebellar, often with hydrocephalus) with pilocytic astrocytoma (cystic with mural nodule).
- Forgetting that abusive head trauma can present without external signs.
Worked example / rule of thumb
A child with a posterior fossa mass and hydrocephalus most likely has medulloblastoma or ependymoma; both can obstruct the fourth ventricle. Rule of thumb: in a child with a shunt, any new headache, vomiting, or lethargy is shunt malfunction until proven otherwise, and imaging plus shunt series should be obtained.