Pediatric Neurosurgery - exam-focused guide
Pediatric Neurosurgery covers congenital anomalies, hydrocephalus, paediatric tumours and craniosynostosis. The exam tests developmental anatomy, age-specific management and long-term surveillance.
Core rules
- Neural tube defects require prenatal counseling, early closure and hydrocephalus surveillance; folate supplementation reduces risk.
- Chiari malformation may cause tussive headache, syrinx and lower cranial nerve signs. Dandy–Walker malformation includes cerebellar vermis hypoplasia, cystic fourth ventricle and hydrocephalus.
- Paediatric tumours: medulloblastoma arises in the cerebellar vermis and can disseminate via CSF; pilocytic astrocytoma is common in the posterior fossa; ependymoma arises from the fourth ventricle floor; craniopharyngioma causes endocrine and visual deficits.
- Craniosynostosis is premature suture fusion: sagittal gives scaphocephaly, coronal gives plagiocephaly, metopic gives trigonocephaly. Surgery relieves raised ICP and improves shape; positional plagiocephaly is not synostosis.
- Hydrocephalus in infants causes macrocephaly, sunset eyes, irritability and vomiting. ETV/CPC may be used in selected infants; shunt remains common.
Worked example: A 6-month-old has progressive macrocephaly, a sunset sign and ventriculomegaly on ultrasound. This is hydrocephalus until proven otherwise. MRI defines obstruction; the child is assessed for raised ICP. Treatment is CSF diversion, with shunt or ETV chosen by anatomy and age.
Traps: confusing positional plagiocephaly with coronal synostosis; missing medulloblastoma CSF dissemination; using radiation without staging in young children; attributing macrocephaly to benign extra-axial fluid when ICP is raised.