Congenital or childhood-acquired neurological diseases. Treatment of congenital diseases, such as malformations of the nervous system that cause neurological problems and impaired neuropsychomotor development, but which can be corrected by pediatric neurosurgery.
Hydrocephalus is the abnormal accumulation of cerebrospinal fluid within the braincase. It can occur in children and symptoms vary according to the cause and age. Premature babies or infants may experience apnea and changes in the shape of their skull. Up to 1 year of age, children with hydrocephalus may experience a disproportionate increase in head circumference, irritability, nausea, ocular changes, and difficulty fixing and controlling the head. In older children, symptoms of hydrocephalus can include headache, nausea, vomiting and delayed neuropsychomotor development.
Through neurological examination and complementary tests such as ultrasound, head tomography and magnetic resonance imaging, the diagnosis of hydrocephalus can be established. The definitive treatment is carried out by neurosurgery, which can be done through the implantation of a valve to drain this excess fluid (ventricular shunt) or through neuroendoscopy (third ventriculostomy).
Congenital malformations in the spine that occur between the third and fourth week of pregnancy are known as open spina bifida or myelomeningocele.
Spinal defects that appear later in pregnancy and are covered by intact skin are called closed spina bifida. Prenatal examination provides the diagnosis of spinal dysraphism during the second trimester of pregnancy and from then on treatment can begin.
Symptoms of spinal dysraphism in children can be: partial or complete paralysis associated with lack of sensitivity in the lower limbs and loss of urinary and fecal control. Most of these children also have hydrocephalus and require neurosurgical treatment.
Corrective surgery for spinal dysraphism can be performed during pregnancy (intrauterine surgery) or immediately after birth (time zero). Children undergoing this neurosurgical treatment can lead a normal life with multidisciplinary care.
The diagnosis of Nervous System Tumors and Neurovascular Diseases in children can be made through complementary neuroimaging exams, such as tomography and magnetic resonance imaging.
Through neuronavigation, intraoperative electrophysiological monitoring and microsurgical techniques, it is possible to remove the tumor and treat neurovascular diseases (cavernoma, moyamoya, aneurysm, arteriovenous malformation) while preserving the delicate structures of the nervous system.
Cranial asymmetry caused by posture defects or congenital torticollis is called positional plagiocephaly. Treatment for these cases involves repositioning the baby (tummy time), physiotherapy and cranial orthosis (helmet).
Early closure of one or more cranial sutures characterizes craniostenosis, which can be simple or syndromic (for example: Apert syndrome, Crouzon syndrome, Pfeiffer syndrome). The correction for craniostenosis is surgical and improves craniofacial development, the functioning of the brain, breathing, swallowing and vision.
According to the suture that closed early, the head takes on a typical shape. The most common types of simple craniostenosis are: scaphocephaly, trigonocephaly and anterior plagiocephaly.
Up to the 6th month of life, the neurosurgical procedure can be performed, and in specific cases, with a minimally invasive neuroendoscopic technique associated with the use of a cranial orthosis.
From the 6th month onwards, classical open neurosurgery is indicated for the treatment of craniostenosis – correction with surgical removal of the closed suture early (suturectomy), bone remodeling and cranial plastic surgery with absorbable plates.
