Paediatric Neurosurgeon

Services Overview

#

Hydrocephalus (Shunt Surgery)

Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain.

Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a range of impairments in brain function.

Hydrocephalus can happen at any age, but it occurs more frequently among infants and adults 60 and over. Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. Many different therapies are often required to manage symptoms or functional impairments resulting from hydrocephalus.

Signs and Symptoms of hydrocephalus vary somewhat by age of onset
Infants: Changes in the head

An unusually large head

A rapid increase in the size of the head

A bulging or tense soft spot (fontanel) on the top of the head

Physical signs and symptoms

Vomiting

Sleepiness

Irritability

Poor feeding

Seizures

Eyes fixed downward (sunsetting of the eyes)

Deficits in muscle tone and strength

Poor responsiveness to touch

Services Overview

#

Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure offered to children and adults diagnosed with obstructive or non-communicating hydrocephalus.Shunting, or using a small silicone tube to carry the cerebrospinal fluid (CSF) to a different body cavity for reabsorption, is the most common treatment for hydrocephalus. While shunts may be lifesaving, they are man-made devices and may fail for a variety of reasons.

Endoscopic third ventriculostomy is an alternative surgical procedure that creates a bypass for the cerebrospinal fluid in the head that eliminates the need for a shunt. It is helpful only to people with hydrocephalus caused by a blockage of the flow of cerebrospinal fluid.

Endoscopic means that the surgery is performed with the use of an endoscope. An endoscope is a thin tube that has a strong light, a powerful magnifying lens and an opening where tiny instruments are passed.

Third ventriculostomy refers to the area of the brain where the bypass is made. Because the most common site of blockage is the narrow pathway between the third and fourth ventricle of the brain, the bypass is made through the thin membrane in the bottom (or floor) of the third ventricle.

The cerebrospinal fluid may then flow from the lateral to the third ventricle and from the third ventricle through the new opening to the normal fluid chambers below the base of the brain.

The cerebrospinal fluid then flows up and over the surface of the brain where it is reabsorbed into the bloodstream.

Services Overview

#

Spinal Dysraphism

Spinal dysraphism is an umbrella term that describes a number of conditions present at birth that affect the spine, spinal cord, or nerve roots.

Spine: The bony structure also known as the spinal column. Made up of individual vertebrae (bones), the spine protects the spinal cord.

Spinal cord: The bundle of nerves and other tissue that connects brain and body. Inside the spine, the spinal cord is also protected by a series of membranes (coverings). The spinal cord relays sensory information from the body to the brain, and movement instructions from the brain to the body.

Nerve roots: Nerves that branch off the spinal cord to reach the rest of the body.

All forms of spinal dysraphism result from an event very early in an embryo’s development. In about the third week of development, a sheet of cells called theneural plate folds up to form a structure called theneural tube. The top of the neural tube develops into the brain, and the rest of the neural tube develops into the spine and spinal cord. Spinal dysraphism results when a section of the neural tube that will become the spine and spinal cord does not close completely.

Types of spinal dysraphism include myelomeningocele (also known as spina bifida aperta or open spina bifida), spina bifida occulta, split cord malformation (diastematomyelia), spinal cord lipoma (lipomyelomeningocele), dermal sinus tract, tight filum terminale, and tethered spinal cord. A person with spinal dysraphism may have more than one type.

SYMPTOMS

Myelomeningocele: Can cause incontinence, hydrocephalus, tethered cord, sensory loss, orthopedics deformities, leg weakness and/or or paralysis.

Spina bifida occulta: Rarely causes symptoms and most often does not require treatment.

Split cord malformation (diastematomyelia): Symptoms include structural scoliosis (spinal curvature) and tethered cord. Cases where each part of the cord has its own dura are usually associated with more severe symptoms.

Spinal cord lipoma (lipomyelomeningocele): Sometimes cause no symptoms for a time. Symptoms are usually caused by the tethered spinal cord, and may include problems with bowel and bladder function, frequent urinary tract infections, spasticity, back and leg pain, weakness, and sensory loss.

Dermal sinus tract: Sometimes cause no symptoms. However, these tracts often lead to tethered cord, and can also be a pathway for infection.

Dermoid and epidermoid spinal cysts: May cause no symptoms at all, or may cause neurological symptoms like weakness, clumsiness, and incontinence if they compress the spinal cord and nerve roots.

Tethered cord: Symptoms vary, but often include leg weakness, sensory loss, orthopedic deformities, low back and leg pain, and bowel or bladder incontinence. Symptoms can progress to become quite severe.