Sakra Department of Paediatric Neurosurgery

Children are not merely young adults. Childcare calls for specialized expertise, more so in the field of neurosurgery.  The department of neurosciences, SWH, has left no stone unturned in its efforts in providing world-class paediatric neurosurgical care. Around one-tenth of the approximately 45,000 surgeries performed by the directors of the department, are paediatric cases. All-encompassing, comprehensive care is provided to all the children and ensures exhaustive evaluation, accurate diagnosis and world-class surgical and post-surgical care to the patients. It also ensures the patients receive proper post-surgical adjuvant therapy(radiation/chemotherapy), when indicated, in liaison with oncological centres in the city and elsewhere. The procedures performed to run the gamut from simple to the most complicated conditions. These include:

Congenital brain and spine conditions:

Congenital hydrocephalus - It is a build-up of excess cerebrospinal fluid (CSF) in the brain at birth. The extra fluid in the baby’s brain causes brain damage and mental and physical problems. Congenital hydrocephalus is caused by an imbalance between how much fluid the brain makes and how well the body is able to process it.

The major symptom of congenital hydrocephalus is a head that is larger than normal which you may notice when the baby is born or within the first several months of life.

Treatment includes creating an alternate pathway for drainage of CSF, which is done mostly endoscopically through a small hole in the skull. The procedure is called endoscopic third ventriculostomy.

Skull deformities - Also known as craniosynostosis.

Arnold-Chiari malformations.

Neural tube defects – encephaloceles, meningoceles, meningomyelocele, lipomyelomeningocele, tethered cord.

Congenital spine deformities- Congenital atlanto-axial deformities (AAD) kyphosis, scoliosis, kyphoscoliosis. The spine team, headed by Dr. Satish Rudrappa has considerable experience in managing complex spinal deformities with excellent results.

Split cord malformations.

Arachnoid cysts: both brain and spine.

Brain tumours:

• Commonest including gliomas, pilocytic astrocytomas, medulloblastomas, ependymomas.

• Craniopharyngiomas, pituitary tumours.

• Meningiomas, hemangioblastomas, primitive neuroectodermal tumours (PNET)

• Dysembryoplastic neuroepithelial tumours (DNETs)

• Intraventricular tumours.

• CNS lymphomas.

• Cerebellopontine angle tumours- acoustic schwannomas, meningiomas, epidermoids.

• Brainstem lesions.

• Pineal tumours.

• Skull base tumours including clival chordomas.

• Retinoblastoma.

• Metastases.

Spine tumours:

• Intradural-extramedullary tumours: meningiomas, neurofibromas.

• Intramedullary tumours: astrocytomas, ependymomas.

• myxopapillary ependymomas.

• Spinal dermoids, epidermoids.

• Sacrococcygeal teratomas.

Epilepsy :

SWH is one of the few recognized epilepsy surgery centers in the country. The department has one of the most comprehensive epilepsy care programs called EPIC. 

Vascular conditions:

• Cerebral aneurysms.

• Cerebral and spinal arteriovenous malformations.

• Moya moya disease - Moyamoya disease is a rare blood vessel disorder in which the carotid artery in the skull becomes blocked or narrowed, reducing blood flow to the brain. It may cause a ministroke (transient ischemic attack), stroke or bleeding in the brain. There are certain risk factors associated with the condition such as Down syndrome, sickle cell anemia, neurofibromatosis type 1 and hyperthyroidism.

Treatment consists of creating a bypass between the scalp and brain blood vessels to ensure the re-establishment of blood flow to the brain. The surgery most commonly done is called STA- MCA bypass whereby a connection is established between the scalp artery and the brain blood vessel. It is a technically demanding procedure done in few centres in the country and Dr. Swaroop Gopal is a stalwart in this field with results comparable to international standards.
Cerebral and spinal dural AVFs

Infectious/ inflammatory conditions:

• Brain abscesses, spinal abscesses: bacterial, fungal, tubercular.

• Brain and spine tuberculosis.

Trauma:

• Traumatic brain injury: extradural haemorrhage, subdural haemorrhage, depressed skull fracture,

• Diffuse axonal injury, cerebral contusions.

• Traumatic spine injury: cervical, thoracic or lumbar spine fracture with or without cord injury.

To sum up, the department of paediatric neurosurgery, SWH, is a tertiary care centre in the private sector managing the whole spectrum of paediatric neurosurgical cases with excellent results, at par with international standards.