A neurosurgeon is much more than a doctor capable of operating on the brain. He is a specialist in all diseases that affect the nervous system and which may require surgery. There are neurosurgeons who specialize in spinal surgery, conducting oncological pathology and others. There are also specialists in pediatric neurosurgery, which is a very specialized branch of this discipline. doctor Francis VillarejoThe head of the neurosurgery service at the Hospital La Luz (Madrid) is one of them, so he is well aware of the differences between the two types of interventions.
The first is the singularity, and that is that pediatric neurosurgeons can operate on adults, but An adult neurosurgeon cannot operate on children, “During the residency of the specialty in all countries, the pediatric neurosurgeon has previously rotated through an adult service to access the two branches of the specialty already in place,” said Dr. Villarejo explains.
The first thing that is worth noting is that The child is not a “little adult”, Its circulatory volume is 10% of its weight, and it presents a completely different neurosurgical pathology. In addition, his body is in the stage of full development, which determines his response to interventions. For this reason, Villarejo insists that minors should be cared for by children’s specialists in specialized centres, “such as a children’s hospital, with a variety of personnel, from pediatricians to nurses, through assistants and anesthesiologists.” “
The child’s body is in the full stage of development, which determines its response to interventions
Childhood malformations and malformations of the nervous system and its envelops are typical. “For example craniosynostosis, a birth defect in which the baby’s bones close prematurely, deforming the skull, and which in most cases requires surgical intervention. This is an operation that can result in significant blood loss and you have to be very trained so that it doesn’t happen,” says the doctor.
There are other differentiated malformations, such as “brain cysts and malformations, tumors, spina bifida, hydrocephalus or epilepsy”. In children, brain tumors are often located in the posterior fossa, where the cerebellum is located, and are usually malignant tumors called medulloblastomas. Meanwhile, in adults, tumors are more frequent in the upper part of the skull. In this case, glioblastomas, tumors with rapid growth and poor prognosis, are usually the most aggressive.
Treatment after surgical intervention in children and adults also differs. They are usually technically more sensitive than in the case of children due to the smaller circulatory volume of their bodies. When it comes to tumours, it is necessary to achieve complete removal because later, “in chemotherapy, due to the low weight of the patient, the dosage is very low. For radiotherapy, it is not convenient nor is it suitable for young children.” should be implemented in the case,” says Dr Villarejo.
To the head of the neurosurgery service at the Hospital La Luz, MRI has been one of the great advances in its specialty. This allows the brain and spinal cord to be inside out in all projections, it serves to identify the type of tumor, the best way to reach it and warns of the presence of malformations, hemorrhages or herniated discs .
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