Children's neurosurgery

Children can develop conditions of the brain and spine that need a neurosurgeon's assessment, including brain and spinal cord tumours, hydrocephalus (a build-up of fluid in the brain), head injuries and conditions present from birth. Dr Chou was previously the paediatric neurosurgeon at the Children's Cancer Centre at the National University Hospital.

Signs that may need assessment include headaches that are new or getting worse, especially in the morning or with vomiting; changes in walking, balance or coordination; a head that is growing faster than expected in a baby; changes in vision; seizures; or back pain, weakness or bladder problems in a child.

Assessment includes a history from the child and parents, a neurological examination suited to the child's age, and imaging such as MRI or CT. Depending on the condition, care may involve observation, medicines or surgery, and is planned with the family and with paediatricians, oncologists and other specialists.

Some conditions of the brain, spine and skull are present from birth. Spina bifida is a group of conditions in which the spine and spinal cord do not form fully. In a tethered spinal cord, the lower end of the cord is held down by tissue, so it is stretched as the body grows and moves. In craniosynostosis, one or more of the joins between a baby's skull bones close too early, which can change the shape of the head.

These conditions are not only a concern in childhood. Adults with spina bifida, or with a tethered cord found later in life, may develop new back or leg pain, numbness, weakness, foot changes, or bladder and bowel problems, and benefit from neurosurgical review. Craniosynostosis is usually assessed in babies and young children.

Assessment includes an examination and imaging such as MRI of the spine or brain, or CT of the skull. Depending on the condition, care may include observation, surgery to release a tethered cord, or skull surgery for craniosynostosis, often planned together with other specialists.