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James Brown
James Brown

Pediatric Neurosurgery (Neurosurgery By Example...


Salik, I., Dominguez, J. F., Vazquez, S., Ng, C., Das, A., Naftchi, A., ... & Stewart, D. (2022). Socioeconomic characteristics of pediatric traumatic brain injury patients. Clinical neurology and neurosurgery, 107404.




Pediatric Neurosurgery (Neurosurgery by Example...



The Stanford Concussion and Brain Performance Center brings together experts in pediatric neurosurgery and pediatric emergency medicine to provide clinical care and conduct research, with the goal of advancing diagnosis and treatment of mild traumatic brain injury in children.


Dr. Aria Fallah is a pediatric neurosurgeon who practices at UCLA Mattel Children's Hospital and Ronald Reagan UCLA Medical Center in Westwood and sees patients at the UCLA Health pediatrics office in Manhattan Beach. He is board-certified in neurosurgery by the Royal College of Physicians and Surgeons, and board-certified by the American Board of Pediatric Neurological Surgery. He is also an associate professor of neurosurgery and pediatrics at the David Geffen School of Medicine at UCLA.


Dr. Fallah received his medical degree and his graduate degree in clinical epidemiology and biostatistics from McMaster University in Ontario. He then trained in the neurosurgical residency program of the University of Toronto, and completed his pediatric rotations at the prestigious Hospital for Sick Children in Toronto, before rotating through the epilepsy surgery program at the Cleveland Clinic. He later completed his fellowship training in pediatric neurosurgery at Miami Children's Hospital.


The pediatric neurosurgery team offers diagnostic surgeries including stereotactic electroencephalography and subdural grid implantation; resective epilepsy surgeries, ranging from focused microsurgical resections to large hemispheric resections; as well as MRI-guided laser thermal therapy for minimally invasive treatments. Children who are not deemed eligible for resective surgery are often offered implantation of the latest generation of vagal nerve stimulators, responsive neurostimulation and deep brain stimulation.


Dr. Fallah's research interests are in Evidence-Based Surgery, Clinical Trials, Observational Studies, Meta-Analyses, and Umbrella Reviews, as it relates to Pediatric Epilepsy Surgery and Pediatric Neurosurgery. He has been the principal investigator in several multicenter collaborative studies in epilepsy surgery including the HOPS (Hemispherectomy) Study and REST (Tuberous Sclerosis Complex) Study. Dr. Fallah has written extensively, having authored or coauthored more than 100 peer-reviewed publications. He has written book chapters and is a regular invited speaker at international and national epilepsy and pediatric neurosurgery conferences.


At University of Florida Health in Gainesville, our chief of pediatric neurosurgery, Lance Governale, MD, co-directs the multidisciplinary craniosynostosis program with pediatric craniofacial plastic surgeon Jessica Ching, MD. The UF Health Craniofacial Center has nearly 500 actively managed patients at any given time and continues to grow by about 15% per year because of the high-level care provided. We are proud to offer the full range of surgical options for craniosynostosis, including minimally invasive endoscopy, springs, and distractors. Ultra low dose CT scanning minimizes radiation exposure for our patients, and intraoperative blood management protocols avoid the risks associated with transfusion. Our ACPA-approved multidisciplinary craniofacial clinic allows patient management by the full team in one visit.


At the University of Chicago Medicine Comer Children's Hospital, our pediatric neurosurgery experts provide the most up-to-date and effective treatment for the entire spectrum of neurological disease. Every year, we perform hundreds of complex neurosurgical procedures on infants and children.


This emerging field of neurosurgery offers new hope to children with difficult-to-treat diseases such as spasticity and dystonia. In functional pediatric neurosurgery, neurosurgeons implant drug pumps and electric current-producing stimulators to treat children with movement disorders. These approaches affect the function of the nervous system without injuring it, and eliminate the need to remove brain or spine tissue.


Pediatric neurosurgery focuses on the care of infants, children and adolescents with neurosurgical disease. In many cases, pediatric neurosurgeons also care for adults with congenital or childhood-onset neurosurgical disease. Because their subspecialty is primarily defined by patient age, pediatric neurosurgeons enjoy the opportunity to take care of all types of neurosurgical problems, including tumors, trauma, craniofacial disorders, management of congenital malformations, vascular disease, epilepsy and other functional neurosurgery. Many current technologies in neurosurgery were developed in the pediatric arena, such as neuro-endoscopy and the treatment of spasticity. Fetal neurosurgery is an example of a new technology that exists only within pediatrics.


Pediatric neurosurgery is practiced in both academic and community-based settings across North America. Today, most individuals practicing full time pediatric neurosurgery completed accredited fellowships after residency training. The ACPNF exists to establish and maintain criteria for accrediting those fellowship programs that ultimately lead successful candidates on a path to certification by the American Board of Pediatric Neurosurgery.


Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions, and are not always able to be patient and cooperative during a medical examination. Pediatric neurosurgeons know how to examine and treat children in a way that makes them relaxed and cooperative. In addition, pediatric neurosurgeons use equipment and facilities specifically designed for children. Most pediatric neurosurgery offices are arranged and decorated with children in mind. This includes the examination rooms and waiting rooms, which may have toys, videos, and reading materials for children. This helps create a comfortable and nonthreatening environment for your child.


In the United States, a neurosurgeon must generally complete four years of undergraduate education, four years of medical school, and seven years of residency (PGY-1-7).[3] Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue additional training in the form of a fellowship after residency, or, in some cases, as a senior resident in the form of an enfolded fellowship. These fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, skull-base surgery, peripheral nerve and complex spinal surgery.[4] Fellowships typically span one to two years. In the U.S., neurosurgery is a very small, highly competitive specialty, constituting only 0.5 percent of all physicians.[5]


A common procedure performed in neurosurgery is the placement of ventriculo-peritoneal shunt (VP shunt). In pediatric practice this is often implemented in cases of congenital hydrocephalus. The most common indication for this procedure in adults is normal pressure hydrocephalus (NPH).[45]


How to cite this URL: Voramol Rochanaroon, Danil A. Kozyrev, Jonathan Roth, Shlomi Constantini. Illustrated dynamic stories behind pediatric neurosurgery. 13-Sep-2019;10:178. Available from: -articles/9641/


We selected five common procedures of pediatric neurosurgery, in a series of positioning, surgical intervention, and subintervention [ Figures 1 - 5 ]. These procedures are examples that show how surgical illustrations can depict the dynamic story, as well as focus on specific surgical nuances. For each operation, we dissected the chronological train of intraoperative sequences to depict from beginning to end flow of surgery. We decided to use comic-like style of depiction to show dynamic story and step-by-step technique, to appreciate techniques with clear details.


Max Brödel was the pioneer who famously created the original angle.[ 13 ] In his collaboration with Harvey Cushing for the depiction of transsphenoidal approach, Brödel deliberately depicted the patient in sagittal section to illustrate the heart of this surgery.[ 17 ] His legacy had carved the path and inspired countless innate artists like Cushing,[ 5 , 6 ] who exceptionally excelled at utilizing his artistic skills as a tool for surgical documentation, such as his pediatric cases.[ 12 , 14 ] Their imagination had set a milestone for medical education in neurosurgery, and we have not stopped improving since.


The purpose of this article is to serve as a rational guide for the pediatric neurosurgeon in navigating common medicolegal issues that arise in the management of abusive head trauma (AHT). Many of these issues may be unfamiliar or unpleasant to surgeons focused on addressing disease. The authors begin with a brief history on the origins of the diagnosis of AHT and the controversy surrounding it, highlighting some of the facets of the diagnosis that make it particularly unique in pediatric neurosurgery. They then review some special medical considerations in these patients through the perspective of the neurosurgeon and provide several examples as illustration. The authors discuss how to appropriately document these cases in the medical record for expected legal review, and last, they provide an overview of the legal process through which the neurosurgeon may be called to provide testimony. 041b061a72


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