Hyderabad, known for its cultural heritage and technological advancements, is a hub for medical excellence, including paediatric neurosurgery. Paediatric neurosurgeons provide advanced surgical care with compassion to children with neurological disorders, using their expertise, state-of-the-art facilities, and multidisciplinary approach. They treat a wide range of complex disorders, including brain tumours, hydrocephalus, spina bifida ( spinal dysraphisms), craniosynostosis and more. The collaborative approach involves paediatric neurologists, neuroradiologists, paediatricians, intensivists,  oncologists, and rehabilitation specialists providing personalised and holistic care. 

Paediatric neurosurgeon’s expertise:

Neurosurgery may be necessary for children due to their unique conditions and medical requirements.

• Hydrocephalus: Blockage of fluid flow or overproduction of cerebrospinal fluid can result in excess cerebrospinal fluid collecting in the brain, leading to raised pressure in the brain.

• Brain and spine tumours: Brain tumours, both benign and malignant, can originate from various brain regions and cause varying symptoms based on their location and size. Tumours affecting the spinal cord can cause back pain, weakness, and sensory deficits, potentially necessitating surgical removal to alleviate pressure on the spinal cord and nerves.

• Spina Bifida (Spinal dysraphism): Spinal dysraphism is a fetal neural tube defect due to improper spinal column closure during a baby’s development in the womb. It might lead to paralysis in both limbs, bowel and bladder dysfunction, and neurological complications.

• Tethered cord syndrome: Abnormal spinal cord attachment can cause neurological symptoms, necessitating surgery to release the tethered cord and prevent further complications.

• Craniosynostosis: Premature fusion of cranial sutures can cause abnormal skull shape, restricted brain growth and increased pressure, necessitating surgical correction for normal brain development.

• Chiari malformation: A structural defect in the skull and cerebellum, resulting in herniation of part of the cerebellum into the spinal canal, which can cause headaches, neck pain, and balance issues.

• Traumatic brain injury (TBI) or spine injury: Severe head injuries from accidents or trauma may require neurosurgical intervention to remove blood clots, repair damaged tissue or bone, or relieve intracranial pressure.

1. 1. Stroke: Children with stroke might require surgery to remove the blood clots in the brain or relieve the pressure in the brain. Few children with a specific condition called Moyamoya syndrome which can cause stroke, need Revascularization surgery to increase the blood supply to the brain.

• Epilepsy: Children with epilepsy/seizures may require neurosurgical intervention if their seizures don’t respond to medication, which may involve the removal of some part of the brain or disconnection or placement of seizure control devices.

• Vascular malformations: Neurosurgery may be necessary to treat abnormalities in brain or spinal cord blood vessels, such as arteriovenous or cavernous malformations, to prevent bleeding or alleviate symptoms.

Neurosurgical intervention in children may be necessary, and a decision must be made collaboratively by parents, paediatric neurosurgeons and healthcare team members, considering risks, benefits, and overall health. 

The recovery period following a Pediatric Neurosurgery

A child’s recovery period after neurosurgery can vary greatly depending on various factors, including the kind and complexity of the operation, the underlying ailment being treated, the child’s age and overall health, and any problems that may occur during or after the treatment.

Immediate postoperative period:(after surgery)

• After neurosurgery, the child typically spends time in the recovery room under close healthcare professional monitoring or in the intensive care unit depending upon the condition of the child and the risks and the expected complications. 
• The initial recovery period for a child can range from several hours to days, depending on the child’s condition and the complexity of the surgery.

Hospital stay:

• Once the child is stable, he or she will be shifted to either the high-dependency unit or the room. The child will be closely monitored for signs of complications, and appropriate pain management and rehabilitation therapies may be initiated as needed.

Recovery at home:

• After hospital discharge, the child will continue to recover at home under the care of caregivers and healthcare providers.
• The recovery period at home can significantly differ based on the specific surgery and the child’s unique requirements.
• Some children may require continuous rehabilitation therapy, medication management, or specialised home care.

Return to normal activities:

• The child’s recovery progress and the nature of the surgery will determine the timeline for returning to normal activities.
• Children may resume normal activities quickly, but some may need a gradual return, especially if the surgery involves significant physical or neurological impacts.

Long-term follow-up: 

• Neurosurgery children may require long-term follow-up care to monitor progress, manage symptoms, and address developmental or functional concerns post-surgery.

The prognosis for paediatric neurosurgeons:

• Condition-specific factors:  The prognosis of a neurological condition depends on its underlying cause, with some conditions like hydrocephalus, spinal dysraphism, craniosynostosis, and few brain tumours potentially having favourable outcomes. In contrast, others, like severe injuries or complex anomalies, have more uncertain outcomes.

• Effectiveness of treatment:  The prognosis of paediatric neurosurgery depends on surgical intervention effectiveness, surgical skills and the use of newer advanced gadgets to improve the safety of surgery. The success rate of surgery has improved due to advancements in techniques, tools and care.

• Complications and risks:  Paediatric neurosurgery involves risks like 

• Infection
• Bleeding
• Neurological deficits
• Adverse anaesthesia reactions

• Neuroplasticity and rehabilitation:  Neuroplasticity in children’s brains aids in recovery and adaptation after neurosurgical procedures, with rehabilitation therapies like physical, occupational, speech, and cognitive therapy maximising functional outcomes and quality of life.

• Long-term follow-up:  Paediatric neurosurgical conditions necessitate long-term monitoring and follow-up care to assess progress, detect recurrence, and address ongoing neurological needs. Regular appointments with neurosurgeons and other healthcare providers optimise long-term outcomes.

Paediatric neurosurgery has seen an improved prognosis due to advancements in medical technology, surgical techniques and gadgets and multidisciplinary care approaches. However, each case presents unique challenges, and open communication between healthcare providers, patients, and families is crucial for achieving the best possible prognosis for paediatric neurosurgery patients.

Paediatric neurosurgeons in Hyderabad are renowned for their expertise in treating complex brain and spinal disorders in children. They treat a range of conditions, including congenital anomalies, traumatic injuries, tumours, and epilepsy.

Dr Vishakha Basavraj Karpe, a senior consultant at Rainbow Children’s Hospital in Banjara Hills, Hyderabad. She is known for her comprehensive care approach and is one of the few dedicated leading paediatric neurosurgeons in the city and India with over ten years of extensive experience in paediatric neurosurgery. Her expertise includes treating hydrocephalus, spinal dysraphism, craniosynostosis, paediatric brain infections, brain and spine tumours and stroke surgery.

She has a special interest in craniosynostosis surgery, which is done only in very few centres in India.