Yale’s pediatric neurosurgical service welcomes inquiries from families as well as referring physicians. The service employs a full-time pediatric physician assistant, Eileen Lydon. Eileen received her bachelor’s degree in nursing from the Hunter-Bellevue School of Nursing in New York and her physician assistant training at King’s College in Pennsylvania. She also completed the Norwalk Hospital-Yale University School of Medicine postgraduate PA residency in pediatrics. She participates in all aspects of the child’s care and carefully coordinates evaluation and treatment appointments to make the process as convenient and timely as possible for patients and their families.
The staff of the pediatric neurosurgery service discusses each aspect of care with the patient and his or her family and ensures that referring physicians are kept updated on each phase of treatment.
Often a families’ first contact with the service takes place when they learn their unborn baby has a congenital abnormality of the central nervous system such as hydrocephalus or spina bifida. We provide counseling for these parents helping them understand how these conditions might affect the lives of children and family members.
Spina bifida is the most common of a class of congenital conditions known as neural tube defects. It occurs very early in fetal development often before a woman even knows she is pregnant. Infants with spina bifida should be delivered by cesarean section at a medical center such as Yale-New Haven Children’s Hospital equipped with a neonatal intensive care unit and staffed by a specialized neurosurgical team to repair the opening shortly after birth.
The pediatric neurosurgery service often works with these children and provides support to them and their families for many years. Ongoing care of children with spina bifida requires the close teamwork of several pediatric specialists working with the pediatric neurosurgeon, These children have varying degrees of central nervous system problems as well as difficulties with bladder and bowel control and lower limb movement.
All of the pediatric subspecialties involved in the comprehensive care plan, which might include orthopedists, urologists, physical therapists, occupational therapists and social workers, collaborate closely with the neurosurgical department at Yale.
Hydrocephalus, which affects about one in every 500 children, is a build-up of fluid inside the brain. Congenital hydrocephalus is caused by a complex interaction of genetic and environmental factors. Acquired hydrocephalus may result from spina bifida, intraventricular hemorrhage, meningitis, head trauma, tumors and cysts.
It is typically treated with a shunt, a small flexible tube that allows the blocked fluid to drain safely into the abdomen. Since the advent of shunting, the outcome for most children with hydrocephalus is very good, but some children will have complications. Shunt malfunctions and infections, developmental delays, learning disabilities and visual problems are not uncommon. Families need to be aware of the life-long complexities of hydrocephalus to ensure their children receive comprehensive on-going care and appropriate intervention services and therapies.
Yale pediatric neurosurgeons were pioneers in the use of endoscopes (tiny, fiberoptic cameras) to treat hydrocephalus surgically. Endoscopes provide a clear picture of the ventricles within the brain, so surgeons are able to cut an opening in the ventricle, making it possible to bypass the obstruction and restore normal fluid flow. The procedure, called endoscopic third ventriculostomy, is a safe and effective treatment for some children.
Craniosynostosis and Craniofacial Reconstruction
There are a large number of conditions that can affect the shape of a child’s head. When a baby is born, the skull is composed of a collection of small bones that abut one another along areas known as sutures. The one most people are familiar with is the fontanel, or soft spot, where four bones meet. As the brain grows, the sutures make it possible for the skull to grow to accommodate it.
If one or more of the sutures close too quickly, the brain is forced to grow in a direction where the bones are not resisting it. This condition known as craniosynostosis may be congenital, but it is usually not associated with any developmental abnormalities. It can be disfiguring, however, and since the most rapid head growth occurs during a baby’s first year, it is most often treated during that time.
At Yale, pediatric neurosurgeons team with plastic surgeons to treat craniosynostosis. The surgeons recontour the bones of the skull and resecure them in such a way that symmetrical growth can occur.
Children with both malignant and benign growths of the central nervous system benefit from evaluation by a multidisciplinary team of pediatric specialists at Yale that may include a neurosurgeon, neurologist, radiation oncologist, neuropathologist and an oncologist. Once a tumor has been identified, most children will undergo a biopsy and/or surgical removal of the tumor.
Specialized treatments such as stereotactic radiosurgery, electrocorticography and cortical mapping are available where indicated. These are techniques to identify areas of the brain that are critical to movement, feeling, memory and speech so surgeons can remove as much of the tumor as possible without removing critical areas of the brain.
There are several rare problems that affect the blood vessels in the brain of newborns, infants and growing children. While very frightening and potentially lethal, many if not most of these conditions can be treated successfully. At Yale, a pediatric neurosurgeon works in collaboration with the neurovascular service aided by state of the art imaging technology, including magnetic resonance imaging (MRI) and interventional neuroradiology.
Surgical Management of Medically Intractable Epilepsy
The Yale Epilepsy Surgery program was one of the nation’s first and has evolved into one of the most active and advanced in the world. It provides promising options for children whose epilepsy has not been managed successfully with medication. The department’s pediatric neurosurgeon works in close concert with the director of the epilepsy surgery program to ensure the best outcome for these children.
Head and Spinal Cord Trauma
The Yale-New Haven Children’s Hospital is a Level One Trauma Center and a Spinal Cord Injury Center, and as a result, receives either directly or in transfer, many infants and children with extensive and often life threatening brain and central nervous system injuries.
Emergency Division physicians are fully equipped to take care of the most severely traumatized patient. After initial assessment and diagnostic studies, the patient is either transferred to our fully equipped pediatric ICU or to the operating room as indicated.