Tailoring Neurosurgery to Meet the Unique Needs of Pediatric Patients

At a Glance

  • The neuroendoscope has transformed pediatric neurosurgery, allowing for a less invasive approach that is easier for children to endure because there is less discomfort, smaller incisions and a shorter recovery time.
  • UVA pediatric neurosurgeons involve parents, referring providers and a team of specialists in each child’s treatment plan.
  • Pediatric neurology patients at UVA remain under the care of pediatric specialists into adulthood to ensure continuity of care.

“Children are not little adults, and the methods we use to treat them should reflect their unique status,” says UVA Health System pediatric neurosurgeon Hasan Syed, MD. With this in mind, Syed and his colleagues are extremely selective about the surgical techniques they choose to correct pediatric neurological issues, collaborating with a multidisciplinary team of specialists, parents and referring pediatricians and using minimally invasive procedures if possible.

Surgery with a Light Touch
Although minimally invasive surgery is now utilized regularly among all age groups, it is especially beneficial for babies and young children. “In pediatric neurosurgery, the neuroendoscope has transformed the paradigm for treatment,” Syed notes. For instance, in the past, the primary option for repairing craniosynostosis, the premature fusion of fibrous sutures in the skull, was an open cranial bone reconstruction. The endoscopic technique that Syed uses is easier for children to endure, requiring small incisions to remove a portion of the abnormal suture, followed by helmet therapy.

Minimally invasive surgery has also opened up an entirely new approach for treating hydrocephalus. Rather than insert a ventriculoperitoneal shunt, Syed and his colleagues can perform an endoscopic third ventriculostomy to create a pathway that allows cerebrospinal fluid to drain and be absorbed. Pediatric neurosurgeons at UVA also use minimally invasive techniques to resect brain tumors and for spine surgery.

“Regardless of location, these endoscopic techniques result in less blood loss, shorter hospital stays and quicker recovery,” Syed says. “Because of this and because we are an academic medical center, we are deeply committed to exploring the latest pediatric applications of endoscopic surgery.”

The More Minds the Better
Another advantage of an academic medical center: having the full realm of multidisciplinary expertise easily within reach. Syed takes full advantage of the breadth of knowledge available to him, involving all relevant specialists in each patient’s surgical treatment plan.

“The more eyes you have on the patient and the more perspectives you can draw on, the better,” Syed says, citing craniopharyngiomas as one example. These pituitary gland tumors require consultations with ENT, ophthalmology and endocrinology. Another, Myelomeningoceles (defects in the spine and spinal cord), requires input from specialists from such fields as orthopedics and urology as well as physical medicine and rehabilitation.

Putting Patients and Families First
Helping streamline this multidisciplinary approach is Kelly O’Connell, NP, who coordinates specialists and schedules appointments that enable families to see multiple providers on the same day. In the case of some conditions, like myelomeningoceles, UVA has established a regular clinic to ensure all necessary specialists are accessible to patients. “We know that some families must travel several hours to come to Charlottesville,” O’Connell says. “We do our best to arrange appointments so that the child doesn’t miss school and the parents don’t miss work.”

Because parents are instrumental members of a patient’s care team, O’Connell also reaches out to families to share information and answer their questions. And Syed actively involves parents in their child’s treatment plan. “I’m a big proponent of patient- and family-centered care,” Syed says. “We like to make sure that the family is comfortable with the evaluation process and treatment plan. We pursue a treatment option only when they are comfortable with it.”

Partnering with Referring Providers
Equally important, the pediatric neurosurgical team places a premium on developing partnerships with local pediatricians. “This goes beyond sending notes and records through our electronic medical record system,” Syed says. “I try to reach out personally to our referring physicians, especially for complex patients.”

At the same time, Syed urges referring physicians to contact him when they have even the slightest question about care. “My cellphone number is available on all our materials,” he says. “Our message is that we want to be available to everyone.”

Ensuring a Lifetime of Quality Care
Despite best efforts, symptoms of a childhood neurological condition, even those corrected by surgery, can recur later in life. For example, patients who have had a tethered spinal cord treated as children can sometimes experience back pain or bowel or bladder incontinence as adults that requires surgery to correct. Hydrocephalus patients who have had a shunt inserted as babies can require additional intervention if it fails or needs to be replaced.

This is why the UVA team has made a commitment to lifelong care, following patients through adulthood to ensure continuity. “Our connection with a patient can begin as early as a prenatal consultation and can extend for decades,” says O’Connell. “These long-standing relationships are beneficial for patients, but they are also satisfying for us.”

“Once a child is seen here, there is no graduation date,” adds Syed. “While we call ourselves pediatric neurosurgeons, we can follow up with former patients throughout their lives.”

 

To refer a patient to UVA Children’s Hospital, call UVA Physician Direct at 800.552.3723.