Fields of interest and diseases commonly dealt by Pediatric Neurosurgery are listed below:

* Congenital anomalies of the nervous system

* Hydrocephalus – buildup of water secondary to CSF circulation in brain

* Brain and spine tumors

* Spina bifida – closure defect of the spine and the spinal cord

* Childhood vascular diseases of brain and spinal cord – aneurysm, arteriovenous malformations and Moya Moya disease

* Deformities of scalp – craniosynostosis

* Epilepsy

* Pediatric movement disorders, dystonia and spasticity

* Neonatal congenital cerebral hemorrhages

* Head traumas and spinal traumas

* Deformity of spine

Pediatric Neurosurgery is a specialized branch that deals with childhood disorders of the brain, nervous system and spine that require a surgical intervention.
Pediatric Neurosurgery Division of Liv Hospital Ulus is re-organized in the Department of Neurosurgery based on a distinctive concept. Offering round-the-clock services to pediatric patients, the division works in close cooperation with other departments of our hospital. All details of the division, including experienced medical team, special pediatrics clinic, neonatal and pediatric intensive care units and operating theaters equipped with state-of-the-art devices, are designed to generate efficient solutions for both simple and complex diseases within a short time.
The whole team involves in the assessment of all neurosurgical problems of all children, ranging from fetus to 18 years old adolescent, in the division. The division works in cooperation with Pediatrics, Perinatology, Gynecology and Obstetrics, Pediatric Surgery, Pediatric Neurology, Pediatric Oncology, Pediatric Psychiatry, Pediatric Urology, Plastic and Reconstructive Surgery, Physical Medicine and Rehabilitation, Anesthesiology and Reanimation, Orthopedics and Traumatology, Neuroradiology and other relevant departments as required by its primary field. Patients are quickly assessed using up-to-date and scientifically evidenced methods in common platforms and solutions are generated.

Pediatric Neurosurgery is a division that requires special workup. The principle is making the diagnosis with minimum workup in children. Our principle is to report workup results within shortest time for children who refrain from the hospital environment. Our Hospital considered all details to facilitate examinations of pediatric patients. Such as a friendly environment, experienced nurses and personnel and sedation for necessary cases… Computed tomography (CT) and magnetic resonance imaging (MRI) devices not only ensure special imaging of the brain and spinal cord, but they are also used for advanced tumors and vascular examinations along with the routine daily imaging studies. A special pediatric team is assigned by Anesthesiology Department to make pediatric patients stay immobile for a particular time in these devices. Our Neuro-radiology group performs pediatric angiography and interventional neuroradiology (intravascular treatment of vascular diseases), which can be implemented in only a few hospitals. Blood drawing units are specially designed; any and all advanced blood and tissue tests can be analyzed. Moreover, there are many other examination means, such as ultrasound, low-dose digital radiography, electroencephalography (EEG), electroneuromyography (EMG) and neuro-psychometry.

Pediatric Neurosurgery Division of Liv Hospital Ulus adopted the principle of implementing top-tier, up-to-date and scientific surgical procedures in this field. In this context, equipment and tools required for each group of operations are carefully selected.

* Brain and spinal cord tumors: pediatric brain tumors are conditions that are difficult to cope with for both the child and the family. Not every pediatric tumor is a malignant formation (that may recur after treatment and requires postoperative radiotherapy/chemotherapy). It is recommended that pediatric brain tumors are assessed by medical teams experienced in this field. Findings of examinations are reviewed in detail by the team before the treatment modality is finally decided.

Treatment of brain tumors involves relieving intra-cranial pressure and eliminating the cerebral compression by removing the tumor. The tumor is surgically removed and pathological examination is ordered for the specimen. Recently, very advanced technological systems are used for brain surgeries and success rates are very high. The special surgical microscope mentioned in the section “technical infrastructure” magnifies the surgical site and tumors are stained with special dyes and removed using microsurgical methods. Navigation systems, ultrasound, CT/MRI and neuromonitoring (continuous monitoring of brain functions during surgery) are also frequently used during surgeries.

Relevant departments are cooperated for other treatments that patients need in the postoperative period.

* Hydrocephalus: Brain and spinal cord are protected in a special system of fluid that is continuously produced and absorbed. If this system dysfunctions, fluid may build up in the brain, resulting in a condition referred as hydrocephalus. If the child with this condition is younger than two, the head starts enlarging. Symptoms of increased intracranial pressure are manifested, similar to other children with intracranial tumors. Surgical management of hydrocephalus involves placement of a special shunt system in order to drain the buildup fluid into another body cavity, especially intra-abdominal cavity. There are also shunt systems that enables pressure adjustment with a remote control. Endoscopic procedures, also known as endoscopic third ventriculostomy (ETV), are also carried out for some patients.

* Congenital anomalies: There are many congenital anomalies of the nervous system. Unfortunately, a part of those pregnancies results in miscarriage. In our day, pregnancies associated with anomalies can be identified with special diagnostic methods even at very early stages. For pregnancies that could not be diagnosed early and should be continued, it is possible to create optimal conditions for the birth by planning prenatal workup in cooperation with Gynecology and Obstetrics clinic or to surgically manage the condition immediately. For this issue, our team renders services round the clock. A part of those anomalies can be surgically corrected; Chiari malformation, Dandy-Walker malformation etc.

* Spina bifida: Brain and spinal cord develops in configuration of a long groove followed by a tube during intra-uterine life. If problems develop at this phase, babies are born with a lumbar sac covered or not covered by skin. This special anomaly, known as spina bifida, has many types and it usually requires urgent surgery. Such babies also suffer from severe bone and urological problems. Urgent microsurgery is required for open spina bifida (aperta), while others are surgically treated in late periods.

* Craniosynostosis:  Skull bones are not completely fused in babies and they become totally fused around the age of two. If those connection points fuse early, special deformities develop in the skull. Such babies under the age of 6 months are operated at our hospital with minimally invasive technique and thus, recovery period and hospital stay are shortened, blood loss is minimized and small incision scars are formed. Patients presenting at late stages and patients with bone deformities involving the face are prepared for reconstruction surgery in cooperation with Plastic Surgery Clinic.

* Pediatric vascular diseases of brain and spinal cord: These rarer diseases are assessed together with the Neuro-radiology unit and all diagnostic tests are performed; surgical management or neuro-radiological interventions are performed for necessary cases. Our Neurosurgery Department has substantial experience in neurovascular diseases.

* Epilepsy and movement disorders: Epileptic seizures can mostly be regulated with medications. However, some babies and children may have seizures that recur many times at the day time and resist the medicines. Such patients are assessed jointly by pediatric neurosurgery team and pediatric neurology unit and specific brain surgeries are planned. For some patients, “vagal nerve stimulators” – a device similar to cardiac pacemaker- is inserted to alleviate seizure attacks. Some patients manifest involuntary and unpreventable arm, leg and body movements. For these diseases, including some with genetic etiology, “deep brain stimulation – DBS” device is placed to special targeted zones of the brain with a surgical procedure, similar to Parkinson’s diseases, and stimuli are delivered to control involuntary movements.

* Neonatal congenital cerebral hemorrhages: Bleeding in a tissue that is responsible for the development of the brain leads to a life-threatening condition especially in premature babies. Such babies require urgent surgery followed by a long-term treatment at neonatal intensive care unit. Pregnancies associated with this risk are supervised jointly by Gynecology and Obstetrics, Perinatology and Pediatric Neurosurgery clinics and the system is kept ready for intervention.

* Head traumas and spinal traumas: Unfortunately, accidents are inevitable events of childhood. For pediatric patients suffering from head, spine and spinal cord traumas, services are available round the clock and all related departments, especially emergency medicine department, work in coordination for any and all urgent interventions.

* Spasticity and deformities of spine: Spastic tone increases and spasms that develop in arms and legs in some diseases, especially stroke, make daily life and the care of patients very challenging. A special spinal surgery (rhisotomy), carried out for those patients, is performed in our department. Computer controlled special drug pump systems (Baclofen pump) are placed around the spinal cord in older children. Patients with severe spinal deformity (scoliosis and kyphosis) are assessed and operated on in cooperation with pediatric spinal orthopedics team. Pediatric Physical Medicine and Rehabilitation Unit is the most important division that we cooperate for those diseases.

Pediatric Neurosurgery Division of Liv Hospital Ulus renders inpatient services for pediatric patients in pediatrics and perinatology inpatient clinics. All necessary infrastructure and modern technologies are available for children in these departments. Fluorescein-guided surgery is available in the Neurosurgery Clinic of Liv Hospital and this technique enables visualizing the tumor in various colors under special microscope filters, as a special fluorescent drug is administered at the initial phase of the surgery. By this way, the tumor is removed, while healthy tissues are left intact, and very good outcomes are obtained in brain tumors of pediatric patients, as the case for adult patients.
Navigation System (Medtronic Stealth Station) that increases the accuracy substantially in brain surgeries and special neuro-ultrasound systems (Hitachi Aloka Alpha) are used in almost all surgeries. Intraoperative computed tomography (CT) and/or magnetic resonance imaging (MRI) is scanned for all necessary cases. Functions of the brain and spinal cord can be continuously monitored using neuromonitoring methods during the surgery. The cutting edge endoscope systems, ultrasonic aspirator – a device that facilitates tumor surgery- and any and all surgical / microsurgical sets are available. Equipment and infrastructure of the operating theater are beyond standards.
State-of-the-art devices and materials are used by our experienced team to administer anesthesia that ensures the safety and efficiency of surgeries. Infrastructure and equipment of intensive care are specially designed for pediatric patients and services are rendered by an experienced team.