Pediatric Neurosurgery

The ABNS Oral Examination evaluates an applicant’s knowledge and judgment in clinical neurosurgical practice after an applicant has been an independent practitioner. With the new format, the oral exam is divided into 3 sessions, each consisting of 5 questions. Questions in the first session deal with general neurosurgery, questions in the second session focus on the preidentified area of practice chosen by the applicant (e.g., pediatric neurosurgery), and questions in the third session are based on cases submitted by the applicant. Common pediatric neurosurgical problems treated by neurosurgeons may be included on the American Board of Neurological Surgery Oral Examination in the general neurosurgery session. Therefore, one should be familiar with the neurosurgical management of pediatric cases, including disorders of cerebrospinal fluid dynamics, congenital cranial and spinal malformations, tumors, vascular congenital and acquired disorders, intracranial and spinal infections, and intractable epilepsy. In this chapter, clinical vignettes of common pediatric neurosurgical conditions will be presented including (a) myelomeningocele, (b) craniosynostosis, (c) hydrocephalus, (d) posterior fossa tumors, and (e) moyamoya disease, with the cases subdivided into those that may be seen in the general session (1 to 3) and those more likely to be seen in the subspecialty specific session (4 and 5). The applicant will be given the history, physical examination, pertinent imaging studies, and test results and will then be expected to provide a rational differential diagnosis and plan of management, outline the risks of surgery, and describe the operation, if proposed, and handle intraoperative and postoperative complications that occur.

Vascular lesions of the spinal cord

Vascular malformations of the spinal cord are uncommon and diverse conditions. Presentation is frequently with an indolent, radiculomyelopathy, the origins of which will be traced back many months or years. Fruitless investigation may be pursued for inflammatory or neoplastic processes. This is all the more regrettable as many such malformations are treatable. Haemorrhage from spinal malformations is still more rare and a considerable management challenge. In this chapter we will describe the pathophysiology of these conditions and summarize the current approach to management, while the adaptation of the Bicêtre system is covered towards the end. The pathophysiology of spinal ischaemia and primary spinal haemorrhage is also reviewed.

Limited Dorsal Myeloschisis with and without Type I Split Cord Malformation: Report of 3 Cases and Surgical Nuances

Limited dorsal myeloschisis (LDM) is a rare form of spina bifida which is characterized by a fibroneural stalk between the inner part of the skin and the spinal cord. It may be associated with split cord malformation (SCM). Diagnosis and management of this complex malformation is challenging. We presented 3 different cases of LDM. Two of them were associated with Type I SCM and the other had no associated malformation. All of them were evaluated radiologically just after the birth and underwent surgical treatment under intraoperative neuromonitoring. They discharged without any complication. Newborns with spinal cystic lesions should be carefully evaluated for spinal malformations after the birth and treated surgically as soon as possible in order to prevent neurological and urological complications secondary to tethered cord syndrome. Surgical technique in LDM-SCM patients is quite different than the patients with solitary LDM.

Pediatric Neurosurgery

Common pediatric neurosurgical problems treated by neurosurgeons will be included on the American Board of Neurological Surgeons (ABNS) Oral Board Examination. Therefore, the candidate should be familiar with the neurosurgical management of such problems, which include disorders of cerebrospinal fluid (CSF) dynamics, congenital cranial and spinal malformations, tumors, vascular congenital and acquired disorders, intracranial and spinal infections, and intractable epilepsy. Neurological disorders that mimic pediatric neurosurgical conditions may also be on the examination. In this chapter, clinical vignettes of common pediatric neurosurgical conditions are presented, including hydrocephalus, myelomeningocele, intraventricular hemorrhage (IVH) of prematurity, craniosynostosis, and posterior fossa tumors. The examinee will be given the history, physical examination, pertinent imaging studies, and test results and will then be expected to provide a rational differential diagnosis and plan of management, outline the risks of surgery and describe the operation if proposed, and handle intraoperative and postoperative complications that occur.