It's not brain surgery!
No, it's even harder. It's pediatric brain surgery
By LOUIS BERGERON
“So, how are the munchkins today?” It’s a common way
of phrasing an inquiry into the well-being of little children. But their
munchkin-like stature aside, children are hardly miniature adults, especially
when it comes to medicine. So different are their needs, treatments and
reactions, pediatric care can seem almost Oz-like compared with the relatively
straightforward Kansas of adult medicine.
“We’re dealing with a totally different physiology than
with adults,” says professor Michael Edwards, MD, director of regional
pediatric neurosurgery at Lucile Packard Children’s Hospital. And
that physiology is constantly changing as a child goes from barely more
than an embryo to a newborn baby to a young child to a teenager in puberty.
As a pediatric neurosurgeon, Edwards says he sees a totally different
spectrum of tumors than in adults. “We deal with tumors in the
back part of the brain and the spinal cord and for the most part the
adult neurosurgeon deals with a tumor in the upper part of the brain.”
“No one knows why,” he says. “That’s just the
reality of it.”
Before operating on a tumor, Edwards sits down with the family and other
pediatric specialists to discuss options and ramifications. Here again,
there are special considerations. “We’ll get asked, ‘If
you do this, what’s he going to be like as an adult’? Sometimes
that’s a tough question to answer,” he says.
Every aspect of treating pediatric brain tumors is different from treating
adults, says Edwards. “For instance, giving radiation to a young
child, say a 2 year old, may have very severe prolonged damaging effects
that an adult would tolerate with minimal side effects.”
Brain injuries or tumors sometimes result in weakness on one side of
a child’s body, affecting the child’s future growth. But
treatment can affect growth as well — something Edwards says it’s
critical to consider.
Children are also more sensitive to medications. “Certain drugs
used in adults are contraindicated in children. We don’t ever use
them,” he says, noting that dosages have to be calculated differently,
too. Typically, adults get the same dose, regardless of age or weight.
But dosages for children depend on how much they weigh, he says.
Even the instruments used in surgery have to be different for a child’s
brain. “Everything is miniaturized as we go to smaller and smaller
children,” says Edwards. “If you had a tool set, you’d
have different size wrenches to deal with different size nuts and bolts.
It’s the same issue.”
Because children are relatively small and delicate, not to mention still
growing, pediatric brain surgery will always hold special challenges.
“It’s a different mind-set,” Edwards says.
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