It's not brain surgery!

No, it's even harder. It's pediatric brain surgery


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“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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