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Pediatric Neurosurgery Gets Active Boy Back to Good Health

Brain surgery in children is most successful when performed by an experienced specialist

Better Medicine Summer 2022 David Hong, MD

Brain tumors in children often have features, such as type and location, which distinguish them from the brain tumors typically seen in adults. Treatment considerations and technical aspects of brain surgery differ significantly in the pediatric population as well.

Consequently, it is important to enlist the expertise of pediatric specialists for the treatment of childhood brain tumors.

“The goal is to ensure that young patients are treated safely while minimizing any long-term impact of treatment,” says David Hong, MD, a fellowship trained pediatric neurosurgeon with Lehigh Valley Reilly Children's Hospital and Lehigh Valley Fleming Neuroscience Institute.

Brain tumor with hydrocephalus

Hong met one recent patient, 8-year-old Ethan Horst, after the boy’s worried mother brought him to the  Breidegam Family Children’s ER at Lehigh Valley Hospital–Cedar Crest. Over the previous six weeks, Ethan had experienced nausea and vomiting. More recently, he had developed headaches, blurred vision and an imbalance in his gait.

A brain MRI scan revealed a 4-centimeter tumor in the posterior fossa of the brain. This is the most common site for brain tumors in children. The tumor had blocked the flow of cerebrospinal fluid (CSF), leading to obstructive hydrocephalus.

“The posterior fossa is a small, confined space,” Hong says. “When a sizable tumor forms there, it can start to compress the brain stem. It can also cause fluid buildup in the head, leading to symptoms of elevated intracranial leading to symptoms of elevated intracranial pressure.”

State-of-the-art surgical treatment

The first step in treatment was the placement of an procedure quickly diverts CSF to reduce pressure inside the skull.

Once Ethan’s condition had stabilized, surgery was scheduled. “Prior to the procedure, a specialized MRI scan was done to obtain the exact localization of the tumor,” Hong says. “That allowed us to plan the smallest possible incision and perform very precise surgery.”

During the surgery, intraoperative neuromonitoring provided real-time feedback to the surgical team, which helped minimize the risk for long-term injury. A pilocytic astrocytoma was resected. This type of central nervous system tumor is more common in children than adults.

“Today, Ethan is playing, swimming and engaging in his other usual activities,” Hong says. “He is back to being an active boy with the same spunky personality as before.”

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