Other frequently encountered paediatric neurosurgical conditions

Arachnoid cysts

Fluid-filled sacs within the layers covering the brain or spinal cord. Most are found by chance and need no treatment; a small number cause symptoms through pressure or hydrocephalus and are treated endoscopically or with surgery.

Dr Labuschagne's publications on this topic

• Labuschagne J, Mutyaba D, Pillay T, Swart P. Suprasellar arachnoid cyst due to ectopic choroid plexus: case report. Childs Nerv Syst. 2022;38(7):1381-1384.
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Head injury

Most head injuries in children are minor. Neurosurgical care is needed for skull fractures, bleeding around or within the brain, or raised pressure. Any child who is drowsy, vomiting repeatedly or has a seizure after a head injury needs urgent assessment.

Encephalocele

A rare condition, present at birth, in which part of the brain and its coverings protrude through an opening in the skull, often at the back of the head or near the nose. Surgery is planned to repair the opening, sometimes with the craniofacial team, and hydrocephalus is treated if present.

Skull bone abnormalities

Rare conditions of the bones of the skull, including acalvaria (absence of the flat bones of the skull), are assessed individually with the wider team.

Dr Labuschagne's publications on this topic

• Mutyaba D, Ouma J, Pillay T, Neethling W, Mohale D, Labuschagne J. Acalvaria: case report and review of the literature. Wits Journal of Neuroscience. 2023;4:6-9.
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Moyamoya

A rare condition in which the main arteries at the base of the brain gradually narrow, which can cause strokes or brief stroke-like episodes. Treatment, planned with neurology, may include revascularisation surgery to improve blood flow to the brain.

Vascular malformations

Abnormal blood vessels in the brain or spine, such as arteriovenous malformations (AVMs) and cavernomas. Some are found by chance; others cause bleeding or seizures. Treatment options include observation, surgery, endovascular treatment and radiosurgery, often in combination with specialist colleagues.

Dermal sinus tract

A small channel from the skin of the back (or occasionally the head) that may extend to the spinal cord or brain, often seen as a dimple or opening above the crease of the buttocks. Because it can lead to infection and tethering, surgical removal is usually recommended.

Macrocephaly (a large head)

A head circumference above the normal range. Often it runs in the family and is harmless, but it may be caused by hydrocephalus or fluid collections. Assessment involves charting head growth, examination and sometimes an ultrasound or MRI scan.

Lipomyelomeningocele

A form of closed spina bifida in which a fatty lump under the skin of the lower back is connected to the spinal cord, which may be tethered. Management, including whether and when to operate, is individual and discussed with you in detail.

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