Medical Consultant Professor: Dr. Monges, Jorge
Chief of Department: Dr. Jaimovich, Roberto

The Pediatric Neurosurgery Department at FLENI has a specialized inpatient area with cutting edge equipment for the neurosurgical treatment of infants, children and adolescents. 
1. Congenital Pathology
-Antenatal assessment
-Neurosurgery of congenital  brain and spinal cord malformations with intraoperative neurophysiological monitoring
-Spina bifida interdisciplinary consulting  team (including Neurology, Neurosurgery, Neuroorthopedics, Urology, Rehabilitation and Educational Therapy)
-Surgery of complex craniofacial malformations (including Neurosurgery and Plastic Surgery staff)
2. Tumors
-Diagnosis and treatment of brain and spinal cord tumors using microsurgical techniques, neuronavigator and ultrasound aspirator
-Diagnosis and treatment of skull base tumors
3. Vascular Malformations
-Diagnosis and treatment of vascular malformations of the brain and spine using microsurgical techniques and, if necessary, intraoperative  angiographic control
-Diagnosis and treatment of brain ischemic processes. Brain revascularization.
4. Hydrocephalus
-Antenatal assessment
-Diagnosis and surgical treatment of congenital and acquired hydrocephalus in specifically adapted areas to control infection
5. Head and Spine Trauma
-Evaluation and treatment of mild head trauma
-Evaluation and treatment of severe head trauma with intracranial pressure and brain perfusion monitoring at the Child Intensive Care Unit
-Evaluation and treatment of spine trauma (Neurosurgery and Neuroorthopedics)
6. Epilepsy
-Evaluation and surgical treatment of refractory epilepsy. Monitoring with deep driven electrodes. Intraoperative neurophysiology
7. Spasticity and Gait Disorders
-Diagnosis assessment and surgical treatment of spasticity and abnormal movements
8. Endoscopic Neurosurgery

Hydrocephalus
 Hydrocephalus is the excess of fluid which accumulates in the brain. This fluid, called cerebrospinal fluid (CSF) is produced in the chambers inside the brain, flows through channels in the brain to get outside the brain and is reabsorbed into the blood stream. Every day our body produces a certain quantity of CSF which is absorbed. Any unbalanced circulation of CSF, like excess of production, blockage, reabsorbtion disorder, causes the fluid to accumulate abnormally and produce hydrocephalus. If left untreated, this disease produces harmful pressure on the brain, damaging it and, eventually, it may be lethal.
1. Types of Hydrocephalus
2. Symptoms
3. Diagnosis
4. Samples of standard and pathological results of hydrocephalus studies
5. Treatment
6. Follow up
7. When to consult the specialist/neurosurgeon

1.There are two types of hydrocephalus:
- Communicating Hydrocephalus is caused by an overproduction of CSF in the brain and reabsorbtion difficulties. The most frequent causes are post-hemorrhage and post- meningitis hydrocephalus and normotensive hydrocephalus in adults.
- Obstructive Hydrocephalus is caused by a blockage of the CSF flow within the ventricles or at the Sylvian aqueduct, a narrow canal that enables CSF to flow from one cavity to the other. The most frequent causes of this type of hydrocephalus are congenital hydrocephalus and hydrocephalus resulting from secondary tumors.

2. Symptoms of uncontrolled hydrocephalus
Increasing intracranial pressure causes symptoms such as headaches, vomiting, and sleepiness, cognitive impairment, blurred or double vision, and motor disabilities. In infants, where the growth plates in the skull are not yet welded, there is a progressive and abnormal increase in head size which may result in death.

3. Diagnosis methods may vary but often includes:
- Ultrasound based on ultrasound waves to assess structures in the skull
- CAT scan (computerized tomography) using X-Rays
- MRI (magnetic resonance) using radio signals and a magnet
- CSF studies to measure and see how CSF flows within the brain
- Neuropsychological tests to evaluate cognitive impairment

4. Samples of standard and pathological results of hydrocephalus studies

5. Treatment
Fortunately there is treatment for hydrocephalus.
In the past, neurosurgeons focused on creating balanced communication systems of CSF in the brain or diminishing the overproduction of CSF, but the procedure entailed major surgery and not very satisfactory outcomes.
A major innovation was CSF diversion; that is, the placement of a shunt. A tube is placed to drain the ventricles using a single direction valve that, when pressure is excessive,  allows the liquid to flow under the skin to the abdomen or the venous system.
This is how hydrocephalus has been treated in the last  45 years, approximately.
But a valve is only a method to control hydrocephalus, but not to cure it. Valves require regular surgical control due to blockage, child growth, infection, among other causes. 
Significant technological evolution in recent years led to cutting edge endoscopic neuronavigation techniques where a flexible tube with an optical system enters in the ventricles of the brain and surgery is performed by inserting and manipulating equipment through the tube.
This procedure, called endoscopic ventriculostomy, is performed in carefully selected patients, with non communicating hydrocephalus, to drain CSF from inside the ventricles to outside the brain without using a permanent “hardware” implant.

6. Follow up
Patients with implant valve can lead a normal life provided they do not perform highly demanding physical activities. Life long periodical evaluations are needed  to check, repair or change the valve.
Ventriculostomy hardly ever blocks, yet in some cases a new surgery or implant of a shunt is necessary. It is important that hydrocephalus is appropriately controlled.
The family and the patient himself must be aware of the changes (signs and symptoms) which indicate valve trouble.

7. The following list is just an example but you must not hesitate, call the neurosurgeon if you notice:
1. Abnormal head growth in small children
2. Growth plates in the skull are full with the baby in vertical position and still
3. Fever and vomiting (of unknown origin)
4. Headaches
5. Sleepiness
6. Decreasing performance/ loss of acquired abilities
7. Seizures
8. Swelling in the valve tract
Please, in case of doubt, or for more information, call your physician.

ENDOSCOPIC NEUROSURGERY
Chief: Dr. Roberto Jaimovich

Endoscopic neurosurgery is a technique with minimum invasion allowing for:
- Treatment without prosthesis of a specific group of congenital hydrocephalus
- Communication of cavities in post infectious and post hemorrhage hydrocephalus
- Treatment of arachnoid  and intra ventricular cysts
- Drainage of abscess, hematomas and brain cysts
- Biopsy of intra ventricular brain tumors
- Resection of colloid cysts of the third ventricle
- Video-assistance in microneurosurgery (mixed techniques in Microsurgery and Neuroendoscopy) in the treatment of brain tumors and vascular diseases. 

Medical Staff
Dr. Jaimovich (Chief) Roberto
Dr. Monges Jorge A. (Professor and Consultant) 
Dr. Routaboul Carlos (A)