Table Of ContentCommon
Neurosurgical
Conditions in the
Pediatric Practice
Recognition and
Management
Jeff rey P. Greenfi eld
Caroline B. Long
Editors
123
Common Neurosurgical Conditions
in the Pediatric Practice
Jeffrey P. Greenfi eld • Caroline B. Long
Editors
Common Neurosurgical
Conditions in the
Pediatric Practice
Recognition and Management
Editors
Jeffrey P. Greenfi eld, MD, PhD Caroline B. Long, MD
Associate Professor of Neurological Manhattan Pediatrics
Surgery New York , NY , USA
Weill Cornell Medical College
New York , NY , USA
ISBN 978-1-4939-3805-6 ISBN 978-1-4939-3807-0 (eBook)
DOI 10.1007/978-1-4939-3807-0
Library of Congress Control Number: 2016945972
© Springer Science+Business Media New York 2017
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Pref ace
Within medicine, increasing subspecialization has created an almost impos-
sible task; primary care providers are now asked to triage their patients and
provide appropriate referrals within a dizzying array of diverse medical fi elds.
Pediatric neurosurgery remains one of a number of highly specialized fi elds
within which most pediatric practitioners including physicians, physician’s
assistants, and nurse practitioners have never received any training. This fact,
combined with the rarity of pediatric neurosurgical diseases, the acuity with
which many of them present, the need for rapid triage and tertiary care, and
parental anxiety when receiving a neurologic diagnosis, creates a challenging
situation for providers caring for children with these conditions.
S everal years ago, we hosted a CME event in New York City bearing the
same name as this textbook. We solicited comments from attendees and were
pleased that most participants felt we were fi lling a real defi ciency in medical
education—the cross-fertilization between subspecialties. In fact, a recent
survey of pediatricians through an AAP initiative supports our suspicion that
many primary care providers felt uncomfortable managing patients with neu-
rosurgical conditions. This survey also suggested a number of neurosurgical
topics that pediatricians felt they wanted more assistance in managing and
triaging. All of these topics, and many others, are covered from both a neuro-
surgical and pediatric perspective in this textbook.
In fact, this textbook was designed around a central concept:
Pediatricians and subspecialists need to have a closer working relationship to make
childhood medicine work seamlessly in 2016 and beyond.
A pediatrician in a busy practice should not be expected to explain to a
concerned parent what the differences in treatment options may be between
different types of brain tumors; however all pediatric practitioners should be
able to discern between benign and worrisome headaches and to decide when
imaging, referral to neurology, or triage to an emergency department is war-
ranted. The relationship between primary care physicians and subspecialists
such as pediatric neurosurgeons is obviously at the crux of this book, but
should also be at the forefront of mutual efforts to improve care of children.
This textbook will never be able to replace the trust and confi dence that is
built through years of communication and shared patient experiences.
To highlight our belief in the strength of the relationship between primary
care providers and subspecialists, this book was envisioned by and co-edited
by a pediatric neurosurgeon and a pediatrician each providing the perspective
v
vi Preface
from within the lens through which they view these common neurosurgical
conditions. We hope the vignettes provide real-life fl avor to experiences
many of you have had, or will have. We expect that the “red fl ags,” “pediatri-
cian’s perspective,” and references will serve as focused reviews on many of
these topics. When reading a newly arrived imaging report, or caring for a
child with an unfamiliar diagnosis, these chapters can serve as a medical
refresher before calling a parent back with unexpected news or reviewing a
fi nding in the offi ce.
The book is organized into parts that loosely approximate the neurologic
development of a child and address issues that are commonly encountered.
The fi rst part reviews neurologic development and birth-related trauma com-
monly seen in the neonatal intensive care unit including issues such as brain
injury, brachial plexus injury, and hematomas. The second part addresses
fi ndings commonly encountered in the fi rst month of life in the pediatri-
cian’s offi ce. Lumps and bumps, manifestations of neurocutaneous diseases,
or tethered cord stigmata are all reviewed in depth. The third part is a com-
prehensive review of hydrocephalus from birth-related intraventricular hem-
orrhage through the work-up of macrocephaly and headache management.
Part 4 is an important group of chapters describing up to the date thoughts
on imaging the central nervous system in children from prenatal ultrasound
through MRI and CT including when these different modalities are impor-
tant to select and the risks associated with each. The fi fth grouping of chap-
ters consists of explorations of common neurosurgical conditions that many
pediatricians are uncomfortable dealing with, including brain tumors, spas-
ticity, and vascular lesions to use as a reference tool when caring for a com-
plex neurosurgical patient. Finally a series of chapters related to head trauma
concludes the textbook, including sections on non-accidental trauma and
concussion management.
Most importantly, we hope the topics we cover in the ensuing chapters
provide you with some measure of confi dence in dealing with conditions you
may feel less comfortable with than others, and provide a framework within
which you can direct subspecialized care.
W e would very much like to take this opportunity to thank our mentors
within medicine—Dan Cohen, Gary Edelstein, Sarah Long, Phil Stieg, and
Mark Souweidane—for supporting and inspiring our careers and providing
continual support and guidance through the years. Educating subsequent gen-
erations of pediatricians and neurosurgeons with the lessons you taught us is
your greatest legacy and we are proud to be within your lineages.
T o our parents and families who instilled within us the belief that educa-
tion and academics can be at the center of a rich and meaningful life, thank
you for supporting our endless training and sharing pride in our demanding
but fulfi lling careers. Everything we have learned began with your confi dence
in us and now allows us to begin to pass this on to the next generation of
pediatric physicians.
F inally, we are forever indebted to Richard Lansing and Joni Fraser from
Springer for seemingly unending patience as we tried to balance our busy
medical careers and four young boys at home with an innocent foray into the
editing and publishing world. We hope your confi dence in us is rewarded in
Preface vii
the impact this book will have and the children benefi ting from the shared
knowledge going forward.
To our readers, best of luck caring for your patients with these neurologic
conditions—there is often no greater challenge in medicine but also often no
greater reward!
New York, NY, USA Jeffrey P. Greenfi eld
Caroline B. Long
Contents
Part I Development of the Brain and Spine
1 Normal Development of the Skull and Brain ............................ 3
Waleed A. Azab
2 The Neurologic Exam in Neonates and Toddlers ...................... 11
Alison S. May and Sotirios T. Keros
Part II Newborn Through Infancy
3 Birth Trauma to the Scalp and Skull ......................................... 27
Babacar Cisse , Ibrahim Hussain , Jeffrey P. Greenfi eld,
and Caroline B. Long
4 Brachial Plexus Injuries During Birth ....................................... 35
Peter F. Morgenstern
5 Neonatal Brain Injury ................................................................. 47
Anil Sindhurakar and Jason B. Carmel
6 Evaluation of Head Shape in the Pediatric Practice:
Plagiocephaly vs. Craniosynostosis ............................................ 61
Charlotte A. Beam , G. Rene Alvarez Berastegui ,
and Jeffrey P. Greenfi eld
7 Neurocutaneous Disorders .......................................................... 71
Kaleb H. Yohay and Matthew McCarthy
8 Cutaneous Markers of Spinal Dysraphism ................................ 93
Assem M. Abdel-Latif
9 Tethered Cord ............................................................................... 101
María Teresa Alvarado Torres
10 Lumps and Bumps: Scalp and Skull Lesions ............................ 107
Nelson Moussazadeh and Matei A. Banu
ix
