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Neurosurgery (HP)

neurosurgery-header

Neurosurgery Department
Temple Street Children’s University Hospital
Temple Street
Dublin 1
Tel: (01) 878 4254
Email: ei.hu1511436683c@yre1511436683gruso1511436683ruen1511436683

The Department of Paediatric Neurosurgery is a dedicated national service. It accepts referrals from all parts of the Republic of Ireland.

Personnel

  • Four consultant paediatric neurosurgeons, each of whom has a specific sub-specialist interest)
  • Three registrars (who rotate, one at a time, between Temple Street and Beaumont Hospitals)
  • Two clinical nurse practitioners, one of whom is dedicated to co-ordination of spina bifida treatment.
  • Senior clinical neuro-psychologist
  • Consultant paediatrician who is attached to the spina bifida service

Our Mission Statement

We recognise that children who require neurosurgical attention merit special care in an environment of their own. Where necessary, we aim to work closely with other healthcare professionals to ensure that they are treated with dignity and compassion.

Our Department

We treat all central, peripheral nervous system and spinal column diseases which are amenable to surgical intervention. We are responsible for the provision of paediatric neurosurgical services at:

  • Temple Street, Children’s University Hospital
  • Beaumont Hospital
  • Our Lady’s Hospital for Sick Children in Crumlin

We also deal with neonatal and paediatric neurosurgical issues such as hydrocephalus, spina bifida, trauma, vascular abnormalities and other associated problems.

“One of Northern Europe’s most active neonatal neurosurgery services”

Our paediatric neurosurgery service carries out the second highest number of operations of any centre in the UK and Ireland. A large proportion of procedures are also performed on neonates because of our high incidence of congenital central nervous system anomalies such as spina bifida and hydrocephalus. This makes Temple Street one of Northern Europe’s most active neonatal neurosurgery services. In many instances; we can also offer antenatal diagnosis and counselling in a maternity hospital setting. There are regular neurosurgery foetal medicine clinics in Holles Street and the Coombe Hospital.

Spinal dysraphism

Spina bifida is one of the most frequent neurosurgical conditions we encounter. We have the highest incidence of this condition in Europe. These children require surgery for the spinal defect in the neonatal period and often require surgery for hydrocephalus. Some children with ‘closed spina bifida’ also require surgery. This is also carried out by our department.


Hydrocephalus

Operations for this condition make up over 50% of our activity and include:

  • Ventriculoperitoneal shunts
  • Endoscopic procedures (ETV)
  • Skull expansion procedures

Emergency care of children with acute hydrocephalus or a malfunctioning shunt has been made clearer through well-defined referral and care pathways.

Craniofacial surgery

We support the work of the cranio-facial service along with the department of plastic surgery. This will specifically deal with skull deformities, most commonly caused by craniosynostosis (premature closure of skull sutures). An initial assessment is made in a combined bi-monthly outpatient clinic, run by a neurosurgeon and plastic surgeon with the subsequent admission being handled jointly with support from ophthalmology and clinical genetics. The results are audited and presented at the annual UK craniofacial meeting.

Brain trauma

At present, the team also manages all children with moderate to severe head injuries. Specialised guidelines for their stabilisation and transfer have been drawn up by the neurosurgical and anaesthetic services at Temple Street and Beaumont and distributed to the paediatric units around the country. There are now established protocols for the intensive care treatment of children with severe head injury in Temple Street.

“We are the busiest unit neuro-oncology unit outside London. Surgery is carried out in all cases with state of the art equipment and intra-operative navigation”

Brain and spinal tumours

Treatment of brain tumours is carried out by a multidisciplinary team spanning Temple Street, Crumlin and Beaumont with a specialist neuro-oncology nurse assigned to coordinate the individual care of each child. Over 50 new tumour cases are referred each year with over 70 operative procedures. This makes Dublin the busiest neuro-oncology unit outside London. Surgery is carried out in all cases with state of the art equipment and intra-operative navigation.

Treatment of spasticity in cerebral palsy

This service is new to Ireland. Spasticity (increased stiffness of the muscles) can cause increased disability, pain and difficulty with day-to-day care in children with cerebral palsy. It is largely treated with physiotherapy, orthotics and medicines to relax the muscles. Occasionally it is more severe and unresponsive and requires surgery including muscle releases, Intrathecal Baclofen and selective dorsal rhizotomy. This service is run in conjunction with the Central Remedial Clinic, Clontarf.

Equipment

“Our neuro-endoscope has revolutionised the treatment of hydrocephalus, meaning that many children now have their condition treated without the hindrance of lifelong shunt dependency”

Since 2008, the neurosurgical service has benefited hugely from specialist equipment including:

  • An image-guided neuro-navigation (for brain tumour resection and occasionally shunt placement)
  • A neuro-endoscope (for minimal access surgery to the brain)
  • Intra-operative ultrasound
  • An operating microscope

This equipment is top specification and is as good as or better than that available to any of our UK counterparts. For instance, our neuro-endoscope has revolutionised the treatment of hydrocephalus, meaning that many children now have their condition treated without the hindrance of lifelong shunt dependency.

There is no longer a need to refer patients abroad for neurosurgical treatment and patients can now receive all of their neurosurgical treatment in Ireland.

Ongoing Research

“We participate in ongoing clinical research regarding neurosurgical conditions”

All operative activity in the UK and Ireland is submitted to the British Paediatric Neurosurgery Audit database for comparison of activity and identifying norms and standards. This audit is collated and reported from Dublin for the UK and Ireland.

Our department participates in ongoing clinical research regarding neurosurgical conditions, mainly in oncology and neural tube defects. Papers have been accepted from Dublin for international meetings in Britain and Europe and the department has produced 16 publications in the last 3 years alone. In 2011, the Temple Street team hosted the annual meeting of the British Paediatric neurosurgery group as well as the annual European Society for Paediatric Neurosurgery training course at the University of Limerick.

A good clinical network has been established with our paediatric colleagues around the country. To date, all paediatric units have been contacted and offered a visit with a lecture and discussion about the delivery of Irish paediatric neurosurgery and management of common neurosurgical emergencies.

The Paediatric Clinical Neuropsychology Service

The paediatric clinical neuropsychology service is available to both inpatients and outpatients attending neurosurgery with cognitive, behavioural or educational changes in the context of actual or suspected neurological illness or injury. The service provides specialist assessment in order to assist families and the wider community in understanding the neuropsychological consequences of neurological syndromes or injury and the functional impact on the child. It aims to provide the best care possible for the child by informing families and those involved in the child’s life about the cognitive, behavioural and educational implications of the individual child’s neurological condition and/or injury and to provide educational and behaviour management strategies where necessary.

Areas of assessment include:

  • General intellectual functioning
  • Academic skills
  • Learning and memory
  • Concept formation and problem solving
  • Planning and organisation
  • Attention
  • Auditory and visual processing
  • Language
  • Behavioural and emotional functioning.

Referral to the service is by Consultant only.

Spina Bifida Programme

The Spina Bifida programme is a comprehensive, coordinated inpatient and outpatient service for children of all ages with neural tube defects. It provides team evaluation and periodic re-evaluation utilizing the disciplines of neurosurgery, orthopaedic surgery, urology, rehabilitation medicine, occupational therapy, physical therapy and social services.

Our aim is to provide the best care possible to each and every patient. The team goal is to help each patient lead a normal life. We want our patients and their carers to be active members of this team.

Team members

  • Paediatric Neurosurgeon  The neurosurgeon performs the surgery to close your child’s myelomeningocele and treats your child if he or she has hydrocephalus.
  • Paediatric rehabilitation consultant  The Rehabilitation consultant co-ordinates management of the disability of spina bifida as a whole, liaising with community team and education as appropriate.
  • Paediatric plastic surgeon  The plastic surgeon is involved (where required) in the procedure to close your child’s back wound. This is necessary in order to achieve the best aesthetic and protective result.
  • Paediatric Physiotherapist  The physiotherapist aims to restore your child’s mobility and encourage the development of motor skills. Where possible sessions are conducted through play activities. Often the physiotherapist will advise about stretching and movement programmes to be done on the ward or at home. They work closely with the wider neurosurgery team and community therapists.
  • Paediatric Occupational Therapist   The occupational therapist makes recommendations in relation to splinting (hands and feet), seating/mobility equipment, pressure relief, and independence skills in activities of daily living (school, play etc.). They work closely with local occupational therapy and equipment services.
  • Dietitian  The dietitian will oversee dietary issues and promote good eating habits as well as a healthy lifestyle.
  • Nurse specialist  The nurse coordinates your child’s care among all members of the team. The nurse will teach you about the special needs of children with Spina Bifida. The nurse will also help your child establish a bladder and bowel programme.
  • Orthopaedic surgeon  The orthopaedic surgeon specialises in bones and joints. The surgeon will evaluate your child’s legs and back and make recommendations about the need for surgery on the muscles and bones. He/she works closely with specialised nurses and the physiotherapist in selecting the best braces for your child.
  • Paediatric general surgeon  This consultant specialises in the kidney, bladder and bowel problems of children born with Spina Bifida. The goal is to prevent kidney damage and urinary infection and to promote satisfactory bladder and bowel control.

For more information:

If you have any questions about the Spina Bifida programme at The Children’s University Hospital please contact our nurse coordinator on: 00353 (1) 892 1768

Outside agencies:

Association for Spina Bifida Hydrocephalus, UK (www.asbah.org)

Beaumont Hospital (www.beaumont.ie)

Central Remedial Clinic (www.crc.ie)

Irish Cancer Society (www.cancer.ie)

National Rehabilitation Hospital (www.nrh.ie)

Our Lady’s Children’s Hospital, Crumlin (www.olhsc.ie)

Spina Bifida Hydrocephalus Ireland (www.sbhi.ie)

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