Paediatric Neurosurgery
The University Hospitals Bristol NHS Foundation Trust
paediatric Neurosurgery Department is located at Bristol
Royal Hospital for Children (BRHC). The paediatric
Neurosurgery Department serves the entire southwest peninsula
including the counties of Devon and Cornwall.
The Department of Paediatric Neurosurgery at BRCH was formed
following the successful transfer of the service from Frenchay
Hospital in 2014 as part of the wider restructuring of Healthcare
in Bristol. The new unit has state of the art facilities
including an intra-operative MRI theatre suite, robotic
neurosurgery, Gamma Knife surgery, HD-Neuroendoscopy &
Neurovasc. The 4 neurosurgeons have all undertaken one-year
specialist paediatric fellowship training at International Centres
of Excellence in the UK, Canada and the USA.
The Paediatric Neurosurgical Service at BRCH provides a full
range of neurosurgical services including:
Paediatric Epilepsy Surgery
Led by Mr Michael Carter, we have 2 paediatric video EEG
monitoring suites, we have pioneered the development of robotic
stereo-EEG monitoring and have surgical expertise in the treatment
of lesional and non-lesional epilepsy in children of all ages.
Surgery for Cerebral Palsy & movement
disorders
We have developed a comprehensive service for the
surgical management of spasticity in children with CP, including
Selective Dorsal Rhizotomy (SDR), intrathecal baclofen pump
implantation (for the management of severe cerebral palsy) and
robotic deep brain stimulation (DBS) for children with dystonia. We
work closely with paediatric orthopaedic surgeons, paediatric
neurologists, and neurorehabilitation paediatricians in a
multi-disciplinary setting to ensure decision making is tailored to
the individual needs of the child. We have access to state of the
art computerised gait lab analysis to help inform our decision
making. Our service is supported by our highly experienced
physiotherapy team who specialise in children with cerebral
palsy.
Tumour Surgery
Bristol has expertise in the treatment of all brain and spinal
cord tumours in children. We have developed advanced
intra-operative monitoring techniques to minimise the risk to
neurological function during surgery and now have access to a state
of the art intra-operative MRI facility to allow real time
evaluation of the completeness of tumour removal to increase the
likelihood of complete resection of tumours. We have a National and
International referral base for brain tumours. We are developing a
novel means of treatment for a severe, fatal type of brain tumour
known as diffuse pontine glioma (DIPG) using robotically placed
microcatheters to deliver chemotherapy into the tumour directly.
Tumour cases are referred to a weekly multi-disciplinary team (MDT)
meeting that includes paediatric neuro-oncologists, neurologists,
and paediatric endocrinologists. We have an on- site "Gamma Knife"
facility for the treatment of [paediatric brain tumours suitable
for this therapy.
Craniofacial Surgery
We offer surgery (undertake jointly with plastic
surgery and maxillofacial surgery services) for all non-syndromic
craniofacial conditions in children, with access to full
multidisciplinary support services including, genetics,
neuropsychology, neuro-ophthalmology and counselling services.
Paediatric Vascular Surgery
We deliver a full range of paediatric vascular services
including complex, giant aneurysm surgery requiring intracranial
arterial reconstruction/bypass (with procedures undertaken jointly
with Mr Rick Nelson an adult vascular neurosurgeon with
internationally recognised expertise in the treatment of complex
vascular disorders). We have one of the largest angiography suites
in a paediatric hospital in Europe and can offer a wide range of
interventional neuroradiological procedures for complex vascular
disorders. Vascular cases are discussed in a Paediatric
Neurovascular MDT at BRCH.
Hydrocephalus
All of the paediatric neurosurgeons have expertise in the
management of complex hydrocephalus and idiopathic intracranial
hypertension (IIH) in children. We have intra-operative
neuronavigation facilities for CSF shunt placement, and expertise
in advanced neuroendoscopic techniques including third
ventriculostomy, choroid plexus coagulation and neuroendoscopic
treatment of multi-loculated hydrocephalus.
Emergency Services
We provide 24/7 consultant led cover for paediatric
neurosurgical emergencies, the hospital has air ambulance access
and fully equipped paediatric intensive care and high dependency
facilities.
Research
We have a comprehensive research program, with current research
into intra-operative neurophysiological monitoring to improve
safety in cerebellar surgery; collaborative research with centres
in the USA into severe traumatic brain injury; a number of research
projects in the field of hydrocephalus; and research into the
treatment of DIPG, a severe fatal form of brain tumour in children
through the development of novel means of direct delivery of
chemotherapy to the tumour via robotically placed microcatheters
known as "Convection Enhanced Delivery (CED)".
