Pediatric Neurosurgery for the General Neurosurgeon

It is an honor for me to edit this issue of Seminars in Neurosurgeryon pediatric neurosurgery for the general neurosurgeon. The utility of discussing important pediatric neurosurgery issues in a format that is both useful and interesting to the general neurosurgeon was borne out at several well-attended, successful symposia at national neurosurgical meetings. These were conducted at the request of the general adult neurosurgeon, who is on the ``front lines'' providing care for a wide variety of patients. As academic neurosurgery becomes increasingly sub-specialized, the general adult neurosurgeon is faced with a staggering array of complex issues in a multitude of neurosurgical areas including pediatrics, spine, vascular, pain, and functional. Pediatric neurosurgeons have witnessed an enormous evolution in many subjects in this relatively specialized field. Due to economic restraints and increased sophistication of neurosurgical training, pediatric neurosurgeons have now populated most large cities and states. The adult neurosurgeon, who in the past took care of many pediatric problems, is currently faced with a diminished exposure to pediatric problems. It is our goal to provide a modicum of education, by leaders in our field, in some very crucial and sometimes controversial areas of pediatric neurosurgery.

We have started the issue with a superb treatise and update on pediatric brain tumors by Pollack, Jakacki, Deutsch, and Hamilton. Pediatric brain tumors are a very important disorder, representing one of the leading forms of cancer in children, second only to leukemia.

Insights, learned from caring for children, into the management of hydrocephalus in adults are provided by author Rekate. This article helps the general neurosurgeon avoid the pitfalls that only too often confound treatment in this complex population.

Mazzola and Adelson have contributed a concise and useful article on pediatric head trauma. This invaluable guide sums up our body of knowledge and current guidelines on this subject.

The current management of spinal cord and spinal column injuries in children is discussed by Douglas L. Brockmeyer. There is a new breed of pediatric neurosurgeons, trained both in pediatrics and spine, who has advanced our surgical and technical knowledge in this field.

A very readable and useful synopsis of the current issues in the management of patients with spasticity and hypertonia is provided by Paul Steinbok. This is a field that has undergone major paradigm shifts, just in the last two decades.

Moores and Martin have authored a timely article on the management of patients with myelomeningocle. This population, which received aggressive surgical therapy for the first time only a few decades ago, is now aging and thus currently receives care from general neurosurgeons as well as pediatric neurosurgeons. This is a subject that has been covered only recently and too rarely.

In his manuscript on surgical treatment of pediatric epilepsy, Ojemann covers surgical options for children with intractable seizures, and identifies the best surgical intervention for patients with different epilepsy syndromes.

We end this issue with an overview by Hopper, Grant, and myself on the current controversies in craniofacial surgery. This article ranges from who not to operate upon to how and when to operate on patients who truly require this common neurosurgical intervention.

The authors of the papers in this issue and I hope that readers will benefit from the excellent discussions of these various disorders.