10 S T pinal Dysraphism : he Search For Magic

Although pediatric neurosurgery is relatively young as a formal subspecialty of general neurosurgery (the first meeting of the Section of Pediatric Neurological Surgery was held in 1972 and the American Society of Pediatric Neurosurgery first met in 1978), it has been practiced for millennia. Trephined pediatric skulls were excavated in Peru and at other ancient sites.1 The father of neurosurgery, Sir Victor Horsley, performed his first epilepsy surgery on a child in 1886.2 Harvey Cushing wrote extensively about the unique disorders of childhood.3,4 Many other notables followed these icons, ensuring the momentum for further progress and refinement in the surgical care of children with disorders of the nervous system.5 Congenital spinal nervous system abnormalities continue to be the mainstays and also the pitfalls of pediatric neurosurgery. Paralysis, incontinence, obesity, endocrinopathy, hydrocephalus, short stature, social stigmata, and shortened lifespans are still the norms for children with open neural tube defects (NTDs).6,7 The number of children born with myelomeningocele has decreased over the past several decades and 3 of every 10,000 children born in the U.S. are handicapped by open spinal NTDs.8 Additionally, improved imaging techniques have diagnosed even more children who suffer from spinal cord dysfunctions secondary to closed dysraphisms.9 The future treatment objectives are clear: congenital spinal defects must be prevented or their neurological sequelae must be cured. Imagine that a pill or procedure could