Pediatric Neurosurgery: The First Subspecialty

Marion L. (Jack) Walker, MD
Professor Emeritus, Department of Neurological Surgery
University of Utah Health Sciences Center
Salt Lake City, Utah

 

The care of pediatric neurosurgery patients has advanced tremendously in a short period of time. Thankfully, the spectrum of medical issues that pediatric neurosurgeons successfully address includes:

  • Tumors;
  • Trauma;
  • Congenital malformations;
  • Infections;
  • Spine problems; and
  • Vascular diseases.

In the early years of neurosurgery as a specialty, pediatric patients were cared for by the same neurosurgeons who treated adults. The Boston Children’s Hospital evolved as the first full-time pediatric neurosurgery service and many of the neurosurgeons who trained there developed strong pediatric neurosurgery programs in other institutions. As neurosurgery matured as a surgical specialty during the first half of the 20th century, many neurosurgical program chairmen developed a strong interest in pediatric neurosurgery. Some of their young faculty began to focus more and more on the neurosurgical care of children. Also, the development of the shunt to treat hydrocephalus led to a rapid increase in the need for well-trained pediatric neurosurgeons. There then followed a period where the characteristics and scope of practice of pediatric neurosurgery were defined. To this end, as the interest in pediatric neurosurgery grew the Pediatric Section of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), formed and in 1972, became the first neurosurgery subspecialty section. In addition, The American Society of Pediatric Neurosurgeons (ASPN) was founded in 1979 as a separate society to identify those neurosurgeons whose practice was focused predominately on children.

The interest in pediatric neurosurgery grew rapidly after the formation of the ASPN, and soon the need for more formal training in pediatric neurosurgery was recognized. Because the American Board of Neurological Surgery (ABNS) didn’t certify fellowship training in pediatric neurosurgery, the American Board of Pediatric Neurological Surgery (ABPNS) and the Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF) were formed. Along with the push toward recognition of pediatric neurosurgery as a neurosurgical subspecialty, the formation of a board and the certification of fellowship training programs, the need for a specialty journal became apparent. The early journal Pediatric Neurosurgery had a limited subscription. Through the efforts of Jerry W. Oakes, MD (University of Alabama Birmingham and Alabama Children’s Hospital) and John Anthony Jane Sr., MD, PhD (University of Virginia and Editor of the Journal of Neurosurgery) the Journal of Pediatric Neurosurgery was founded in 2004 as the first subspecialty publication by the Journal of Neurosurgery. The subscriptions for the pediatric neurosurgery journal went from ~800 to over 11,000 overnight. This added to the increased interest in and the rapid growth of pediatric neurosurgery as a neurosurgical subspecialty. Ultimately, this led to the recognition by the ABNS of the need for their oversight. Today, pediatric neurosurgeons may now be certified in neurosurgery by the ABNS and given a certificate of focused practice in pediatric neurosurgery.

These efforts forged by neurosurgeons to make #PedsNeurosurgery the first subspecialty go a long way to elevate the quality of care provided for pediatric patients. Today, collaboration with other specialists (otolaryngologists, intensivists, cardiologist, neurologists, plastic surgeons and radiologists) are pushing treatments ahead and making outcomes even better. Boston Children’s Hospital led the way, and as a result, today there are many specialized hospitals to help care for pediatric neurosurgical patients and their families.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #PedsNeurosurgery.

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