What we do
Clinical Service
The Hospital for Sick Children (SickKids) is located in downtown Toronto adjacent to three premier adult hospitals and the University of Toronto campus. SickKids serves both the Greater Toronto Area as well as the central corridor of the Province of Ontario, thus drawing upon a population base of 6.5 million.
Each year, approximately 1,200 newborns, infants and children are admitted for care to the Neurosurgical Unit, and 800 operative procedures are performed annually for a wide variety of structural abnormalities which involve the child's brain, spinal cord and peripheral nervous systems. All patient care is provided in The Atrium which opened in 1993 and has individualized rooms each of which contains appropriate monitoring and support equipment, a full service bathroom and bed for the parent. Senior, experienced nursing and rehabilitation staff supervise the child's care. More than 3,000 children are examined each year in the neurosurgical clinics.
Clinical Programs
Brain and Spinal Cord Tumors
The compassionate care of a child's brain or spinal cord tumor has been a major divisional activity since 1956. At present, children are assessed by modern imaging techniques which are interpreted by widely experienced neuroradiologists. Similarly, computer assisted, microscopic and laser technology is available for the intra-operative care of the child. The pathological examination of the tumor is performed by highly knowledgeable neuropathologists, and subsequently the child's case discussed at a weekly Tumor Board conference. In that forum, a decision about the need for further investigation and adjunctive therapies is made by a panel of neurosurgeons, neuro-oncologists and radiation therapists. The child's case may be entered into an open international multi-centre protocol. BRAINCHILD is a support and information network providing assistance to the families of children with brain tumors.
Craniofacial Disorders
The Craniofacial Team was formed at the Hospital in 1971. Since then, hundreds of children with complex craniofacial syndromes and dysostoses have been evaluated by the multi-disciplinary team comprised of plastic craniofacial surgeons, neurosurgeons, neuro-ophthalmologists, otolaryngologists, neuroradiologists, anthropologists, specialized denistry and graphics personnel. The treatment of this type of disorder frequently requires staged procedures, and so multiple follow up evaluations are carried out in the Craniofacial Clinic.
Epilepsy
Children with epilepsy which is refractory to medication and/or associated with a defined lesion, are evaluated in the Epilepsy Monitoring Unit by experienced senior neurologists. Once the characteristics of the convulsive disorder have been defined with imaging and modern physiologic instrumentation (eg digital video EEG monitoring, MR spectroscopy and SPECT scan), the child's case is discussed at a weekly conference. An experienced and dedicated neurosurgeon operates upon those children for whom surgery is recommended. The child is subsequently followed in the Epilepsy Clinic.
Peripheral Nerve and Brachial Plexus Injuries
Most neonatal brachial plexus injuries will recover spontaneously. However, the neurosurgical division offers expert microsurgery for those infants and children whose traumatic brachial plexus or peripheral nerve insult does not recover.
Spasticity
In conjunction with orthopedic surgeons and, rehabilitation staff associated with the Bloorview- MacMillan Centre, the division has a continuing involvment in children with gait spasticity. The child's status is assessed by the multi-disciplinary team at the Centre as well as in their gait analysis laboratory. Children who are identified as candidates for dorsal rhizotomy are operated upon by a dedicated divisional neurosurgeon.
Spinal Dysraphism
Over 75 operative procedures for the "open" and "closed" forms of spinal dysraphism are performed each year. This includes 30 newborns assessed annually for myelomeningocele. These infants are placed on an established protocol, assessed by multiple allied specialists, and once released from hospital, are followed in a Spina Bifida Clinic. Infants and children with the "closed" dysraphic problems receive thorough neurologic, urologic, imaging and evoked response testings before a decision is made as to the timing and nature of their operative treatments.
Pediatric Rehabilitation Facilities
Neurosurgical patients who require continuing rehabilitation, cognitive assessment or schooling as part of their recovery from head injury or brain tumor or spinal dysraphic conditions, are admitted to The Bloorview MacMillan Centre on an attractive campus in the north end of the city.
Spinal Column Trauma/Developmental Anomalies
Children and adolescents with defined spinal column/cord injuries or developmental anomalies are treated jointly by the orthopaedic and neurosurgeons. Both external and operative internal fixation procedures are carried out and the rehabilitation program customized individually for each patient.
Trauma
The hospital is a Level I Trauma Centre. Since 1956 the hospital has received children who are critically injured from all over southern Ontario. In the acute phase, the child who has sustained sever head trauma is admitted to the Critical Care Unit and placed on a head injury protocol. The neurosurgeons have been studying and writing upon the issues of head injury in children since 1964.
Vascular
Various ischemic and hemorrhagic vascular disorders are treated by the neurosurgical staff. Some children with ischemic stroke are candidates for a revascularization procedure. A greater number of children who have suffered spontaneous brain hemorrhage from a defined malformation will require operative and possibly adjunct therapies for their particular lesion. The assessment of these children is facilitated by experienced hospital and university neuroradiologists who are facile with pediatric endovascular techniques.