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.

There are 4 consultant neurosurgeons at BRHC:

Mr Richard Edwards, Consultant paediatric neurosurgeon
Mr Will Singleton, Consultant paediatric neurosurgeon
Mr Greg Fellows, Consultant paediatric neurosurgeon
Mr Mike Carter, Consultant paediatric neurosurgeon

The Paediatric Neurosurgical Service at BRHC 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 therapy (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)”.