Depending upon the type of injury an infant experiences, surgery may be one of the options needed for treatment. Although it’s worrisome to think of babies and young children undergoing such an invasive procedure, it may be the only type of treatment that can help the problem. In the majority of cases, surgery is successful for infants and children.
Brain and Head Trauma
One of the main reasons infants undergo surgery is if they’ve went through severe brain and head trauma, such as brain hemorrhaging and/or a skull fracture. For instance, a skull fracture, if severe enough, can cause broken blood vessels and bleeding in the brain. Prior to surgery, sometimes there a CT scan or a magnetic reasoning image to see how serious the injury is. For babies, however, the most common testing is an ultrasonography, which has a high precision for smaller skulls.
Surgery for infant brain and head trauma generally includes:
- Surgical decompression
- Craniotomy draininge
- Surgical debridgement
- Surgical evacuation
- Decompressive craniotomy
According to the National Institutes of Health (NCHI), the most common area for surgery for infants with brain and head trauma is the top portion of the head, above the ears. For babies under 3 to 6 months of age, a couple of small cuts are made into the scalp, usually around 1 inch long. The physician may then use an endoscope to observe the injuries.
Afterwards, the physician uses specialized medical devices to remove some of the infant’s skull bones and begin the surgery. This specific type of surgery usually only lasts around an hour and much less blood is lost compared to other types of surgeries. NIH recommends that if an infant needs surgery, it should be performed before 6 months of age.
Surgery is typically the last option for infants with Erb’s palsy, but if the disorder is severe, this may be the only option. Nerve surgery is usually the type of surgery performed, but it’s important to note that surgery usually does not completely restore normal function, especially if the procedure is done after 1 year of age. However, it provides the opportunity for the patient to have better use of the affected arm and shoulder. The sooner the infant has the procedure, the better.
Nerve grafting is the most common type of surgery for Erb’s palsy and other brachial plexus injuries, which consists of reconstructing the damaged brachial plexus nerves with a nerve graft. According to the Brachial Plexus Center of the Washington School of Medicine, the C5 and C6 nerves are generally the most damaged nerves.
In some cases, the C7 root is damaged, with 74% of the site of injuries located in the upper brachial plexus. The aforementioned damages nerves are generally treated by nerve grafting, but neurolysis, neurotization, or a combination of all three may be used.
In a study after 241 infants underwent surgery, 81% of the patients who had surgery on the C5 and C6 nerves were able to life their shoulders higher than 90 degrees. For infants who had surgery on the C5, C6, and C7 nerves, around 76% could life their shoulders higher than 90 degrees. If an infant total brachial plexus injuries, 66% were able to life their shoulders higher than 90 degrees while 30% were able to exhibit hand function.
Some infants with severe cases of cerebral palsy may require surgery to help diminish severe muscle stiffness and spasms. Surgery can also provide more control over muscle flexibility and better mobility. There are generally two types of surgeries for cerebral palsy: orthopedic surgery and selective dorsal rhizotomy (SDR).
Orthopedic surgery helps to increase range of motion. This type of surgery entails lengthening a tendon and cutting through the tendon or muscle in order to attach an additional tendon. In some instances, an additional tendon is attached to a bone.
Selective Dorsal Rhizotomy
SDR helps with mobility issues. It’s one of the most common type of surgery for cerebral palsy. It helps to relieve muscle tightness and spasticity in the legs. SDR surgery entails cutting a portion of the sensory nerve fibers that are attached to the muscles that enter the spinal cord.
To begin, the physician generally divides the dorsal roots into several rootlets and then electrically stimulates each rootlet. The muscles responses are then examined via electromyographic responses (EMG). Afterward, the rootlets that are causing the spasticity and motor issues can be determined. The abnormal rootlets are then cut, and the normal rootlets are left intact. Along with decreasing the chances of leg deformity, SDR also helps patients to move their legs better.
Other Types of Surgery for Cerebral Palsy
In some cases, infants and children with cerebral palsy may undergo surgery for medicine related issues. For those who need continuous medication, a small pump is implanted surgically into the abdominal region, under the skin. The pump then disperses medication routinely. Baclofen in the most popular type of medication used for patients who have a surgical medicine pump.
There is a common debate among physician as to when babies and children with cerebral palsy should receive surgery. Some doctors feel that surgery should be performed at a young age, while others think that all other treatments should be exhausted before doing surgery. It’s important to discuss all options with your doctor to figure out the best options for your child.
After surgery, infants and children with cerebral palsy generally start physical therapy. Equipment is often needed when starting physical therapy, such as splints and casts. In most instances, physical therapy will start right away after surgery, and on average, lasts around 6 months.