Neurosurgery

The surgical treatment of disorders and malformations of the brain and spine in childhood is uniquely challenging and complex. At the Great Ormond Street Hospital (GOSH) Department of Neurosurgery, we have a core team of 7 full-time paediatric neurosurgeons, supported by specialist doctors, nurses and allied health professionals. We offer a comprehensive paediatric neurosurgery service 24 hours a day, 365 days a year.

We are the largest paediatric neurosurgery centre in the UK, performing over one thousand surgeries per year. Our practice is built on child-centred multidisciplinary teams, working in close collaboration with colleagues from Neurology, Neurophysiology, Craniofacial, Neuroradiology/Interventional Radiology, Neuro-disability, the Children’s Epilepsy Surgery Service, Ophthalmology and Orthopaedics/Spinal Surgery. Every case referred to us is reviewed as a team, to ensure the best opinion and care is offered on an individualized basis.

Our large volume of complex cases has allowed our consultants to devote themselves to particular specialised conditions and surgeries, so the care of all children referred to the department is led by the most appropriate specialist to ensure the very latest knowledge and treatments are offered and the best outcomes are achieved.

Specialist areas of interest in the department include neuro-oncology (brain and spine tumours), epilepsy, craniofacial, spinal disorders including Chiari/craniocervical junction, neurovascular conditions, hydrocephalus, spasticity, foetal surgery, neurotrauma/critical care and others.

Our team-based approach means that a consultant paediatric neurosurgeon is available 24/7 to deal with new referrals or any changes in the condition of inpatients. We are a designated UK referral centre for Epilepsy Surgery, Craniofacial Surgery, Vein of Galen Malformation, Selective Dorsal Rhizotomy, Foetal myelomeningocele (Spina Bifida repair and Stereotactic Radiosurgery (Gamma Knife).

Outcomes 

GOSH is the largest paediatric neurosurgery unit in the United Kingdom. In 2020, despite the Covid-19 global pandemic, we performed 913 neurosurgical procedures. In the previous 5 years, this figure has consistently been over 1100.

In 2020 the team conducted 96 epilepsy, 174 craniofacial, 126 brain/spine tumour and 52 spinal dysraphism surgeries. We undertook 221 procedures related to CSF and hydrocephalus. We openly publish our clinical outcomes, including adverse events, on our website: https://www.gosh.nhs.uk/conditions-and-treatments/clinical-outcomes/neurosurgery-clinical-outcomes/

• In 2019/20 our VP shunt infection rate was 2.55% and our early shunt revision rate for primary VP shunts was 1.76%.
• In 2019/20, for all surgeries, the serious adverse event (grade 3 and 4) rate was 1.04%.
• A total of 8692 operations have taken place at GOSH since 1/1/2013 and during that period the team has recorded a 0.3% mortality rate. For elective (planned) operations, the mortality rate is 0.0006%.

Innovation and research

The Neurosurgery team and colleagues from across GOSH and the UCL Great Ormond Street Institute of Child Health come together to create new and better treatments for the benefit of children and families around the world. Consultants from the team lead or contribute to a number of research programmes in paediatric neurosciences. In 2020, the neurosurgery team published 48 PubMed registered publications.

Specialised technology and treatments include:

• Robot-assisted stereoEEG implantation
• Intraoperative MRI
• Integrated endoscopic operating room (Storz OR1)
• VisuaLase laser thermal interstitial therapy
• Minimally invasive craniosynostosis repair (spring-assisted cranioplasty and endoscopic strip craniectomy with helmet orthosis)
• Frontofacial surgery with external distraction for syndromic craniosynostosis
• Vagal Nerve Stimulators
• Intrauterine myelomeningocele repair
• Radical surgery for lipomyelomeningocoele/spinal lipoma
• Joint neurosurgical/orthopaedic operating for complex spinal deformity
• Selective dorsal rhizotomy for cerebral palsy/spasticity
• Gamma Knife stereotactic radiosurgery
• Endovascular treatment for aneurysm/AVM/vein of Galen malformation
• Surgical revascularization for moyamoya
• Robot-assisted brain tumour biopsy (including brainstem tumours)
• Frameless neuro-navigation
• Advanced neuro-imaging for brain tumours
• Endoscopic third ventriculostomy-choroid plexus coagulation (ETV-CPC)
• CSF access for treatment of metabolic conditions and malignancy/tumour