Pediatric Clinic

Abnormal Head Shape Screening Clinic
Evaluations and treatment of infants and children with head shape abnormalities are available through Carolina Neurosurgery & Spine Associates. If you have questions about abnormal head shape or are interested in making an appointment please call 704-376-1605 to make a patient referral.

Overview
For newborns and infants with abnormal head shapes, Carolina Neurosurgery & Spine Associates has begun a screening clinic designed to identify children who can benefit from early intervention. Most often, this intervention is in the form of a nonsurgical treatment known as cranial banding. Twice a month, our practice offers the screening clinic at the Charlotte office to assess infants with abnormal head shapes and determine if they are candidates for cranial bands or other forms of early interventional treatment including repositioning, neck exercises and, in rare cases, surgery.

After determining the appropriateness of cranial banding, our surgeons refer these infants to a local office of Cranial Technologies where the actual treatment program is implemented. Cranial Technologies is the Phoenix-based company which developed cranial banding and which owns and operates offices around the country.

The cranial band, or orthosis, is often described as “braces for the head” as it helps to reshape the child’s skull, encouraging growth in the desired directions. Abnormal head shapes that are treatable with banding can be caused by a variety of factors including premature birth, restrictive intrauterine positioning, cervical (neck) abnormalities and even preferential sleeping positions. 

Children with abnormal head shapes between the ages of 3 and 18 months can benefit from cranial banding. The treatment typically lasts three to four months, at which point the child is reevaluated and, if needed, banding is continued with a second cranial band.

Pediatric Spasticity Clinic
Recently relocated from Carolinas Medical Center, the Pediatric Spasticity Clinic is where children can be evaluated as candidates for selective dorsal rhizotomy, intrathecal Baclofen therapy, or other forms of spasticity management. Please contact Lisa Schloeder, RN, with any questions, or call 704-376-1605 to refer a patient.

Overview
This movement disorder, which manifests itself primarily as a stiffness in the arms and legs, is often a permanent and progressive complication of injuries to the brain or spinal cord. It is also seen in children and adults with cerebral palsy, stroke, multiple sclerosis (MS) amyotrophic lateral sclerosis (ALS), and a variety of other disorders.

Spasticity, in its milder and more localized forms, may respond to stretching exercises, the use of a variety of medications, or the local injection of Botox, a drug which partially and temporarily interferes with the way nerves cause muscles to contract. When spasticity and its accompanying involuntary, and sometimes painful, muscle spasms are severe, a more aggressive treatment program is needed.

Intrathecal Baclofen
One of these advanced options involves the use of intrathecal Baclofen, a drug which helps control the over stimulation of motor nerves which cause spasticity. Using an implantable, programmable and refillable pump, Baclofen can be delivered directly to the areas of the spinal cord where it is needed to loosen muscles and prevent spasms. This continuous infusion avoids the sedative effects commonly seen when the same drug is given orally.

To determine if a patient is a candidate for the implanted device, a single trial dose of Baclofen is administered directly into the spinal space. With the assistance of a physical therapist, changes in the patient’s muscle tone or spasm severity are then monitored for four to six hours, which is the approximate duration of the test dose’s effect. If the patient responds in a positive way, a surgical procedure can be performed to place a small pump underneath the abdominal wall and a catheter in the spinal space, thereby providing continuous delivery of Baclofen. Typically, a patient will have his or her pump refilled every four to six weeks. The pumps themselves, which are battery powered can last anywhere from seven to ten years.

The greatest advantage of this treatment option is the pump’s ability to be programmed after it is implanted. This allows us to precisely meet the patient’s need for spasticity control. In the past, the options for patients with severe spasticity were a variety of destructive and irreversible surgical procedures.

The specific causes of spasticity varies from patient to patient. These individuals range in age from 7 to 66 years old, and represent many different conditions which cause spasticity. Clinics are held in the practice’s Charlotte office on a regular basis for new and established patients.

A New Endoscopic Technique For Treating Craniosynostosis Leads To Quicker Patient Recovery
Endoscopic technology now allows the neurosurgeons at Carolina Neurosurgery & Spine Associates to greatly reduce recovery time for patients undergoing treatment for craniosynostosis. With this condition, one or more of the fibrous sutures that hold together the bones in a baby’s skull cap closes prematurely. These sutures normally remain open as long as the brain is expanding to allow growth in all directions. If even one suture closes before it is supposed to, the baby’s brain will grow in the direction of least resistance, resulting in a misshapen skull or face. This can happen before the baby is born or in the first few months of life.

Diagnosis Of Craniosynostosis
A suspected diagnosis of craniosynostosis is confirmed by X-rays. A CT scan is also performed to ensure there are no underlying abnormalities in the brain. The child must also be evaluated for any signs of increased intracranial pressure due to restricted skull growth. The next step is to restore the normal shape and relationship of the forehead and orbital rims.

Before Endoscopic Technology
Traditional craniosynostosis surgery involves an incision or opening in the skull behind the hairline so that afterwards the scar is covered by the hair. The bone in the area of the defect is reshaped or replaced with bone from another area of the skull. The surgery is usually very successful, however, a blood transfusion is often necessary and the child must stay in the hospital for up to four days.

A New Solution
Pediatric neurosurgeons at Carolina Neurosurgery & Spine Associates now utilize a new endoscopic technique for surgical management of craniosynostosis. With endoscopic strip craniectomy, a child’s closed suture in the skull is removed using only one or two incisions, each about one inch in length. Because the incisions are so small, there is less need for a blood transfusion, and the baby usually goes home after only two or three days. This procedure must be performed prior to six months of age. Pediatric craniofacial plastic surgeons often assist with this technique. After surgery, cranial banding is utilized to assist in reshaping craniofacial contours so the head will grow in a normal direction.

This endoscopic surgery is a much less invasive technique and is very effective. There’s much shorter recovery time for the child which makes it less stressful for parents and family.