Paediatric Conditions

Our senior consultant neurosurgeon treats a wide range of paediatric conditions, from fluid imbalances in the brain to complex spinal and cranial malformations, as well as vascular abnormalities and tumours.

Reach out to us for 24-hour emergency services or for a prompt treatment plan.

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Dr Keith Goh

What Are Paediatric Conditions

Paediatric conditions in the context of neurology encompass a wide range of disorders affecting the nervous system, i.e. brain, spine and peripheral nerves of children. These conditions can be congenital, meaning present from birth, or may develop during childhood.

These conditions often require specialised medical attention, including surgical interventions, to manage and treat the complexities associated with the developing nervous system so that the child has a good chance of growing into adulthood.

Types of Paediatric Conditions

Paediatric conditions range from fluid imbalances in the brain to complex spinal and cranial malformations, as well as vascular abnormalities and tumours.

  • Hydrocephalus: This condition, often called “water on the brain,” causes pressure inside the skull, leading to symptoms like headaches, vomiting, and in severe cases, developmental delays. It includes conditions such as aqueduct stenosis, communicating hydrocephalus, arachnoid cyst, Dandy-Walker syndrome, post-meningitis, and post-haemorrhagic hydrocephalus. These conditions usually require surgery to establish a normal flow of the cerebrospinal fluid. Left untreated, the high fluid pressure will damage the child’s brain.
  • Spinal Cord Malformations: These malformations can lead to problems like back pain, difficulties in walking, or bladder and bowel issues, depending on the severity and location of the malformation. Types of malformations include spinal dysraphisms like lipoma, tethered cord syndrome, and myelomeningocele. These conditions often require surgical repair and reconstruction, so as to prevent neurological deterioration.
  • Chiari Malformation and Syringomyelia: These conditions involve structural defects in the cerebellum, the part of the brain that controls balance. Chiari malformation may lead to the development of syringomyelia, a condition where a cyst forms within the spinal cord. This can cause chronic headaches, abnormal sensory symptoms and poor walking ability.
  • Craniosynostosis and Related Cranio-Facial Syndromes: Craniosynostosis is a condition where the bone sutures in a child’s skull close prematurely, resulting in abnormal head shape, and affecting normal brain development. Surgical intervention is almost always required.
  • Paediatric Brain and Spinal Cord Tumours: These tumours can cause various symptoms like headaches, seizures, changes in behavior or learning, poor vision and weakness of the arms and legs. There are various tumours such as optic nerve glioma, craniopharyngioma, neuroblastoma, astrocytoma, ependymoma, medulloblastoma, brainstem glioma, intramedullary spinal cord tumour, and neurofibroma. Treatment typically involves a combination of surgery, radiation therapy, chemotherapy, and molecular target therapy, depending on the type and stage of the tumour.
  • Vascular Malformations: These include abnormalities in the blood vessels of the brain and spinal cord. It includes conditions like arteriovenous malformation, cavernomas, and haemangiomas. If untreated, these can lead to complications like seizures, brain haemorrhage or stroke, requiring multimodality treatment, i.e. endovascular radiology, gamma knife radiosurgery and microsurgery.

Causes of
Paediatric Conditions

The causes of paediatric neurosurgical conditions are varied and often multifactorial, including:

  • Genetic Predisposition: Many paediatric conditions, such as certain types of hydrocephalus and neurofibromatosis, have a genetic component, making children more susceptible to these conditions.
  • Developmental Disorders: Conditions like spina bifida and Chiari malformation can arise due to anomalies in the development of the nervous system during pregnancy, including dietary deficiencies.
  • Complications from Other Conditions: For example, hydrocephalus can be acquired secondary to meningitis or intraventricular haemorrhage, where the normal flow of cerebrospinal fluid is disrupted.
  • Trauma at Birth: Some conditions, such as certain types of brain injuries, can result from complications during the birth process.
  • Vascular Anomalies: Conditions like arteriovenous malformations and cavernomas are caused by abnormalities in the blood vessels of the brain or spinal cord, and might have a genetic component.

Symptoms and Signs

The symptoms and signs of paediatric neurosurgical conditions are varied, reflecting the diverse nature of these disorders.

  • Head Size and Shape Changes: Enlarged head circumference or unusual head shape, often seen in conditions like hydrocephalus and craniosynostosis.
  • Neurological Symptoms: These can include headaches, seizures, numbness or tingling, and frequent drowsiness, common in various paediatric neurosurgical conditions.
  • Motor Skills and Movement Issues: Difficulty in movement or coordination, particularly in the lower limbs, which is indicative of spinal cord malformations, such as tethered cord syndrome.
  • Pain: Persistent or recurring pain, especially in the back or neck, can be a sign of spinal malformations or tumours.
  • Cognitive and Behavioral Changes: Delays in development, learning difficulties, and changes in behaviour can signal underlying neurosurgical conditions.
  • Physical Deformities: Visible changes such as bulging in the skull or deformities in the spine, often associated with conditions like hydrocephalus or spinal dysraphism.


Diagnosis of paediatric neurosurgical conditions involves a combination of clinical assessment and advanced imaging techniques.

  • Clinical Evaluation: A thorough medical history and physical examination, focusing on neurological function, are fundamental in identifying potential neurosurgical conditions in children.
  • Imaging Studies: Techniques such as MRIs, CT scans, and ultrasounds can help visualise structural abnormalities in the brain and spinal cord.
  • Neurophysiological Tests: Tests that assess brain and nerve function, including EEG (Electroencephalography) for seizure activity, are often employed in the diagnostic process.
  • Lumbar Puncture: In cases like hydrocephalus or infections, a lumbar puncture may be performed to analyse cerebrospinal fluid.

Surgical Treatment Methods

Paediatric neurosurgical conditions often require precise and specialised surgical interventions. We collaborate with neurologists and paediatricians to offer treatments for children with neurological conditions, using microsurgical techniques and endoscopic equipment.

  • Neuro-Endoscopy: A minimally invasive procedure using a small video and endoscopic instruments, inserted through small incisions, often used for conditions like hydrocephalus to relieve fluid pressure and to do tumour biopsies.
  • Ventriculo-Peritoneal Shunt: A surgical method to treat hydrocephalus, where a shunt tubing and valve system is placed to divert excess cerebrospinal fluid from the brain to the abdomen.
  • Spine Malformation Repair and Reconstruction: This involves correcting deformities and malformations in the spinal cord, like spina bifida, through surgical intervention to improve neurologic function.
  • Craniofacial Bone Reconstruction: Surgical correction of cranial and facial abnormalities, often required in conditions like craniosynostosis, to allow normal brain growth and improve appearance.
  • AVM and Cavernoma Resection Surgery: The removal of arteriovenous malformations (AVMs) and cavernomas, which are abnormal, tangled blood vessels in the brain or spinal cord. These conditions often require multimodality treatment, eg. endovascular embolization and radiosurgery.
  • Gamma Knife Radiosurgery: A non-invasive, targeted form of focussed and highly-accurate radiation therapy used to treat some brain tumours and vascular malformations without a traditional surgical incision.
  • Craniotomy Brain Tumour Resections: A surgical procedure to remove brain tumours, utilising microsurgical techniques and advanced intraoperative imaging technology to guide the tumour resection. Intra-operative Neurophysiological monitoring helps to ensure intact brain function during the procedure.
  • Spinal Cord Tumour Resections: This is a surgical technique to remove tumours from the spinal cord, usually involving the removal of a portion of the vertebra (lamina) to access the tumour.

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Dr. Keith Goh






With more than 20 years of experience in the field of Neurosurgery, Dr Keith Goh’s subspecialty includes treatment of brain and spinal cord tumours and pediatric neurosurgery.

He is the Medical Director of International Neuro Associates, which is based at Mount Elizabeth Medical Centre, and provides specialist neurological services to all the hospitals within the Parkway Pantai hospital group. He also was Honorary Associate Professor of Neurosurgery at the Prince of Wales Hospital of the Chinese University of Hong Kong.

  • Bachelor of Medicine & Surgery — National University of Singapore
  • Neurosurgical Residency at the Chinese University of Hong Kong
  • Advanced specialty training in paediatric neurosurgery at the Beth Israel Institute of Neurology & Neurosurgery in New York

His bibliography includes 40 original articles, 11 book chapters, and 104 abstracts and lectures on his various research interests, such as brain tumours, spinal cord tumours, head trauma, conjoined twins and congenital malformations in children.


Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510

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    Mount Elizabeth Medical Centre,
    #09-10, 3 Mount Elizabeth
    Singapore 228510

    Frequently Asked Questions

    When Should I Consider Paediatric Surgery for My Child?

    Signs that may warrant surgical consideration include worsening of symptoms and signs, ineffective management through non-surgical means, or evidence of progression in imaging studies. Consult a neurosurgeon for guidance during the decision-making process and personalised treatment options suitable for your child’s condition.