ENWhen parents are told that their child needs surgery on the brain or the spine, they fear not only the operation itself but also that an adult neurosurgeon who rarely sees children will perform it — which is exactly why paediatric neurosurgery in Germany is a separate field within neurosurgery, with its own departments.
This page explains how a paediatric neurosurgeon differs from an adult one, which diagnoses lead to one, how a child is prepared for surgery in Germany and what one trip can realistically achieve. For children’s medicine in general, see treatment of children in Germany.
How paediatric neurosurgery differs from adult neurosurgery
A child is not a small adult. The skull is still growing, the sutures are open, and a small child’s whole blood volume is measured in hundreds of millilitres — hence different approaches, a different tolerable blood loss, different anaesthesia and a different calculation of operating time.
Children also have different diagnoses. Adults are mostly operated on for a disc herniation, an aneurysm or a metastasis; children for a congenital malformation, blocked flow of cerebrospinal fluid or a posterior fossa tumour at the back of the skull. So adult-department experience does not transfer automatically.
The third difference is the horizon. Decisions are made with the child twenty years from now in mind: how the skull will grow, whether the shunt (a thin tube draining excess fluid) will stay, what radiation will do to development. So a German team sometimes chooses the more demanding operation today. For adults, see neurosurgery in Germany.
Which diagnoses are referred to a paediatric neurosurgeon
The largest group is a disturbed flow of cerebrospinal fluid, that is hydrocephalus, treated with shunt operations or with endoscopic third ventriculostomy, in which a thin endoscope opens a bypass for the fluid; details are on the page about hydrocephalus treatment.
Brain and spinal cord tumours in children are a world of their own: the neurosurgeon and the paediatric oncologist almost always work together, and the extent of resection is discussed with the chemotherapy plan; see paediatric oncology in Germany.
The rest are congenital malformations: spina bifida, Chiari malformation, where part of the cerebellum sits too low, and premature fusion of the skull sutures. Vascular malformations and the after-effects of severe head injury also belong here. When medication has not controlled seizures, a child may need epilepsy surgery; see epilepsy in children.
How a child is prepared for surgery
The work-up usually starts again: an MRI to the German hospital’s protocol, under anaesthesia or sedation in small children, and where needed a CT, an EEG and examinations by a paediatric neurologist and an ophthalmologist. Images from home are not discarded but compared with the new ones, so the discs and files must come too.
A board, not one surgeon, decides on surgery: the paediatric neurologist, the neuroradiologist and, for a tumour, the paediatric oncologist and the radiation oncologist. There parents hear not only what will be done but what happens if nothing is done.
In the operating room the surgeon relies on neuronavigation, which carries imaging data into the operating field, and on intraoperative neurophysiological monitoring: nerve pathways are watched during surgery so that movement and speech are not damaged. Intraoperative ultrasound or MRI can show before the end whether tumour remains. For parents, this means healthy brain tissue is checked during the operation itself; the German Society of Neurosurgery explains how such monitoring works.
Where children are operated on and by whom
Paediatric neurosurgery in Germany is done in children’s hospital departments and paediatric sections of neurosurgical clinics. Among AlenMed’s partners are the Altonaer Kinderkrankenhaus in Hamburg, whose paediatric neurosurgery department is headed by Dr Christian Hagemann, and the Dr. von Hauner Children’s Hospital at the Munich university hospital, with its neuropaediatric department under Prof. Florian Heinen and the paediatric surgery clinic of Prof. Oliver Muensterer.
The team also includes a paediatric anaesthetist, a neurophysiologist, the paediatric intensive care unit, a physiotherapist and a speech therapist. What matters most to parents is that paediatric anaesthesia and paediatric intensive care are in the same building, not «in the adult wing next door».
After surgery: intensive care, recovery, school
The first days usually mean paediatric intensive care, a control MRI or CT, removal of stitches and a first neurological assessment. How long each part takes depends on the diagnosis; exact figures come from the hospital, not this page.
Next come early rehabilitation, transfer to a children’s rehabilitation centre where needed, and a follow-up plan: the next MRI, whom to see at home, when school can resume. With a shunt, ask for a list of signs that mean seeing a doctor immediately. Get all of this in writing and translated.
Frequently asked questions
How much does paediatric neurosurgery in Germany cost?
There is no single price: the hospital states the sum in a written estimate after the doctor has seen the images and reports. It depends on the operation, the days in intensive care and on the ward, repeated tests and rehabilitation. Without the child’s documents, any figure would be unverified.
Can a parent stay with the child?
Yes. A place for one parent next to the child is arranged with the hospital in advance, along with the estimate and visa invitation. The parent also attends appointments and the board meeting, with an interpreter. Bring the child’s usual medication and a few favourite things for the ward.
Why bring old MRI images if the scan is repeated?
The earlier images are needed for comparison: they show how things have changed over time. The German hospital usually performs its own MRI to its own protocol, but the doctor reads the new scans alongside the old ones. So bring the discs, files and discharge letters.
How AlenMed arranges surgery for a child
It starts with the documents: MRI files, discharge letters, laboratory results and the neurologist’s report go to a paediatric neurosurgery department, whose doctor answers whether surgery is needed, which investigations must be repeated and how long the trip will take. Then come a written estimate, a visa invitation, a place for a parent beside the child, and an interpreter at appointments, the board meeting and the discussion of the report.
Plan ahead for enough of the child’s usual medication, familiar things for the days on the ward, unhurried time to discuss the discharge letter, and translation of the final documents for the doctor at home.
This material is for information only and is not an offer. The indication for surgery and its extent are decided by a doctor in person.