Tumours of the central nervous system are the most common solid neoplasms in children. According to recent studies, there are approximately 320 new cases per year in the Federal Republic of Germany. Low-grade infratentorial astrocytomas (approx. 30%) and medulloblastomas (approx. 20%) as well as ependymomas are found most frequently, whereas supratentorial gliomas or ependymomas are less common. Apart from a few exceptions (e.g. gliomas of the visual pathway, germinomas), surgical removal of the tumour, possibly followed by adjuvant therapy, is the method of choice.

Whereas 30 years ago the prognosis for children with malignant brain tumours in particular was extremely poor, the use of microsurgery, radiotherapy and chemotherapy in recent years has made it possible to significantly improve both the survival times and the quality of life of affected children.

Spinal malformations or dysraphia have become rare today thanks to modern prenatal diagnostics and prevention. The spectrum ranges from clinically harmless clefts in the spinal column or skull to meningo- and/or myelomeningocele and open spinal canal. The timing of surgical treatment and the ideal procedure depend on the type of malformation (open MMC requires surgical closure in the first few days of life) and the clinical symptoms. In the case of closed dysraphia, increased traction (tethering) of the spinal cord during the child's growth can slowly lead to a deterioration in muscle strength, coordination, bladder and bowel emptying function or even pain. Prompt surgical release (detethering) of the spinal cord is then indicated. Regular clinical follow-up by an interdisciplinary team consisting of paediatric neurologists, paediatric neurosurgeons, paediatric urologists, paediatric orthopaedic surgeons and physiotherapists is therefore very important.

Spinal dysraphia is often associated with other malformations of the central nervous system such as Chiari syndrome, syringomyelia or hydrocephalus. The lowering of the cerebellar tonsils (type I) or parts of the brain stem (type II) into the upper spinal canal can lead to compression of the brain stem, cerebellum and spinal cord and corresponding symptoms. Surgical widening of the foramen magnum relieves the compressed structures and thus improves the symptoms. Associated cavities in the spinal cord (syrinogomyelia) usually disappear as a result.

The premature closure of one or more cranial sutures results in characteristic skull deformities, known as craniosynostosis. Premature synostosis of the sagittal suture with the formation of an elongated head, the scaphocephalus, is most common. While surgical correction by excision of the prematurely closed suture is quite simple in these cases, more complicated skull asymmetries or syndromic suture synostoses require quite complex skull reconstructions. These are carried out in co-operation with oral and maxillofacial surgeons. In these children, further surgical interventions are sometimes necessary later in life.

Hydrocephalus occurs when cerebrospinal fluid production and reabsorption into the vascular system are not in balance (hydrocephalus malresorptivus) or when the outflow of cerebrospinal fluid within the ventricular system is obstructed, e.g. by adhesions or tumours (hydrocephalus occlusus). Clinically, the patient shows signs of increased intracranial pressure with headaches, nausea, vomiting, impaired vision and consciousness, increased head circumference or a tense fontanel. Depending on the cause and radiological picture of hydrocephalus, different surgical procedures are used. If the cause of the occlusive hydrocephalus can be eliminated by removing a space obstruction in the posterior fossa or in the area of the foramina monroi, in most cases no permanent CSF drainage (e.g. via a tube valve system/shunt) is necessary. In the case of outflow obstructions at the level of the mesencephalic aqueduct, an endoscopic ventriculocisternostomy can be used to create a connection between the inner and outer cerebrospinal fluid spaces. In most other cases, implantation of a shunt system (permanent drainage of cerebrospinal fluid) is necessary. For controlled CSF drainage, a valve unit is inserted into the catheter system in order to be able to adjust the drainage resistance of the cerebrospinal fluid to the individual needs of the patient. Ideally, these valves should be adjustable, but their setting should not change automatically in the MR scanner.

Children are particularly susceptible to injuries due to their body proportions and size as well as their lack of experience with dangerous situations. While falls are most common in infancy, in adolescence it is mostly two-wheeled accidents or sports injuries. The still-developing brain and spinal cord are particularly vulnerable in the first years of life and the negative effects on further motor and mental development can sometimes be considerable. This is why the rapid and appropriate treatment of children with brain and spinal cord injuries in an interdisciplinary team with trauma surgeons is of crucial importance. As a supra-regional trauma centre including a helipad, Ulm University Hospital is equipped for the complex treatment of childhood trauma thanks to the permanent presence of neurosurgeons, anaesthetists, traumatologists and intensive care specialists with experience in children.