Neurosciences - El Paso Children's Hospital

Neurosciences - El Paso Children's Hospital
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Neurosciences
Every child in West Texas deserves the chance to grow up healthy and strong. At El Paso Children's Hospital, our team of pediatric neurosurgeons, experts and advanced imaging specialists in our one-of-a-kind Neurosurgery Program are committed to fulfilling that promise.
The department of neurosciences provides specialized care in the diagnosis and treatment of all neurological conditions and includes speciality services from pediatric neurosurgery, pediatric neurology, neuro-interventional radiology, neuropathology, neuroradiology, neuro-critical care, cranial and facial surgery, and neuropsychology, in addition to other specialists that may be involved in the management and care of children with complex medical diagnoses.
The department of neurosciences aims to provide comprehensive care and support to all patients and families that are dealing with a neurological disease. Involvement of physiotherapy, occupational therapy, speech and language pathology, dietician, child life specialist, social work, and orthotics are an integral part of our approach to provide the best personalized care for children under our care.
Brain & Spinal Cord Tumors
Brain and spinal cord tumors are abnormal growths of cells in the brain or spinal cord. These tumors can be either benign (noncancerous) or malignant (cancerous). Even if a tumor is benign, however, it can still cause issues if it begins to grow and crowd the space occupied by the spinal cord or brain.
Chiari Malformations
Chiari 1 (CM1) occurs when the cerebellar tonsils descend into the spinal canal. Many children have no symptoms and are diagnosed incidentally. When symptoms occur—typically in teens—they can include headaches, balance problems, numbness, vision changes, breathing issues, scoliosis, or bowel/bladder changes. Infants may have trouble swallowing, irritability, or breathing problems. Symptomatic children may require surgery to relieve pressure and restore cerebrospinal fluid flow.
Craniosynostosis
Craniosynostosis occurs when one or more sutures—the natural openings in the skull that allow the brain and skull to grow—close prematurely. This results in compensatory growth along the remaining open sutures and restricted growth along the fused suture, leading to an abnormal head shape. In some children, craniosynostosis may also be associated with increased intracranial pressure. Certain cases are linked to genetic syndromes and may involve multiple sutures or additional medical conditions.
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Need a world-class pediatric neurosurgeon in El Paso, Texas? El Paso Children’s Hospital’s Neurosurgery program is your home for compassionate care for families facing these complex issues. We’re committed to delivering the latest and most advanced techniques to treat pediatric neurological problems in West Texas and beyond.
For more information or to make an appointment for your child.
Call:
(915) 298-5444
Multispecialty Center
5400 Alameda Avenue
El Paso, Texas 79905
Phone
915-242-8402
Monday - Friday
8 a.m. - 5 p.m.
Ziyad Makoshi, MBBS, MSc, FRCSC, FAANS
Medical Director of Pediatric Neurosurgery
Sandra Flores, MSN, RN, CPNP-PC, FNP-C, CEN
Pediatric Nurse Practitioner / Family Nurse Practitioner
Cristobal Perez, PA
Pediatric/Neurosurgery Physician Assistant
Hydrocephalus is a condition in which there is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. CSF is a clear, watery fluid that protects the brain and spinal cord. The two main types of hydrocephalus are Simple and Complex. Simple Hydrocephalus is usually due to a single cause, like an infection, blood clot or tumor that's blocking the flow of CSF, or because the body is making too much CSF. Complex hydrocephalus is called "complex" because it's often due to a combination of factors, including CSF blockage, overproduction of CSF and scarring of the brain.
What is Spina Bifida?
Spina bifida is a congenital disorder that occurs early in pregnancy and can lead to a variety of challenges for the newborn. It can range from an open defect along the back with exposed spinal cord and nerves (myelomeningocele) to a normal-appearing back with internal spinal cord and nerve abnormalities (meningocele or other closed neural tube defects). Our multispecialty Spina Bifida clinic includes a pediatric neurosurgeon, pediatric urologist, pediatric orthopedic surgeon, case worker, physiotherapist, orthosis specialist, and clinic coordinator, all working together to provide individualized care tailored to each child’s needs.

Tethered Cord
Tethered cord is a condition in which the filum terminale—a structure at the end of the spinal cord that anchors it—is thickened and contains fat cells, preventing the spinal cord from elongating as a child grows. This can lead to tethered cord syndrome, which may cause leg weakness, sensory loss, changes in bowel or bladder control, recurrent urinary tract infections, tip-toe walking, in-toeing of the feet, scoliosis, or back and leg pain. Management involves appropriate spinal imaging and assessment of bladder function. Once diagnosed, treatment consists of surgically cutting the thickened filum through a small opening in the lower back to relieve tension on the spinal cord and nerves, preventing progressive injury to the neural tissue.
Cysts can occur within the central nervous system (CNS) and may include arachnoid cysts, some of which remain stable and require only routine imaging, while others can grow, cause increased intracranial pressure, and require treatment through minimally invasive endoscopic procedures or shunt placement. Other cysts that can develop in the brain or spine include epidermoid and dermoid cysts, which may grow over time or rupture, potentially causing chemical meningitis and often necessitating surgical resection. Rare cysts, such as neuroenteric cysts, can exert pressure on surrounding structures and require removal. Additional types of cysts may occur post-trauma, post-hemorrhage (after bleeding inside the brain or spine), or post-infection (following CNS infections such as meningitis), and some of these cases may require specialized treatment.
Children can sometimes be born with or develop vascular malformations, such as Vein of Galen malformations, arteriovenous malformations, cavernous malformations, cerebral aneurysms, capillary telangiectasias, sinus pericranii, and dural arteriovenous fistulas. These conditions may present with cardiac problems, seizures, acute neurological changes, headaches, or may be discovered incidentally during imaging for certain genetic mutations. Management requires a specialized, multidisciplinary approach involving our pediatric neurosurgeon and interventional neuroradiologist for appropriate evaluation, counseling, and individualized treatment. Depending on the case, treatment options may include observation, surgery, endovascular procedures (such as coils or embolization), radiation, or a combination of these approaches.
Strokes and intracranial bleeds are fortunately rare in children, but when they occur, they require urgent diagnosis and appropriate treatment to prevent further brain damage. Strokes in children can result from sinus thrombosis, which are blood clots in the veins that drain the brain and are typically treated with blood thinners. Other causes include arterial thrombi or emboli, which may require clot-busting medications or endovascular procedures to restore blood flow. Moyamoya disease and syndrome occur when the arteries at the base of the skull become narrowed, making the brain more susceptible to strokes and bleeds; these conditions are usually treated with bypass surgery performed by a neurosurgeon. Intracranial bleeds can arise from tumors, vascular malformations, medications, or trauma, and severe cases require urgent surgical evacuation of the clot. Management of these patients often involves a multidisciplinary team, including a pediatric neurosurgeon, pediatric neurologist, interventional neuroradiologist, and hematologist.

Skull Tumors
Skull tumors can occur in isolation or as part of a spectrum of diseases. They range from benign lesions, such as dermoid cysts, to inflammatory conditions like Langerhans cell histiocytosis, as well as bony tumors. Many of these require biopsy for diagnosis and, if necessary, surgical removal of the lesion with reconstruction of the skull defect using bone or artificial protective material.

Congenital Skull Defects
Congenital defects of the skull can lead to herniation of the dura (meningocele) or brain tissue (encephalocele), often occurring in the midline, anywhere from the nasal cavity to the back of the head. Appropriate imaging is required to identify the structures within the herniated tissue. Treatment typically involves removal of non-functional herniated tissue, closure of the defect, and reconstruction of the skull deformity. These procedures are performed by our pediatric neurosurgeon, sometimes in collaboration with craniofacial, ophthalmology, or ear, nose, and throat surgeons, depending on the location and size of the defect. Three-dimensional reconstructions may be used for better surgical planning.

Skull Fractures
Skull fractures are common and usually occur after falls or blunt trauma to the head. Many fractures require observation to ensure proper healing without complications. In younger children, there is a risk of rare “growing skull fractures,” in which the dura (lining of the brain) becomes trapped between fracture fragments, causing the fracture to enlarge over time. These cases require surgical repair of the defect.

There are many congenital malformations of the brain and spine that can occur. When diagnosed in utero (during pregnancy), we are able to provide counseling to parents regarding expectations and post-delivery care.

Malformations discovered after birth may include developmental anomalies of the brain and spine, some of which can be associated with intellectual challenges, seizures, hydrocephalus, hormone deficiencies, or visual problems. Each of these conditions requires appropriate diagnosis and management. In some cases, genetic testing may be recommended if a specific syndrome or chromosomal anomaly is suspected.

Congenital malformations of the spine can include spina bifida, vertebral anomalies, scoliosis or kyphosis, basilar invagination and impression, split cord malformation, and other related disorders. Proper imaging and clinical evaluation are essential to determine the most appropriate treatment, which may include bracing, traction, or surgical correction and stabilization.

Epilepsy is a common disorder of the nervous system. It is a neurological condition that affects the brain and causes seizures. Pediatric epilepsy impacts approximately 1% to 2% of children worldwide. A child is diagnosed with epilepsy when they experience two or more seizures on separate occasions.

There are many different causes of epilepsy, and many cases can be managed effectively with medication alone. However, about 1 in 5 children develop seizures that do not respond to medications. These uncontrolled seizures can cause ongoing damage to the brain and significantly affect a child’s quality of life during development and into adulthood.

Surgery plays an important role in children with medically refractory epilepsy and focal seizures. In many cases, surgical intervention can help reduce the severity and frequency of seizures and, in some cases, be curative.

Children with seizures should be evaluated by a pediatric neurologist, who may order an electroencephalogram (EEG)to determine which part of the brain the seizures originate from, as well as a CT scan or MRI to rule out any structural abnormalities or lesions.

If surgery is being considered, further evaluation may include specialized CT scans, functional MRIs, cognitive testing, and invasive monitoring techniques such as stereotactic electroencephalogram (SEEG) or strip electrodes to precisely identify the area and extent of seizure activity.

Surgical treatments for epilepsy may include resection of the epileptic focus, corpus callosotomy, vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). The most appropriate treatment is determined through careful discussion with the patient and their family, based on the cause, location, and characteristics of the seizures. Each child’s treatment plan is unique, as what works for one patient may not be the right approach for another.

Trauma to the brain and spine requires management at specialized centers such as El Paso Children’s Hospital with a trauma team that includes trained trauma specialists, neurosurgeons, and emergency care physicians all certified in the management of pediatric advanced life support to rapidly stabilize and appropriate managed pediatric trauma and provide the best possible outcomes for these patients. Our physiotherapist and occupational therapists are involved once the acute phase is over and recovery has
begun to work with each patient to provide the appropriate assessment, tools, and interventions needed to optimize recovery. Patients that may benefit from further neurological rehabilitation are sent to specialized pediatric rehab centers.
Our Brachial Plexus speciality clinic includes assessment by our plastic surgeon and pediatric neurosurgeon for birth related injuries to the peripheral nerves, e.g. brachial plexus injuries, and also treatment of peripheral nerve injuries due to trauma or tumors.
Children with cerebral palsy and other neurological disorders may suffer from spasticity of the limbs or dystonia. This can affect the function and quality of life of the child. At El Paso Children’s Hospital, we offer selective dorsal rhizotomy (SDR), a procedure that targets abnormal sensory nerve roots in the spine and through disconnection of this circuit relieves the spasticity in the legs. Other options for
treatment of spasticity include medications, Botox injections into select muscles with spasticity, and baclofen pumps. We work closely with our orthopedic surgeons and orthosis specialists for children with hip dislocations, joint contractures, scoliosis, and short ligaments and tendons for appropriate surgeries to help improve functionality.
The Cranial and Facial Clinic at El Paso Children’s Hospital is the first and only comprehensive pediatric cranial and facial program in the region that provides children in the greater El Paso area access to a dedicated multidisciplinary team of physicians skilled in correcting facial, jaw and skull abnormalities. It is the only Cranial and Facial Team in the region to be nationally recognized by the American Cleft Palate‐Craniofacial Association. It is no longer necessary for families to bear the burden of traveling outside of the region to access this service, and our team provides family‐centered, compassionate care you’ve come to expect from a dedicated children’s hospital.
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