PEDIATRIC NEUROLOGICAL SURGERY
Pediatric Neurological surgery is a subspecialty of Neurosurgery that deals with
infants and children. It includes, but is not limited to, the medical and surgical
treatment of patients with congenital, degenerative, vascular, inflammatory and
neoplastic disorders of the central and peripheral nervous system.
The identity of Pediatric Neurosurgery was established by the early 1960s in
major world cities such as London, Paris, Buenos Aires, Boston, Chicago and
Toronto, each of which had free-standing children's hospitals served by
dedicated pediatric neurosurgeons. However, it was not uncommon then for a
children's neurosurgeon, who had accumulated experience with the nuances of
Pediatric Neurosurgery, to also manage a part-time practice in Adult
Neurosurgery. Nonetheless, the momentum was underway with respect to the
identity of the full-time pediatric neurosurgeon. The practice of Pediatric
Neurosurgery as a sub-discipline of Neurosurgery was set in the 1970s. The
International Society for Pediatric Neurosurgery was created in 1972 and shortly
thereafter the American Society of Pediatric Neurosurgeons was formed (1978),
followed by both European and Japanese Societies for Pediatric Neurosurgery.
Similarly, the American Association of Neurological Surgeons and the Congress
of Neurological Surgery established a combined Section of Pediatric
By the early 1980s, neurosurgical practice groups had made the transition away
from delegating Pediatric Neurosurgery to the most junior practitioner in the
group, who may or may not have possessed experience in children’s
Now it is understood that a neurosurgeon who is to take responsibility for a
child’s structural disease within the nervous system must hold special
qualifications. As a starting point, a one-year fellowship in Pediatric Neurosurgery
may by itself be acceptable. In some jurisdictions, such as North America, the
fellowship is designed so that the pediatric practitioner will also:
1. Acquire that experience in an accredited institution,
2. Pass a written examination, and
3. Receive a certificate of competence in the discipline of Pediatric
Alternatively, in some European regions the pediatric neurosurgeon may have:
Obtained instruction in pediatric
neurosurgery via a formal lecture/seminar
Received a certificate of competence in
the discipline of Pediatric Neurosurgery.
Further, in North America, to maintain competence it is required that the
practitioner be responsible for the operative care of a minimum of 125 cases per
year, of which at least 50 percent should be conducted on children less than 12
years of age.
One metaphor that is often used to describe the activities of a neurosurgeon who
practices in a university environment is that of a three-legged stool.
Such an individual provides excellent patient care, serves as an educator and is
able to conduct research. If the research is outcome based, then the pediatric
neurosurgical investigator can bring to his/her international colleagues those
features of children’s neurosurgery that are unique or idiosyncratic to his/her
population base or cultural environment.
Children’s neurosurgery is the most rewarding professional activity within the
discipline of Neurosurgery. Its practitioners have always held the belief that:
Children are our Future.
The following table shows the number of pediatric patients managed in the
Section of Neurosurgery for the past two and a half years:
Total pediatric admissions 170 202 97
(25.8%) (29.4%) (28%)
Total pediatric surgical 170 203 83
procedures (29.9%) (33%) (29.4%)
Total pediatric outpatient clinic 890
The prospective candidate must have completed formal residency training in
Neurological Surgery and be board certified by the Saudi Council for Health
Specialties (SCHS) or its equivalent.
A candidate must have successfully completed a personal interview by members
of the section concerned.
Duration of Fellowship
This Fellowship Program consists of two years of full-time structured supervised
training in Pediatric Neurosurgery. An optional third year may be offered to
meritorious fellows to undertake clinical research in the subspecialty.
Number of Fellowship Positions
One clinical fellow will be accepted each year. An additional fellow may be
accepted if deemed necessary.
Qualifications of the Fellowship Program Staff
A. Fellowship Director Qualifications
The fellowship director must be a SCHS (or equivalent) certified
neurological surgeon possessing special expertise in the surgical and medical
evaluation and management of pediatric problems.
B. Responsibilities of the Fellowship Director
As outlined in rules and regulations of the Academic & Training Affairs
(ATA) Fellowship Training Program.
C. Other Teaching Faculty Qualifications and Number
1. All clinical faculty members who are neurological surgeons shall be
certified by the SCHS or possess equivalent qualifications. In addition to
the program director, the teaching staff must include, at a minimum, one
other board certified neurological surgeon who has special expertise in the
area of Pediatric Neurosurgery and who concentrates his/her practice in
All members of the teaching staff must demonstrate a
strong interest in the education of fellows, sound
clinical and teaching abilities, support of the goals and
objectives of the fellowship program, a commitment to
their own continuing medical education, and
participation in scholarly activities.
The faculty must have regular documented meetings
to review the fellowship training, the financial and
administrative support of the program, the volume and
variety of patients available for educational purposes,
the performance of members of the teaching staff,
and the quality of fellowship supervision.
D. Other Personnel
The fellowships program must be provided with the additional professional,
technical, and clerical personnel needed to support its administration and
1. The fellowship training must provide broad educational experience in
Pediatric Neurological Surgery, which will complement the training in the
neurosurgery residency to promote further acquisition of knowledge and
skills in the subspecialty.
2. A minimum of six (6) months of fellowship training will be spent in a clinical
Pediatric Neurosurgery experience under the
direction of specified clinical faculty. This
period of time must provide the trainee with an
organized, comprehensive, supervised, full
time educational experience in the field of
Pediatric Neurosurgery. This should include
comprehensive patient care, diagnostic
modalities, the performance of surgical
procedures, and the integration of non-
operative and surgical therapies into clinical
3. Each fellowship should provide a broad exposure to clinical evaluation and
appropriate patient selection for operative and non-operative management
in both the inpatient and outpatient settings.
4. Each fellow should actively participate in the operative management of a
wide range of pediatric disorders, including traumatic, degenerative,
neoplastic and congenital conditions. Progressive responsibility in patient
management should be provided. A broad exposure to modern pediatric
surgical techniques is considered an integral part of the Pediatric
Neurosurgery fellowship experience and training.
5. Clinical, anatomic, biomechanical, and neuroscience research constitute
an integral component of the educational experience, and provision should
be made for the successful completion of research projects. Full-time
experience in research will require an extension of the fellowship beyond
the basic six months of clinical training.
The Educational Program
1. All educational components of the fellowship program should be related to
the specified goals and must not interfere with the training opportunities of
residents who are members of the neurosurgical residency program.
2. The fellowship program and/or structure must be reviewed for re-
accreditation by the Committee on Subspecialty Training in ATA.
3. A participant in an accredited fellowship program shall have broad
exposure to the full spectrum of Neurosurgery, with sufficient senior
clinical experience to warrant a focused experience to build upon his/her
already acquired skills. It is anticipated that any fellow will have both the
technical expertise and intellectual maturity to understand and apply the
A. Clinical Components
1. A minimum of two (2) years of fellowship training must be spent in clinical
activities in Pediatric Neurosurgery. That will include daily clinical rounds
and at least two (2) full operating days weekly.
2. The responsibility or independence given to fellows in patient care must
be dependent upon the fellow’s demonstrated knowledge, manual skill,
experience in the complexity of the patient’s illness, as well as the
perceived risks of the surgical management.
3. A portion of the fellowship experience should be allocated to training in an
outpatient clinic or office setting that provides preoperative, perioperative
and postoperative continuity of patient care. That includes at least two (2)
to three (3) Pediatric Neurosurgery clinics weekly, one combined Spina
Bifida clinic weekly, one combined craniofacial clinic monthly, and one
combined antenatal clinic monthly.
B. Other Components
4. The fellowship program should provide opportunities for the fellow to
engage in research relative to the subspecialty.
5. The fellow should actively participate in scholarly activities and should
contribute to the education of Neurosurgery residents by participating
actively in Department of Neurosciences weekly postgraduate activities.
6. The fellowship program should have regular dedicated teaching
conferences with participation of the fellow, the associated faculty, and the
residents. Participation of other affiliated disciplines should be
encouraged. A weekly one-hour dedicated Pediatric Neurosurgery
education section will be initiated.
C. Fellowship Policies
1. All patient care services must be supervised by appropriately qualified
faculty in accordance with institutional guidelines.
2. The fellow who has completed an accredited Neurosurgery residency
program may function independently as a junior staff neurosurgeon
consistent with institutional and departmental/division policies.
3. The fellowship director must insure direct and documented proper
supervision of the fellow at all times by attending physicians with
appropriate experience for the severity and complexity of the patient’s
condition. The fellowship trainee must be provided with rapid, reliable
systems for communication with supervisors.
Maintenance of Case Logs
1. The fellowship program director must maintain accurate case logs of
the Pediatric Neurosurgery case material operated annually within the
institution and the subspecialty experience of the graduating chief
resident(s) throughout his/her training as well as that of the fellow.
2. The fellow must maintain an accurate prospective case log of his/her
operative cases throughout the fellowship that documents all operative
cases and the level of responsibility in the case (assistant versus
Duty Hours and Conditions of Work
Duty hours and work conditions for subspecialty fellows must be
consistent with ATA institutional and program requirements for residency
training in Neurological Surgery.
1. As specified earlier, there shall be written evaluations and constructive
discussions of the fellow by the faculty relative to performance and
accomplishments of stated goals. These evaluations must occur at a
minimum of two (2) times per year and be maintained in a permanent file.
2. The fellow shall provide an evaluation of the faculty and fellowship
program. This may be submitted to the fellowship program director at
completion of the fellowship training. The ATA, if requested, should
maintain this evaluation in a permanent file for review.
Regulations governing leaves are as stipulated in the Policy for Fellowship
Evaluation and Promotion
The fellow’s level of competence and performance will be evaluated at a
frequency determined by the Postgraduate Education Committee and in the
manner detailed in the Policy for Fellowship Training Program. A self-
assessment examination covering the different topics in the subspecialty will
be given at the end of the first and second years of fellowship training. A
fellow’s advancement from year to year is contingent upon professional
performance and personal growth. The criteria for promotion are enumerated
in the Policy for Fellowship Training Program. Promotion depends on
evaluation and the end-of-year examination.
A certificate of fellowship training at King Faisal Specialist Hospital &
Research Centre will be awarded upon satisfactory completion of the
requirements of the program and passing of the end-of-year examination.