Childhood cancer is a group of diseases where cells grow out of control. It harms health by spreading quickly through the body. It can even threaten a child’s life. The Pediatric Oncology Unit at Acıbadem Healthcare Group focuses on cancers in kids. It covers all stages from infancy to adolescence.

Pediatric Neurology and Neurosurgery

Neurosurgical disorders in children need top medical care.

Acıbadem Pediatric Neurosurgery Center has been a leader in this field for over 30 years. It’s known worldwide for treating complex cases. The center brings together experts from various fields to treat neurological issues in kids.

“A child is not a miniature version of an adult. The difference between a child and an adult is as vast as the difference between a mouse and a giraffe. It is not just in size but also in shape, anatomy and function. Function centers of an adult brain are well established, but unlike adult brains, the brains of children are stil in the process of development. Which means some of the safe zones that we can easily operate on adults, are forbidden in children.”

Prof. Dr. Memet Özek, Pediatric Neurosurgeon, ACIBADEM Healthcare Group

The team at Acıbadem Pediatric Neurosurgery is dedicated and experienced. They offer a wide range of services, including physical therapy and rehabilitation. This team works together to provide the best care for each patient.

Prof. Dr. Memet Özek compares a good surgery team to a string quartet. “These four musicians can be virtuosos in their own but playing together in harmony is what makes them a string quartet. And to achieve that, they have to practice day and night for months, even years. We have been working with the same surgical nurses and technicians for 10 years and 27 years with the same pediatric anesthesiologist. This brings harmony to our work, meaning better outcomes for our tiny patients.”

Diagnosis of Neurosurgical Disorders

Accurate diagnosis is key to successful treatment. Acıbadem Pediatric Neurosurgery Center uses the latest technology for diagnosis. This includes PET, SPECT, EEG, CT, and USG.

Acıbadem has advanced MRI models like Siemens Vida and GE Premier. These models are designed for children, making them comfortable during scans. They provide high-quality images, helping doctors diagnose accurately.

The center also uses a Computer-assisted Three-Dimensional Gait Analysis Device. It helps detect and treat gait disorders in children.

Conditions We Treat

The team at Acıbadem Pediatric Neurosurgery Center treats all neurosurgical pathologies in children. They have special expertise in:

• Deep-seated brain tumors (located in the brain stem and thalamus)
• Epilepsy surgery
• Spasticity surgery
• Endoscopic treatment of hydrocephalus (an alternative to shunt surgery)

Congenital Brain Abnormalities

Congenital abnormalities mean a child is born with brain or spine malformations. There are five main types in pediatric neurosurgery. These include hydrocephalus, brain cysts, encephalocele, craniosynostosis, and cerebral vascular malformations.

• Hydrocephalus is when there’s too much water in the brain, causing pressure. It’s also known as “excessive water accumulation in brain”. This condition harms brain tissue.
• Congenital cysts can appear anywhere in the brain. If they press on brain tissue, surgery is needed after birth. Arachnoid cysts are common, caused by the splitting of the arachnoid membrane.
• Encephalocele is a neural tube defect where brain tissue bulges outside the skull. It happens when the skull doesn’t form properly.
• Craniosynostosis is when the skull sutures close too early. This causes a skull deformity. It can lead to brain pressure and harm if not treated early.
• Cerebral vascular malformations are abnormal blood vessel tangles. They can grow and cause symptoms. They don’t need urgent treatment but should be monitored for brain hemorrhage risk.

Symptoms of Congenital Abnormalities

Hydrocephalus

Newborns (0-1 month): Symptoms include a big head, bulging fontanelle, and thin scalp. They might also vomit, be restless, and have eyes that seem to sink.

Children (1 month or older): Symptoms include a big head, headaches, and nausea. They might also have fever, double vision, and trouble walking or talking.

Congenital cysts

• Headache
• Nausea and vomiting
• Developmental delays
• Excessive fatigue or low energy
• Seizures
• Hydrocephalus due to obstruction of normal cerebrospinal fluid circulation
• Vision problems

Encephalocele

• Hydrocephalus: Cerebrospinal fluid accumulated in the brain
• Vision problems
• Microcephaly: An abnormally small head
• Spastic quadriplegia: Paralysis of the limbs
• Mental and growth retardation
• Ataxia: Uncoordinated muscle movement
• Developmental delay
• Seizures

Craniosynostosis

Changes in the head and face shape are the first signs. A small or absent fontanelle is another clue. In rare cases, it can cause skull pressure.

How are Congenital Abnormalities Diagnosed?

During pregnancy, a perinatologist uses ultrasound scans to check for brain tissue issues. If the ultrasound shows problems, a fetal MRI might be needed. This MRI scan helps find congenital anomalies and make an accurate diagnosis before birth.

After the baby is born, the pediatric neurosurgery team will perform surgery if needed.

Surgical Treatments for Congenital Abnormalities

Surgery is a key treatment for children with congenital brain issues. Sometimes, surgery must happen within the first 36 hours after birth.

Hydrocephalus

• Neuroendoscopic Procedures (Endoscopic Third Ventriculostomy): This method creates a new path for cerebrospinal fluid to flow. It uses a small camera system to avoid leaving a foreign body in the child.
• Ventriculoperitoneal (V/P) Shunt Surgery: This is for those who can’t have endoscopic procedures. It drains fluid from the brain to the abdomen. A thin tube and a valve under the scalp control the flow.

Congenital brain cysts

• Craniotomy: This involves removing part of the skull to access the cyst. It’s a more invasive method but allows for precise treatment.
• Shunt: A tube is inserted into the cyst to drain fluid into the abdominal cavity.

Encephalocele

Surgery is essential for encephalocele, often within the first 3 months. If skin covers the tissue, surgery can wait a few months. Without skin, surgery is needed soon after birth.

Craniosynostosis

In Acıbadem, neurosurgeons often use endoscopic surgery for craniosynostosis. But sometimes, other methods are needed. Endoscopic surgery involves small incisions and a camera for precise work.

Before surgery, the child is under general anesthesia. Neurosurgeons make small cuts in the scalp. A thin tube with a camera is inserted for the surgery.

Patients usually stay in the hospital for two to three days after surgery. Babies may need a helmet to shape their head. This can last from a few months to a year.

Cerebral vascular malformations

Surgery for these malformations uses computer-assisted navigation and a microscope. Neurosurgeons aim to remove the malformation without causing rupture. The best surgical method depends on the malformation’s size, shape, and location, as well as the patient’s health.

Pediatric Brain Tumors

Brain tumors in kids are quite different from those in adults. Some tumors in children are rarely seen in adults. The Acıbadem Pediatric Neurosurgery team focuses on tumors in the brain stem and thalamus.

These areas are tiny but vital. Without them, basic functions like breathing and moving are impossible. Tumors here need a lot of expertise to treat.

At Acıbadem, a high-tech MRI helps the team locate tumors precisely. They use brain mapping and monitorization for accurate surgery. This ensures no harm to vital areas.

All brain tumors, whether malignant or benign, affect patients greatly. A team of experts is needed to plan treatment. They discuss each case in a weekly council.

Even benign tumors can come back. Malignant ones can spread. Acıbadem doctors plan carefully to manage the disease.

Symptoms of Brain Tumors

The most common sign is a persistent headache. Other symptoms include:

• Vomiting, often after waking up
• Slow movements and weakness
• Facial paralysis
• Seizures and loss of consciousness
• Eye deviation and limited gaze
• Difficulty swallowing and speaking
• Restlessness and lack of appetite
• Bulging fontanelle
• Continuous sleepiness
• Neck stiffness

Surgical treatment of brain tumors

Surgery is often the main treatment for pediatric brain tumors. Sometimes, just monitoring or biopsy is enough for slow-growing tumors.

At Acıbadem, thin endoscopes are used for surgery. Patients can be discharged the next day.

An ultrasound-guided aspirator is used during surgery. It helps treat tumors in ventricles without open surgery. Laser technology is also used for precise tumor removal.

Gamma-Knife

Gamma Knife therapy is an option for small tumors. For malignant tumors, surgery is followed by radiotherapy. Gamma Knife is used for tumors that come back after surgery and radiotherapy.

Spasticity

Spasticity is when muscles are too tight. This happens because of an imbalance in signals from the brain and spinal cord. It often makes moving hard. The main cause is cerebral palsy in kids.

Cerebral palsy is a permanent disorder that affects movement in early childhood. Symptoms vary and can change over time. They might include poor coordination, stiff muscles, and weak muscles. There can also be issues with sensation, vision, hearing, swallowing, and speaking.

At Acıbadem, doctors can treat these movement disorders. About 60% of cerebral palsy patients have spasticity. Now, there are many treatments available, not just physical therapy. Our team of experts works together to find the best treatment for each patient.

Symptoms of Spasticity

• Newborn to 2 months old infant: Clinical picture of seizures, difficulty in suckling, severely irregular sleep pattern, prolonged crying
• 3 months old infant: Immobility or failure to coordinate movements of arms and legs
• 4 months old infant: Curling hands into a fist – failure of dorsiflexion in fingers; inability to hold the head up
• 8 months old infant: Crossed/scissor legs when the baby is picked up, stepping on toes, inability to grasp toys
• 10 months or older infants: Delay in crawling and standing on their own, lack of response to some visual or audible stimulus

Spasticity treatments

Pediatric Rehabilitation: Doctors can use physiotherapy and rehabilitation to treat spasticity. It helps in several ways:

• Prevention of physical disorders secondary to spasticity;
• Relieving the spasticity with various techniques;
• Increasing functional capacity to boost independency of the child in daily life;
• Selecting medical aids that the child needs and education on their usage.

Acıbadem also has a movement analysis unit. It uses advanced technology to analyze each patient’s muscles. This helps in planning the best treatment for each child.

Spasticity Surgery

Spasticity surgery is an option when other treatments don’t work. It’s for kids who have trouble moving because of muscle stiffness. It also helps if they’re in pain from muscle spasms.

There are several surgeries that can help:

• Botulinum toxin injection
• Selective Dorsal Rhizotomy (SDR)
• Selective Neurotomy (Selective Fasciculotomy)
• Deep Brain Stimulation (DBS)
• Implantation of Baclofen Pump
• Pallidotomy

Epilepsy

Epilepsy is a brain disorder that causes seizures. These seizures can be brief or last a long time. They can hurt the brain, which is a big worry for kids.

Most kids can be treated with medicine. But some kids need surgery to stop their seizures.

Symptoms of Epilepsy

• Stiffening of the body
• Consciousness problem
• Loss in bladder control
• Stopping breathing
• Not responding to words or noise
• Staring
• Jerking movements of the legs and arms
• Nodding head as rhythmic
• Falling suddenly for no reason (it is associated with loss of consciousness)

Epilepsy surgery

Some kids have epilepsy without a tumor in their brain. Their brain might look normal on an MRI but tests show where seizures start. Surgery might be needed to fix this.

Medicine is the first treatment for epilepsy. But if it doesn’t work, surgery can help. There are different surgeries, like removing part of the brain or using stimulators.

Pediatric Cardiology & Cardiovascular Surgery

United to save hearts!

At Acıbadem Children’s Heart Center, we focus on pediatric heart care. For over 30 years, we’ve treated heart problems in kids. We use the latest technology and care with a human touch.

We’re a leading center in Turkey and the region. We treat all kinds of heart problems in kids. Our doctors are experts in heart surgery, even for the most complex cases.

We use advanced equipment to diagnose and treat heart diseases. Our success rate is over 95%. Kids and families come to us from all over the world.

Children with heart problems get the best care from teams in top facilities. Our hospitals, Acıbadem Bakirkoy and Acıbadem Atakent, have experts in many fields. They work together to help kids with heart issues.

Our team includes doctors in cardiology, surgery, and more. They are always ready to help, thanks to our hospital’s setup. Our nurses are also trained to care for kids in the operating room and ICU.

We focus on the special needs of children with heart problems. Our goal is to give them the best chance at a healthy life. We are all working together to save hearts!

Pediatric heart conditions we treat

Children’s heart problems are different from adults’. They can be born with heart issues or get them later. Some common ones are:

• Heart disorders:
  • Arrhythmia—irregular heart rhythm
  • Cardiomyopathy
• CHD:
  • Atrial septal defect (ASD)
  • Ventricular septal defect (VSD)
  • Atrioventricular septal defect
  • Coarctation of the aorta
  • Hypoplastic left heart syndrome
  • Pulmonary atresia
  • Pulmonary stenosis (PS)
  • Tricuspid atresia
  • Tetralogy of Fallot (ToF)
  • Total anomalous pulmonary venous return
  • Transposition of the great arteries (TGA)
  • Truncus arteriosus
  • Patent ductus arteriosus (PDA)
  • Aortic coarctation

Why should you choose Acıbadem children’s heart center?

Here are some reasons to choose us:

• Cumulative team experience: 15,000 patients in 30 years
• More than 600 patients every year, including those with the most complex congenital heart diseases
• Success rate over 95%
• Our center is a reference center for complex congenital heart diseases and other cardiac conditions in children
• World-class physicians, sophisticated technology, and a patient-centered approach

For international patients

Traveling abroad for your child’s treatment can be stressful. That’s why we have the International Patient Services Center at Acıbadem Children’s Heart Center. It supports you from the moment you arrive until you go back home.

We arrange medical appointments, travel, and accommodation. We also handle airport–hotel–hospital transfers. Our 24-hour interpreting services ensure you understand everything in your native language.

Choosing Acıbadem Turkey means your health journey will be smooth. We focus on your comfort every step of the way.

Symptoms of heart problems in children

About 30% of children with congenital heart diseases need treatment in the first month. Early diagnosis and treatment are key. Recognizing symptoms and seeing a doctor quickly is vital.

The risk of congenital heart disease is higher if a parent has it. Common symptoms include bluish lips and mouth, rapid breathing, and frequent illness. Other signs are unwillingness to nurse, lack of appetite, and tiring easily.

Less serious heart diseases might not show symptoms early. In older children, signs like heart palpitations and shortness of breath could indicate a problem.

Diagnosis of pediatric heart conditions

Congenital heart diseases can be detected prenatally, as early as the 16th week. Fetal echocardiography is a non-invasive test that examines the baby’s heart in-utero. If a problem is found, the baby can be closely monitored and treatment planned for after birth.

Heart problems can also be diagnosed later in childhood. A pediatric cardiologist can perform tests to diagnose cardiac disease. These tests include an ECG, chest x-ray, and echocardiography.

• Electrocardiogram (ECG): This noninvasive test examines heart function. It measures electrical activity and heartbeats.
• Chest x-ray: This shows if the heart is enlarged or if there is extra fluid in the lungs. It has no side effects.
• Echocardiography (cardiac ultrasound): This ultrasound shows live images of the heart. It evaluates heart muscle function.
• Transesophageal echocardiography: This uses a special ultrasound probe through the mouth for better images.
• Stress test: This ECG is performed while the child walks on a treadmill. It detects heart function problems during exercise.
• Cardiac computed tomography: This provides detailed images of the heart and blood vessels. It’s used for complex cases.
• Cardiac magnetic resonance imaging: This uses magnetic technology to provide clear pictures of the heart and blood vessels without radiation.
• Cardiac catheterization and angiography: This method uses a thin tube and x-ray to visualize the heart. It’s used for direct visualization.
• Electrophysiology study: This test diagnoses irregular heartbeats. Special catheters are used to examine the heart and identify abnormal electrical activity.

Interventional pediatric cardiology

Some heart diseases in children can be treated with cardiac catheterization instead of traditional surgery. This method involves inserting a thin, flexible tube called a catheter through a blood vessel to the heart, under x-ray guidance. It can be used for both diagnosis and treatment.

When used to fix a heart defect, the procedure is called interventional catheterization. This method allows experienced physicians to treat certain heart disorders without surgery. Tiny tools can be delivered through the catheter to repair the defect.

For example, balloon catheters can be used to open narrowed valves or vessels. Some catheters can also close holes between the chambers of the heart. Therapeutic interventional procedures include:

• Balloon angioplasty and valvuloplasty: A catheter with a balloon at the tip is inserted to open a narrowed heart valve or vessel.
• Transcatheter aortic valve replacement: An artificial valve is inserted using a catheter instead of via open-heart surgery.
• Transcatheter ASD and VSD closure: Septal defects can be repaired using catheterization techniques.
• Endovascular stenting can be used to expand narrow vessels.
• Electrophysiology and transcatheter arrhythmia ablation can be used for the treatment of heart rhythm problems through cauterization (destruction by heating) of a small tissue using radiofrequency ablation.
• Hybrid procedures and MAPCAs occlusion: Hybrid cardiac procedures are usually used for complex heart conditions. They may combine surgery and cardiac catheterization.

Cardiac catheterization is performed under anesthesia, but it does not require a surgical incision. It allows for fast recovery and a short hospital stay. There are no age restrictions; it can be used for small children and infants immediately after birth.

At Acıbadem Children’s Heart Center, our highly experienced pediatric cardiologists perform advanced interventional procedures with high success rates. Whenever possible, they choose minimally invasive approaches to reduce pain, the recovery period, and the length of the hospital stay.

Surgery and minimally invasive cardiac surgery

Cardiac surgery in children is very different than in adults. It requires experienced pediatric cardiac surgeons and a team of professionals specially trained to work with children. At Acıbadem Children’s Heart Center, we perform all types of pediatric cardiac operations successfully, including complex procedures and reoperations.

There are three main types of heart surgery:

• Open heart surgery: The surgeon opens the chest through the breastbone to get access to the heart. This type of surgery usually requires a heart–lung machine to take over heart and lung functions during the operation.
• Closed heart surgery: The chest cavity is opened, but the heart is not stopped. This surgery can be performed without a heart–lung machine.
• Minimally invasive heart surgery: This is a less invasive surgical approach than the two mentioned above. The surgeon makes tiny incisions to insert special tools and a video camera. Minimally invasive techniques have many advantages over conventional methods, including reduced pain, smaller scars, and shorter recovery periods. In children with well-developed ribcages, certain heart anomalies can be eliminated through robotic surgery.

Treatment of rare and common congenital heart diseases (CHD)

Patent ductus arteriosus

All babies are born with a hole that allows passage between the pulmonary artery and the aorta. This exists because, before birth, the blood does not need to pass through the lungs to receive oxygen. Normally, this hole closes within a few hours of birth. PDA occurs when this connection remains open. It is most often seen in premature babies.

TREATMENT: The passage is closed using a special device called an umbrella or coil delivered through a catheter. Closed heart surgery to reconnect may also be performed, depending on the patient’s age and the extent of the PDA.

Atrial septal defect

An ASD is a hole in the wall between the two upper chambers of the heart (atria). Small ASDs often close during infancy. Larger defects may cause serious problems, including right-sided heart failure, heart rhythm abnormalities, increased risk of stroke, and a shortened life span.

TREATMENT: In some patients, the defect can be closed with catheterization. But the condition usually requires open-heart surgery. After treatment, circulation returns to normal and the child can grow up to be a healthy adult.

Ventricular septal defect

A VSD is a hole in the heart’s wall. This hole lets oxygen-rich blood go back to the lungs instead of to the body. The heart has to work harder to get enough oxygen.

Without treatment, problems can arise. These include high blood pressure in the lungs, heart failure, and infection of the heart valves.

TREATMENT: Doctors might watch the child first to see if the hole closes on its own. But usually, surgery is needed to fix a VSD.

Atrioventricular septal defect

This heart condition has a big hole in the heart and faulty valves. Oxygen-rich blood goes to the wrong side of the heart. This means it gets pumped back to the lungs.

TREATMENT: Babies with serious symptoms need surgery. After surgery, blood flows right again. Sometimes, a second surgery is needed because the valves don’t work well.

Aortic stenosis

Aortic stenosis is a problem with the heart valve. It makes it hard for the heart to pump blood. This can damage the heart if not treated early.

TREATMENT: Kids with mild symptoms need to be watched closely. Those with more serious symptoms might need surgery. This could be a balloon procedure or replacing the valve.

Aortic coarctation

Coarctation of the aorta is a narrowing of the aorta. This makes the left ventricle work too hard. It can lead to kidney failure or heart enlargement if not treated.

TREATMENT: The narrowed part of the aorta is fixed with a balloon or stent.

Tetralogy of Fallot

ToF has four heart problems: a hole in the ventricles, a narrowed pulmonary valve, an aorta that connects to the wrong ventricle, and a muscular right ventricle. It’s the most common cause of blue skin in babies.

TREATMENT: There are two steps. First, a temporary fix is done. Then, a complete repair is performed. After surgery, the heart works normally, and the blue skin goes away.

Pulmonary stenosis

PS is a rare condition where the pulmonary valve is narrowed. This makes the right ventricle work too hard. It can damage the heart muscle over time.

TREATMENT: A balloon procedure can fix it. The success rate is 99%. In severe cases, open heart surgery might be needed.

Transposition of the great arteries

TGA is a common heart defect in kids. It happens when the pulmonary artery and aorta are in the wrong places. This means deoxygenated blood keeps going back into the body.

Babies with TGA are often born blue because their blood doesn’t have enough oxygen.

TREATMENT: Babies need surgery right after birth or early on. Doctors might give drugs first to help. There are two surgeries: arterial switch and atrial switch.

The arterial switch is more common. It fixes the artery problem. But, the atrial switch is less common because it can cause heart rhythm issues.

Tricuspid atresia

The tricuspid valve doesn’t develop in this heart disorder. This means no blood flows from the right atrium to the right ventricle. The right ventricle stays small and can’t handle blood flow well.

TREATMENT: Children might need surgery to fix their heart. This could include making a hole between the heart’s upper chambers or creating a bypass. They might also need a band on the pulmonary artery or more surgeries later.

Pulmonary atresia

This rare heart defect stops blood from flowing to the lungs. The pulmonary valve is not fully developed. Often, the tricuspid valve is also small.

TREATMENT: Treatment varies based on how severe it is. A shunt might be placed using a catheter. The Fontan procedure is also common.

Truncus arteriosus

Here, a single blood vessel comes out of the heart instead of two. There’s also a hole in the heart. This mixes the blood.

TREATMENT: Surgery is needed early in life for most babies with this condition.

Total anomalous pulmonary venous drainage

This rare condition means the pulmonary veins don’t connect right to the left atrium. Blood from the lungs mixes with the body’s deoxygenated blood. Babies lack oxygen and turn blue.

TREATMENT: Surgery is a must. Babies need surgery early in life for this condition.

Hypoplastic left heart syndrome

The left side of the heart is underdeveloped in this disorder. This includes the aorta, aortic valve, left ventricle, and mitral valve.

TREATMENT: Surgery is essential. The treatment involves three surgeries: the Norwood procedure, the Glenn Procedure, and the Fontan Procedure.

Preparing for your child’s stay

Diagnosing a congenital heart defect doesn’t mean you should panic. Today, children with heart issues can lead happy lives. High-volume, experienced teams usually get the best results.

If your child needs surgery, they should be as healthy as possible. Tell the doctor about any health issues before the surgery.

After surgery, following the doctor’s orders is key. A strict diet and medication are often required. Children with heart defects may need ongoing treatment.