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The history of pediatric neurosurgery in Ukraine

     Officially, the history of pediatric neurosurgery in Ukraine dates back to 1997, when by the order of the Ministry of Health of Ukraine № 360 "About introduction of amendments to the list of medical positions in health care" "pediatric neurosurgery" was introduced in the country's specialty. This allowed forming of a neurosurgical service with all necessary attributes - training, their certification and recertification, professional development, opening regional offices or specialized selection of beds in children's hospitals, establishment of a Chief Specialist in the country and areas. At the beginning of 2012 there are 63 pediatric neurosurgeons in Ukraine. Each year, nearly 13 000 of children get the qualified help, 4.5 thousand of them are operated.

     The historical beginning of the pediatric neurosurgery in Ukraine is connected with the creation in the country the Kyiv Science Research Institute of Neurosurgery under direction of the Ministry of Health and opening of the first pediatric neurosurgery department in it in 1950. The clinic was led by such eminent specialists as academics Romodanov A.P. (1950-1951), Zozulya J.A. (1952-1960), professors Pelz B.A. (1960-1980), Brodskyi J.S. (1980-1989). Since 1990 the clinic is led by professor Orlov. J.A.  The research unit - department of neurosurgery of childhood was formed. The main areas of research in sixties were the study the peculiarities of localization, the clinical course and treatment of tumors of the brain and spinal cord at children, the issues of surgical treatment of congenital malformations of the nervous system. The results of these studies were summarized in the doctoral dissertation of Romodanov A.P., in master dissertations of  Priymenko D.P., Hook N., Dunaevsky A.E., Lyashchenko D.S.. The works reflected the current acute health problems of the country. In the next two decades, except those studies, the department paid special attention to labor and traumatic brain injury at children, diseases of early childhood. The department staff participated in the implementation of Union sectorial program S.09 – “Trauma of the central nervous system" (1985-1990), national program “Protection of the gene pool of Ukraine” (1991-1993). The research made it possible to reveal age-related features of brain injury at children, to set the negative trend growth rate of injury and to identify ways of prevention. The Chernobyl accident and its consequences have defined the focus researches on hereditary diseases of the central nervous system at children. The declining birth rates and a decrease at child population in the country gave the particular relevance of the study. It is in this frame of researches were the doctoral dissertations of Brodskyi J.S. (1976), Verbovaja L.N. (1990), Egunian M.A. (1990); candidate’s dissertations of Melnikov B.F. (1976), Telengator A.J. (1984), Verbovaja L.N. (1986), Juraschuk B.P. (1990), Sarmiento O. (1990), Borisova I.A. (1990), Hemio G.A. (1991) were defended.    
The department staff was awarded with the State Prize of Ukraine in the field of science and technology for the implementation of an important science theme for the state"Implantable devices for the treatment of diseases of the central nervous system: the scientific and technical development, production and use in health departments" (1991-2001).
The transition of the institute to the sysytem of the Academy of Medical Science in 1993 changed a little the focus of occupation not only of the institute but also of the department. Continuing the organizational and the applied focus of occupation more attention was paid to the fundamental aspects of scientific occupation.  The comprehensive researches on such topics as - "To study the effects of developmental abnormalities and perinatal defeats of the central nervous system on the level of child morbidity and mortality" (1993-1995 gg.) - the program of the Cabinet of Ministers of Ukraine, "To develop the methods to improve the effectiveness of surgical treatment of malformations of the children’s nervous system in order to reduce mortality and disability, "1994-1996 – the program of the Ministry of Health of Ukraine, "To study the mechanisms of atrophic and reparative processes in the brain of children after birth brain injury"(1996 - 1998) - the program of  the Academy of Medical Sciences of Ukraine, "To develop a clinical and morphological criteria of surgery in brain tumors at children with a glance of the risk level and quality of life of the patient" (1999-2001) - the program of the Academy of Medical Sciences of Ukraine. The use of the fundamental researches in the development of the topics deepened a lot the understanding of the processes in the nervous system in the cases of very different pathologies – birth brain injurie, in the cases of development malformations and tumour lesions.  The results of these studies are shown in publications and dissertations of А. Ahmed (1993), Ganem Bilial (1997), Vishnevskaja L.A. (1998),  Shaverskyi A.V. (2000),  Zentani S. (2000), Marushchenko L.L. (2001), Orlov M.J. (2001), Procenko I.P. (2002), Mot Matieu (2005), Vashchenko A.V. (2006), Jushchak I.A. (2008), Kasianov V.A. (2008), Zvonarev A.G (2009).
      There were not only the representatives of Ukraine among the candidates for a degree but also the representatives of other countries such as: Azerbaijan, Armenia, Belarus, Georgia, Kyrgyzstan, Latvia, Lithuania, Russia, Turkmenistan, Uzbekistan, Estonia, the Dominican Republic, India, Korea, Lebanon, Libya, Cameroon, Mexico, Pakistan, Palestine, Syria, and Ecuador. The former candidates for a degree are today the Ministers of Health, heads of institutions, departments and clinics in their countries.
      The new millennium has identified new tasks for the research department, although the issues of child neurooncology and congenital malformations of the nervous system remained as a priority. The comprehensive researches on such topics as- "The study of structural-biological and clinical features of medulloblastom cerebellum and tumors of the brain stem to increase the efficiency of combined treatment" (2004-2006) - the program of the Academy of Medical Sciences of Ukraine, "To study the morphological, genetic and clinical features of congenital brain tumors at children and to develop methods for early diagnosis, prognosis and the combined treatment"(2007-2009) - the program of the Academy of  Medical Sciences of Ukraine, "To study the effects of environmental, age, occupational and genetic factors in the occurrence of congenital malformations of the nervous system at children and to develop the methods to improve their diagnosis and treatment"(2007-2009) on the basis of the program "Health of the Nation". The department participates in the implementation of state program "Children's oncology". The increased attention to the problem caused by the growth of cancer incidence at children, especially in the young age group, the worst results of combined treatment as compared to adults. The themes "To study the factors that affect the metastasis of brain tumors at children, with a glance to early diagnosis and treatment", "To study the development of intracranial hemorrhage in neonates and to develop measures to improve the results of their treatment" are being performed since 2010.
The scientific work is constantly combined with a practical work in order to provide a specialized assistance to the most severe patients who can not be treated on the places. Due to the improvement of technical equipment of the diagnostic unit in the Institute (КТ, МРТ, ОФЭКТ), operating department (microscopes, ultrasonic aspirators, endoscopic desk, high speed elektrotrepan, autotransfusion device), the growth of neurosurgical training assistance the aid began to be provided to children who were previously put contraindication to neurosurgical treatment and were doomed. The results of the surgical department were significantly improved.  During this period, surgical activity increased from 67.7% to 95.4% (at cancer lesions from 82.6% to 83.7%, and hydrocephalus from 76.5% to 86.0%, with deformities from 75, 3% to 88.0%). Overall mortality decreased from 8% to 3.9% (at cancer lesions from 18.1% to 8.1%, with hydrocephalus from 10.1% to 2.9%, with the development of deformities from 14.8% to 1.1 %, and head injury - from 0.8% to 0%, and genetic head injury from 0.9% to 0%). Postoperative mortality decreased from 8.0% to 2.8% (at cancer lesions from 14.4% to 8.0%, with hydrocephalus from 5.6% to 0.9%, with the development of deformities from 19.7% to 1.8%, in the cases of head injury 1.7% to 0%, and genetic head injury from 0.9% to 0%).
In 1999 the second children department was opened -  the Department of Urgent Neurosurgery for Children (the head of the department – Koverkov G.A.), which in 2010 transformed into a branch of congenital malformations and spinal neurosurgery at children. At the same time the children's surgery and resuscitation block with two operating rooms and reanimation department for children was formed (the head of the department – Gavrish R.V.). Since 2012 the head of the Department of Cerebral Neurosurgery of the Child Age is Shaverskyi A.V.
Over the past 10 years the department has become the scientific and organizational, consultative center for pediatric neurosurgery, the basis of training. In clinics where the experienced neurosurgeons work (Professor Orlov Y.A.,  candidate of science – Shaverskyi A.V., Koverkov G.A., Skobskyi E.I., Plavskyi N.V., Borisova I.A., Maruschchenko L.L., Procenko I.P., neurosurgeons – Mihaluk V.S., Plavskyi P.N., Svist A.A.) annually more than 700 operations  for children wi...