Pediatric Neurosurgery in Kerala — Advanced Care for Children’s Brain & Spine Conditions
Internationally Validated Expertise for Your Child
When your child faces a neurosurgical condition, you need a surgeon whose training, research, and results have been validated at the highest international level. Dr. Biji Bahuleyan completed dedicated paediatric neurosurgery fellowship training at Rainbow Babies and Children’s Hospital, Case Western Reserve University (CWRU) in Cleveland, Ohio — one of the most respected paediatric neurosurgery programmes in the United States.
This fellowship, combined with his neurosurgical oncology training at the Cleveland Clinic and neuroendoscopy training at Harvard Medical School, has given him a rare depth of subspecialised expertise. He has developed four first-in-the-medical-literature endoscopic techniques — innovations published in peer-reviewed journals and cited globally.
With over 200 epilepsy surgeries and 300+ Endoscopic Third Ventriculostomy (ETV) procedures, Dr. Bahuleyan brings a volume of paediatric neurosurgical experience that is exceptional in Kerala and across India. His ETV research demonstrated a 75% long-term shunt-free success rate — results that were incorporated into the Congress of Neurological Surgeons (CNS) 2020 Paediatric Hydrocephalus Guidelines and cited in Nature Reviews Disease Primers.
Every child treated at Caritas Neuro Sciences benefits from this combination of world-class training, published innovation, and compassionate care — delivered right here in Kerala.
Times of India Coverage: Child Saved After Cardiac Arrest During Brain Surgery
In a case that made headlines in the Times of India, Dr. Biji Bahuleyan successfully saved a paediatric patient who suffered cardiac arrest during an endoscopic neurosurgical procedure. The child, who was found to have a rare Stenotrophomonas maltophilia brain infection, underwent emergency resuscitation and definitive neurosurgical treatment. The team’s rapid response and expertise turned a life-threatening crisis into a full recovery.
This remarkable case was subsequently published as a peer-reviewed article in Access Microbiology (indexed on PubMed), contributing to the global medical literature on managing rare CNS infections in children. It demonstrates the calibre of emergency preparedness and clinical expertise available at Caritas Neuro Sciences.
Conditions We Treat in Children
Comprehensive paediatric neurosurgical care spanning brain tumours, epilepsy, hydrocephalus, trauma, congenital malformations, and more — backed by fellowship training and published research.
Brain and spinal cord tumours are the most common solid tumours in children. Treatment requires a surgeon who understands the unique biology of paediatric tumours — they behave differently from adult tumours and demand specialised approaches to maximise cure while protecting the developing brain.
Dr. Bahuleyan’s Neurosurgical Oncology fellowship at the Cleveland Clinic provided focused training in tumour surgery using advanced techniques including intraoperative MRI, neuronavigation, and fluorescence-guided resection. He treats the full spectrum of paediatric brain tumours:
- Medulloblastomas and other posterior fossa tumours
- Low-grade and high-grade gliomas
- Ependymomas
- Craniopharyngiomas
- Choroid plexus tumours
- Pineal region tumours
- Spinal cord tumours (astrocytomas, ependymomas)
- Optic pathway gliomas
- Dermoid and epidermoid cysts
Every paediatric tumour case is discussed in a multidisciplinary tumour board with paediatric oncologists, radiation oncologists, and neuroradiologists to develop the optimal treatment plan for each child.
For children with drug-resistant epilepsy, surgery can be transformative — and in many cases, curative. Dr. Bahuleyan has performed over 200 epilepsy surgeries and developed four first-in-the-medical-literature endoscopic techniques that have advanced the field of minimally invasive epilepsy surgery globally.
His epilepsy surgery programme at Caritas includes comprehensive pre-surgical evaluation with video-EEG monitoring, high-resolution MRI, PET scans, and neuropsychological assessment. Surgical options include:
- Hemispherotomy — for children with hemispheric epilepsy syndromes
- Lesionectomy — targeted removal of epileptogenic lesions
- Temporal lobectomy & amygdalohippocampectomy — for temporal lobe epilepsy
- Corpus callosotomy — for drop attacks and generalised seizures
- Hypothalamic hamartoma surgery — including endoscopic approaches
- Vagal nerve stimulator (VNS) implantation — for non-surgical candidates
- Invasive EEG monitoring (SEEG) — for precise seizure localisation
Dr. Bahuleyan’s published innovations include the first endoscopic-assisted hemispherotomy, first pure endoscopic corpus callosotomy, and first endoscopic hypothalamic hamartoma disconnection — techniques now cited in global neurosurgical literature.
Hydrocephalus — excess cerebrospinal fluid in the brain — is one of the most common conditions requiring paediatric neurosurgery. Traditionally treated with VP shunts, many children can now be treated with Endoscopic Third Ventriculostomy (ETV), a minimally invasive procedure that creates a natural drainage pathway without permanent hardware.
Dr. Bahuleyan has performed over 300 ETV procedures — one of the largest single-surgeon series in India. His published research demonstrated a 75% long-term shunt-free success rate, meaning three out of four children treated with ETV never need a shunt. This research has had global impact:
- Incorporated into the CNS 2020 Paediatric Hydrocephalus Guidelines
- Cited in Nature Reviews Disease Primers
- Referenced in UpToDate — the world’s most widely used clinical decision resource
- Published in leading neurosurgical journals
For children who are not candidates for ETV, Dr. Bahuleyan also performs VP shunt placement and revision using the latest programmable valve technology. Combined ETV with choroid plexus cauterisation (ETV+CPC) is offered for selected infants.
Traumatic brain injury (TBI) and spinal injuries in children require urgent, specialised neurosurgical intervention. The paediatric brain and spine respond differently to trauma compared to adults, and treatment must account for ongoing growth and development.
Caritas Neuro Sciences provides 24/7 emergency neurosurgical care with a dedicated paediatric ICU. Dr. Bahuleyan manages the full spectrum of paediatric neurotrauma:
- Epidural and subdural haematomas — emergency surgical evacuation
- Depressed skull fractures — elevation and repair
- Growing skull fractures — a condition unique to children
- Compound and penetrating injuries — debridement and reconstruction
- Paediatric spinal fractures — conservative and surgical management
- Non-accidental head injury — recognition and management
- Post-traumatic hydrocephalus — ETV or shunt procedures
- Cranioplasty — skull reconstruction after decompressive surgery
The team coordinates closely with paediatric intensivists, rehabilitation specialists, and neuropsychologists to ensure optimal recovery for every child.
Congenital malformations of the brain and spine are conditions present from birth that may require neurosurgical intervention in infancy, childhood, or even later in life. These conditions require a surgeon with deep understanding of paediatric neuroanatomy and developmental neuroscience.
Dr. Bahuleyan’s paediatric neurosurgery fellowship at Rainbow Babies and Children’s Hospital, CWRU, provided comprehensive training in managing:
- Chiari malformation (Types I & II) — posterior fossa decompression with duraplasty
- Syringomyelia — addressing the underlying cause (Chiari, tethered cord, tumour)
- Tethered spinal cord — microsurgical detethering to prevent progressive neurological deterioration
- Spina bifida & myelomeningocele — primary closure, management of associated hydrocephalus, and long-term follow-up
- Encephalocele — surgical repair and reconstruction
- Craniosynostosis — surgical correction of premature skull suture fusion
- Dandy-Walker malformation — management of associated hydrocephalus
- Lipomyelomeningocele — prophylactic and therapeutic detethering
These conditions often require long-term follow-up and coordinated care with paediatric neurologists, urologists, and rehabilitation specialists — all available within the Caritas Hospital network.
Beyond the major categories of paediatric neurosurgery, several additional conditions in children require specialised neurosurgical expertise.
Arachnoid Cysts
Arachnoid cysts are fluid-filled sacs that can occur anywhere in the brain or spinal cord. While many are discovered incidentally and require only monitoring, symptomatic cysts — those causing headaches, seizures, developmental delay, or hydrocephalus — may need surgical treatment. Dr. Bahuleyan offers both endoscopic fenestration (minimally invasive) and microsurgical approaches depending on cyst location and size.
Spasticity
Cerebral palsy and other conditions causing severe spasticity can significantly limit a child’s mobility and quality of life. Neurosurgical options include:
- Selective dorsal rhizotomy (SDR) — permanent reduction of spasticity in the lower limbs
- Intrathecal baclofen pump — continuous medication delivery for generalised spasticity
Vascular Conditions
Paediatric vascular conditions of the brain, while rare, require prompt and expert management:
- Arteriovenous malformations (AVMs) — surgical excision or multimodal treatment
- Cavernous malformations — microsurgical removal when symptomatic
- Vein of Galen malformations — multidisciplinary management
- Moyamoya disease — revascularisation procedures
- Paediatric aneurysms — surgical clipping
Four First-in-the-Medical-Literature Techniques
Published innovations in endoscopic neurosurgery that have advanced paediatric care worldwide.
Endoscopic-Assisted Hemispherotomy
First published technique combining endoscopic visualisation with hemispherotomy for paediatric hemispheric epilepsy — enabling better visualisation of deep structures while reducing brain retraction and surgical morbidity.
Published in peer-reviewed neurosurgical literaturePure Endoscopic Corpus Callosotomy
First reported technique for performing complete corpus callosotomy entirely through an endoscopic approach — replacing the need for large craniotomy in children with drop attacks and generalised seizures.
Published in peer-reviewed neurosurgical literatureEndoscopic Hypothalamic Hamartoma Disconnection
First described endoscopic disconnection technique for hypothalamic hamartomas causing gelastic seizures in children — a minimally invasive alternative to open surgery for a deep-seated, challenging lesion.
Published in peer-reviewed neurosurgical literatureEndoscopic Interhemispheric Approach
First reported endoscopic interhemispheric approach for accessing midline brain lesions — expanding the reach of minimally invasive surgery to previously difficult-to-access areas in children.
Published in peer-reviewed neurosurgical literatureWhy Choose Dr. Biji Bahuleyan for Your Child
A combination of credentials, outcomes, and recognition that is unmatched in Kerala.
Triple Fellowship Training
Paediatric neurosurgery at CWRU, neurosurgical oncology at Cleveland Clinic, and neuroendoscopy at Harvard Medical School — three of the world’s most prestigious medical institutions.
Four First-in-World Techniques
Developer of four first-in-the-medical-literature endoscopic neurosurgical techniques — published innovations that have shaped how paediatric epilepsy surgery is performed globally.
300+ ETV Procedures
One of the largest single-surgeon ETV series in India with a published 75% long-term shunt-free success rate — giving three out of four children freedom from lifelong shunt dependence.
CNS Guidelines Contributor
Research cited in the Congress of Neurological Surgeons 2020 Paediatric Hydrocephalus Guidelines, UpToDate, and Nature Reviews Disease Primers — shaping global clinical standards.
Media Recognition
Featured in the Times of India for saving a child who suffered cardiac arrest during surgery — a case that showcases the clinical expertise and emergency preparedness of the team.
NABH-Accredited Hospital
Caritas Hospital Kottayam is NABH-accredited with advanced neurosurgical infrastructure, dedicated paediatric ICU, and the technology standards expected at the nation’s best centres.
Safety & Infrastructure for Paediatric Neurosurgery
The technology and clinical environment your child deserves.
High-Definition Neuroendoscopy
State-of-the-art endoscope systems enabling minimally invasive procedures with superior visualisation of delicate brain structures in children.
Intraoperative Neuronavigation
Real-time 3D image guidance for precise surgical planning and execution, minimising tissue disruption and maximising safety during surgery.
Neurophysiology Monitoring
Continuous intraoperative monitoring of brain and spinal cord function to protect critical neural pathways during surgery.
Dedicated Paediatric ICU
Specialised paediatric intensive care unit with trained paediatric intensivists, child-specific monitoring equipment, and age-appropriate care protocols.
Advanced MRI & CT Imaging
High-resolution MRI and CT scanners with paediatric-optimised protocols for accurate diagnosis and surgical planning with reduced radiation exposure.
Micro-Neurosurgical Instruments
Paediatric-sized microsurgical instrumentation designed for the smaller anatomy of children, ensuring precision and safety in every procedure.
Frequently Asked Questions for Parents
Answers to the questions parents ask most about paediatric neurosurgery.
At what age can a child undergo epilepsy surgery?
Children can undergo epilepsy surgery as early as infancy if seizures are severe and drug-resistant. Early intervention is critical because the developing brain has remarkable plasticity — the younger the child, the better the brain can reorganise function after surgery. Dr. Bahuleyan has performed epilepsy surgery on children across all age groups, with over 200 procedures including hemispherotomy, lesionectomy, and callosotomy. Each case is carefully evaluated with video-EEG monitoring, MRI, and PET scans to determine the optimal timing and approach.
What is the difference between ETV and a VP shunt for hydrocephalus?
Endoscopic Third Ventriculostomy (ETV) creates a natural drainage pathway inside the brain using a tiny endoscope, eliminating the need for a permanent shunt device. A VP shunt, by contrast, is a mechanical tube that diverts cerebrospinal fluid from the brain to the abdomen. ETV has the advantage of being shunt-free — no hardware to malfunction, no lifelong device dependence. Dr. Bahuleyan has performed over 300 ETVs with a published 75% long-term success rate, and his research was incorporated into the CNS 2020 Paediatric Hydrocephalus Guidelines. ETV is not suitable for every child, so a thorough evaluation determines the best option.
What warning signs should parents watch for after a child's head injury?
After any significant head injury, parents should watch for: persistent or worsening headache, repeated vomiting, unusual drowsiness or difficulty waking, seizures, clear fluid leaking from the nose or ear, unequal pupil size, weakness or numbness in limbs, confusion or unusual behaviour, and a bulging fontanelle in infants. If any of these signs appear, seek emergency neurosurgical evaluation immediately. Dr. Bahuleyan and the Caritas Neuro Sciences team provide 24/7 emergency neurosurgical care with a dedicated paediatric ICU.
Does Caritas Hospital have the equipment needed for paediatric brain surgery?
Yes. Caritas Hospital Kottayam is NABH-accredited and equipped with advanced neurosurgical technology including high-definition neuroendoscopy systems, intraoperative neuronavigation, intraoperative neurophysiology monitoring, a dedicated paediatric ICU, high-resolution MRI and CT imaging, and micro-neurosurgical instrumentation sized for paediatric patients. The hospital meets the same infrastructure standards as major metropolitan neurosurgical centres, ensuring the highest level of safety for children.