Posterior Fossa Tumors in Children
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Abstract:
Division of Neurosurgery, The New York Hospital/Cornell University Medical Center, 525 E. 68th St., New York, NY 10021; *Division of Pediatric Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.Keywords:
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Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.
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Subspecialty training in pediatric neurosurgery has been a widely discussed topic over the past several years. This paper will discuss the rationale for subspecialization in neurosurgery, describe what makes pediatric neurosurgery unique as a subspecialty area of neurosurgery, and present a rationale for fellowship training in pediatric neurosurgery following the completion of a general residency in neurosurgery. The difference between fellowship and residency training is outlined, and the importance of integrating the fellowship with the neurosurgical training program is emphasized. Controversies regarding structure of the pediatric neurosurgical fellowship, 'certification' of the fellowship training, and issues of supply and demand are reviewed.
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