An open access, multimedia website about the surgical illnesses found in the nervous system of children and their management.

Embryology of the Central Nervous System in Children Homepage

Author

Mark Dias, M.D.

Section Editors

Bermans J. Iskandar, M.D.

Graham Fieggen, M.D.

Senior Editor

Ann Ritter, M.D.

Editor In Chief

Rick Abbott, M.D.

Introduction

During the first 4 weeks after fertilization, the CNS of the embryo undergoes a series of morphological and structural changes that result in the formation of the neural tube (brain and spinal cord). These can be divided into four phases: 1) blastogenesis, 2) gastrulation, 3) primary neurulation, and 4) secondary neurulation. Once neural tube formation is completed, a series of additional morphological changes occurs within the brain and spinal cord, divided into four additional phases: 1) ascent of the conus medullaris, 2) development of the cranial vesicles and flexures, 3) formation of the basal and alar plates and their derivatives, and 4) migration of neuronal and glial cells. Each of these processes will be summarized in this chapter. The term “postovulatory day” (POD) will be used to describe the phase or gestational age of the embryo; this designation is used in standard embryology studies to describe human embryonic development.

Key Points

  • Gastrulation – conversion of two-layer to three-layer embryo: Gastrulation results in conversion of a two-layered embryo, containing epiblast and hypoblast, to a three-layered embryo, containing ectoderm, mesoderm, and endoderm.
  • Primary neurulation – CNS formation to S2: Primary neurulation results in formation of the brain and spinal cord as far caudal as the second sacral segment (S2) and separation (dysjunction) of the cutaneous ectoderm from the neuroectoderm.
  • Secondary neurulation – cord formation distal to S2: Secondary neurulation forms the spinal cord caudal to S2 and the filum terminale from a different embryonic mechanism.
  • Ascent of conus to L1-L2: Ascent of the conus medullaris results in the tip of the conus lying most commonly opposite the L1-L2 disk space; a conus below the mid-body of L2 is tethered radiographically.
  • Vesicle and flexure formation shapes brain: The formation of the primary and secondary vesicles and three flexures contributes to the ultimate shape and structure of the brain.
  • Neuronal migration region specific: Neuronal migration occurs in a specified pattern from basal and alar plate neurons, a process that is modified somewhat within each regional level of the neuraxis.

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Functional Disorders of the Nervous System in Children

Section Editors

Sanjiv Bhatia, M.D.

William Harkness, M.D.

Editor-in-Chief

Rick Abbott, M.D.


Acknowledgements

Editor-in-Chief

Rick Abbott, M.D.

Director, Surgical Neuro-oncology, Children’s Hospital at Montefiore

Professor Neurosurgery and Pediatrics, Albert Einstein College of Medicine

Department of Neurosurgery, Montefiore Medical Center

111 E. 210th St

Bronx, NY 10467

USA

 

Phone: 001 718 920-8512

Email: rickabbott@me.com

Website: http://www.montekids.org/services/neurosurgery/physicians/abbott/

Senior Editor

Ann Ritter, M.D.

Associate Professor

Virginia Commonwealth University

417 North 11th St, 6th Floor

Richmond, VA 23298

USA

 

Phone: 804-828-9165

Email: aritter@mcvh-vcu.edu

Publication Manager

Zulma Tovar-Spinoza, M.D.

Assistant Professor of Neurosurgery

SUNY Upstate Medical University

750 E Adams St

604 Jacobsen Hall

Syracuse, NY

USA

 

Phone: 001 315 464-4418

Website: www.upstate.edu/neurosurgery

Linkedin: Zulma Tovar-Spinoza

Section Editors

Douglas Brockmeyer, M.D.

Chief of Pediatric Neurosurgery

Professor of Neurosurgery, Adjunct Professor of Pediatrics

University of Utah

Primary Children’s Hospital

Pediatric Neurosurgery

100 N Mario Capecchi Drive

Salt Lake City, UT 84113

USA

 

enkode|douglas.brockmeyer@hsc.utah.edu

Adrian Caceres, M.D.

Associate Professor in Neurosurgery and Pediatric Surgery, University of Costa Rica.

National Children´s Hospital of Costa Rica.

Paseo Colón y Calle 20 sur

Servicio Neurocirugía 4 piso

San José

Costa Rica

 

Phone: 011 506 25233600 Ext. 4519,4520

Email: neuroqx@gmail.com

Skype: Adrian.caceres.chacon.1

Website: www.icneuro.com

Linkedin: Adrian Caceres

Oguz Cataltepe, M.D.

Director, Pediatric Neurosurgery

University of Massachusetts Memorial Medical Center

55 Lake Avenue North, S2-848

Worchester, MA 02493

USA

 

Phone: 001 508 334-7667

Email: oguz.cataltepe@umassmemorial.org

Shlomi Constantini, M.D.

Pediatric Neurosurgery

Dana Children’s Hospital, Tel-Aviv Medical Center

6, Weizman Street

Tel Aviv

62439

Israel

 

Email: sconsts@netvision.net.il

Graham Fieggen, M.D.

Division of Neurosurgery

Groote Schuur Hospital

Old Main Building

Main Road

Observatory

Cape Town 7925

South Africa

 

Email: graham.fieggen@uct.ac.za

Bermans J. Iskandar, M.D.

Director Pediatric Neurosurgery

Professor of Neurosurgery and Pediatrics

University of Wisconsin Hospital and Clinics, Department of Neurosurgery

Madison, WI 53792

USA

 

Phone: 001 608 263-9651

Email: iskandar@neurosurg.wisc.edu

David Sandberg, M.D., FAANS, FACS, FAAP

Associate Professor

University of Texas Health Science Center at Houston, Children’s Memorial Hermann Hospital, and the University of Texas MD Anderson Cancer Center

6431 Fannin Street, MSB#5.144

Houston, Texas

USA

 

Phone: 001-713-500-7370

Email: David.I.Sandberg@uth.tmc.edu

Paul Steinbok, M.B.B.S., FRCSC

Professor

British Columbia’s Children’s Hospital and University of British Columbia

4480 Oak St, K3-159

Vancouver, BC

Canada

 

Phone: 001-604-875-2094

Email: psteinbok@cw.bc.ca

Edward R. Smith, M.D.

Associate Professor

Harvard Medical School

Director, Pediatric Cerebrovascular Surgery

Department of Neurosurgery / Vascular Biology Program

Children’s Hospital Boston / Harvard Medical School

300 Lonwood Ave.

Boston, MA 02115

USA

 

Phone: 001=617-355-8414

Email: Edward.Smith@childrens.harvard.edu

Gianpiero Tamburrini, M.D.

Associate Professor

Pediatric Nerosurgery

Institue of neurosurgery

Catholic University Medical School

Largo Agostino Gemelli, 8

Rome 00168

Italy

 

Phone: 390630155925

Email: gianpiero.tamburrini67@gmail.com

Linkedin: Gianpiero.Tamburrini

Dominic Thompson, MBBS BSc FRCS(SN)

Honorary Senior Lecturer

Great Ormond Street Hospital

Institute for Child Health

Great Ormond Street

Department of Paediatric neurosurgery

London, WC1N 3JH

United Kingdom

Manuscript Editor

Arlene Stolper Simon, M.B.A.

200 East 90th Street

Apt. No: 27E

New York, NY 10128

USA

 

001-212-987-6556

 

Assistant Editors – Website Composition

Andrew Kobets, M.D.

Resident, Department of Neurosurgery

Albert Einstein College of Medicine

Montefiore Medical Center

111 E. 210th St

Bronx, NY 10467

USA

 

Email: ajkobets@yahoo.com

Kara Weber, B.S.

901 East River Parkway

City: Minneapolis, MN, 55414

USA

 

Email: webe0499@umn.edu

Linkedin: Kara Weber

Authors

Varun Badami, B.S., B.A.
Arundhati Biswas, M.D., MS, MCh, DNB

Resident, Department of Neurosurgery

Albert Einstein College of Medicine

Montefiore Medical Center

111 E. 210th St

Bronx, NY 10467

USA

 

Email: abiswas@montefiore.org

Thomas Beez, M.D.

Department of Neurosurgery

Medical Faculty

Heinrich-Heine-University

Moorenstrasse 5

Duesseldorf 40224

Germany

 

Emil: thomas.beez@med.uni-duesseldorf.de

Ira Bowen, B.A.
Sandip Chatterjee, MBBS,DNB(SURG),FRCS(SN),MNAMS(Neurosurg).

Professor And Head Department Neurosurgery

VIMS

4 Gorky Terrace

Kolkata, West Bengal, 700017

India

 

913322800758

David Chesler, M.D., Ph.D.

Fellow

The Johns Hopkins Hospital

Division of Pediatric Neurosurgery

Phipps 579

600 N Wolfe St.

Baltimore, MD, 21287

USA

 

Phone: 001 410 955-7882

Email: dchesle2@jhmi.edu

Chandrashekhar E. Deopujari, M.Ch.

Professor

Neurosurgery

Bombay Hospital & Institute of Medical Sciences

Room 126 B, 1st Floor,

Medical Research Centre19,

New Marine Lines,

Mumbai 400020

India

Sandrine de Ribaupierre, M.D., MSc

Associate Professor

University of Western Ontario

Victoria Hospital – 800 Commissioners Rd E

#:B1-181

London, Ontario

N6C 5W9

Canada

 

Phone: 001-519-685-8107

Email: Sandrine.deRibaupierre@lhsc.on.ca

Website: http://www.cnsuwo.ca/faculty/neurosurgeons/sandrine-de-ribaupierre/

Mark Dias, M.D.
Roberto Jose Diaz, M.D., Ph.D.

Resident, Division of Neurosurgery

University of Calgary

Foothills Medical Centre

12th Floor – 1403 29th St NW

Calagary, Alberta

Canada

T2N 2T9

 

Email: rjdiaz@ucalgary.ca

James Drake B.S., M.B.B.Ch. Medicine, MSc

Professor

Sick Kids Hospital, University of Toronto

555 University Avenue

Toronto, Ontario

Canada

 

Email: James.Drake@sickkids.ca

Mostada El Khashab, M.D.

Pediatric Neurosurgery

Hackensack University Medical Center

20 Prospect Avenue

Suite 905

Hackensack, NJ 07601

United States

Volkan Etus, MD

Professor

Department of Neurosurgery, Kocaeli University Faculty of Medicine

41380, Umuttepe Campus, Izmit

Kocaeli

Turkey

 

Phone: 0090 262 303 7232

Email: volkanetus@yahoo.com

Website: www.kocaeli.edu.tr/int

Linkedin: Volkan Etus

Herbert Fuchs, M.D., Ph.D.

Associate Professor of Surgery, Division of Neurosurgery

Duke University Medical Center

Box 3272 DUMC

Durham, NC

USA

 

Phone: 001 919 681-0894

Email: herbert.fuchs@duke.edu

Kemel Ahmed Ghotme, M.D.

Servicio de Neurocirugía

Clínica Universitaria Teletón

Autopista Norte, Km. 21

Chía

Cundinamarca

00

Colombia

Keith Goh, MBBS, FRCSEd, FCSHK, FHKAM, FAMS

Senior Consultant Neurosurgeon

Mount Elizabeth Hospital, Singapore

3 Mount Elizabeth, 09-10

Mount Elizabeth Medical Centre

Singapore

Singapore

 

Phone: +65 62350945

Email: keith@internationalneuro.com.sg

Website: http://www.intlneurosurgery.com www.drkeithgoh.com

Daniel Guillaume, M.D.
Ajit Jada, M.D.

Resident, Department of Neurosurgery

Albert Einstein College of Medicine

Montefiore Medical Center

3316 Rochambeau Avenue

Department of Neurosurgery

Bronx, NY 10467

USA

 

Phone: 718-920-7400

George Jallo, M.D.

Neurosurgery

Johns Hopkins University

600 North Wolfe Street

Harvey 811

Baltimore, MD 21093

USA

Andrew Jea, M.D.

Associate Professor (with Tenure)

Baylor College of Medicine

Texas Children’s Hospital

6621 Fannin Street, CCC 1230.01

Houston, TX

USA

 

Phone: 001 832 822-1289, 001 832 822-3950

Website: http://www.texaschildrens.org/neurosurgery/

Mark D. Krieger, M.D.

Division of Neurosurgery

CHLA

1300 N Vermont Ave

Suite 1006

Los Angeles, CA 90027

USA

Abhaya V. Kulkarni, MD, PhD, FRCSC

Associate Professor, Division of Neurosurgery

Program Director, Neurosurgery

University of Toronto

Hospital for Sick Children

555 University Avenue

Toronto, Ontario, Canada M5G 1X8

 

Phone: 416-813-6427

Subash Lohani, MBBS

Medical Officer

National Institute of Neurological and Allied Science

P.O. Box No. 3711

Bansbari, Kathmandu

Nepal

 

Mobile Phone: +977-9841457781

Juan F. Martínez-Lage, M.D.

Associate Professor of Neurosurgery

Virgen de la Arrixaca University Hospital

Ave. Alfonso X el Sabio 14

Murcia

Spain

 

Phone: 34 968 369 489

Luca Massimi, M.D., Ph.D.

Assistant Professor

A. Gemelli Hospital, Catholic University Medical School

Largo A. Gemelli, 8

via Barbiellini Amidei, 44, 00168

Rome

Italy

 

Phone: +39 0630154587

John S. Myseros, M.D.

Associate Professor

Children’s National Medical Center

111 Michigan Avenue, NW

Suite 4W-100

Washington, DC 20010

USA

 

Phone: 001-202-476-5320

Website: www.childrensnational.org

Farideh Nejat, M.D.

Professor

Head of Pediatric Neurosurgery, Tehran Univesity Medical Sciences

Children’s Medical Center

Keshavarz Bulvard, Gharib street,Children Medical Center

Jalal Al Ahmad , Parvaneh Street, Number 6, Unit 4

Tehran

Iran

 

Phone: (98) 21 88016835

Email: nejat@sina.tums.ac.ir

W. Jerry Oakes, M.D.

Chief Pediatric Neurosurgery

Professor

Children’s of Alabama, Birmingham, AL

Lowder 400 1600 7th Ave South

Pediatric Neurosurgery

Birmingham, AL 35233

USA

Greg Olavarria, M.D.

Arnold Palmer Hospital for Children

1222 South Orange Ave, 2nd Floor

Orlando, FL

USA

 

Phone: 001 321 841 3539

Mark Proctor, M.D.

Associate Professor

Boston Children’s Hospital/ Harvard Medical School

300 Longwood Avenue

Boston, MA 02115

USA

 

Phone: 617-355-2403

Benedict Rilliet, M.D.

Service de Neurochirurgie

Hôpitaux Universitaires, Geneva

3-4 rue Gabrielle Perret Gentil

Geneva

Canton de Geneve

1211, Geneva 14

Switzerland

Francisco Salomao, M.D.

Department of Surgery – Section of Pediatric Neurosurgery

Instituto Fernandes Figueira – Fundação Oswaldo Cruz (IFF-Fiocruz)

Av. NS Copacabana, 749/604

Rio de Janeiro

Rio de Janeiro

22050-020

Brazil

Adam Sandler, M.D.

Resident, Department of Neurosurgery

Albert Einstein College of Medicine

Montefiore Medical Center

111 E 210th St

Bronx, NY 10467

USA

 

Phone: 001 718 920-7400

Carolina Sandoval-Garcia, M.D.

Resident, Department of Neurosurgery

University of Wisconsin

Dept of Neurosurgeyr, K4/822

University of Wisconsin Hospital and Clinics, Department of Neurosurgery

Madison, WI 53792

USA

 

Email: c.sandovalgarcia@neurosurgery.wisc.edu

Spyros Sgouros, M.D.

Pediatric Neurosurgery

“Mitera” Childrens Hospital

Kifisias Avenue & Erythrou Stavrou 6

Marousi

Athens

Attiki 151 23

Greece

Ash Singhal, M.D.

Neurosurgery

British Columbia Children’s Hospital

4480 Oak Street

Vancouver, BC v6s 1n1

Canada

Jodi L. Smith, Ph.D., M.D., FAANS

John E. Kalsbeck Professor and Director of Pediatric Neurosurgery Riley Hospital for Children at Indiana University Health

Associate Professor of Neurological Surgery

Indiana University School of Medicine

702 Barnhill Drive, STE 1134

Indianapolis, Indiana 46202

USA

 

Phone: 001 317 274-8852

Website: http://www.goodmancampbell.com/faculty-and-staff.cfm/staff/65

Mark M. Souweidane, M.D. F.A.C.S., F.A.A.P.

Professor of Neurological Surgery

Weill Cornell Medical College

525 East 68th Street Box 99

Baker Pavilion Floor 22 Room 2203

New York, NY 10065

USA

 

Phone: 001 212 746-2363

Website: http://weillcornell.org/physician/mmsouweidane/index.html

 Caleb Standafer, B.S
Vassilios Tsitouras, MD

Department of Pediatric Neurosurgery – “Mitera” Children’s Hospital

6, Erythrou Stavrou Street, PC: 151 23

Marousi, Athens

Greece

 

Phone: 0030 210 686 9528

Mobile Phone: 0030 6974 398873

Skype: vatsiskype

Linkedin: Vassilis Tsitouras

Gary Tye, M.D.

Chief, Pediatric Neurosurgery, Children’s Hospital of Richmond

Associate Professor

Medical College of Virginia

MCV Campus, Ambulatory Care Center

417 North 11th St

PO Box 9806

Richmond, VA 23298-0631

USA

 

Phone: 001 804 828-9165

R. Shane Tubbs MS, PA-C, PhD

Anatomist

Professor

St. George’s University, Grenada, Children’s of Alabama, Birmingham, AL

Lowder 400 1600 7th Ave South

Pediatric Neurosurgery

Birmingham, AL 35233

USA

Frank Van Calenbergh, M.D.

Neurosurgery

University Hsopital Leuven

Herestraat 49

Leuven

Vlaams Brabant

3000

Belgium

 Francisco Villarejo, M.D.
Matthieu Vinchon, M.D., Ph.D.

Professor

Lille University hospital

rue Emile Laine

Lille

France

 

Phone: (33)320 44 64 64

Zhiping Zhou, M.D., Ph.D.