**5. Discussion**

Cerebral palsy is characterized by motor dysfunction due to lesion occurring non-progressive disorders of posture and movement caused by injury to the infant or developing fetal brain [1]. Neuromuscular and musculoskeletal problems such as spasticity, dystonia, muscle contractures, abnormal bone growth, poor balance, weakness, and loss of selective motor control are some of the main problems encountered by the patients with CP. Physical and occupational therapy, bracing, oral medications, neurolytic blocks, neurosurgical procedures, orthopedic surgery, and others are the treatment alternatives [4]. These modalities do not cure the disease but improve function and improve quality of life. A multidisciplinary team should evaluate the patient and optimize the treatment. Neurosurgeons also play an important role in this team. Focal spasticity can be treated via lesioning the nerve target [24]. ITB therapy is the first choice in patient that are not responsive to enteral and physical treatments. Ambulatory children with spastic diplegia and good cognitive abilities can be treated with SDR. In a non-functioning limb, dorsal root entry zone lesioning could be an option for severe cases. DBS can be effective in the treatment of primary dystonias (especially those caused by DYT-1 gene mutation [25].

The evidence for recommending neurosurgical procedures (ITB pumps and SDR) is limited and of low quality [5, 26]. Recommendation of these procedures depend on the experience and expertise of the multidisciplinary team. It should be a shared decision-making between surgeon, patient and caregiver. Reported adverse events for ITB pump are catheter or pump infections, battery failure, catheter leakage, baclofen withdrawal or overdose, constipation, anxiety or depression, and seizures. These modalities are considered as complex and invasive. There is a need for high quality evidence for the neurosurgical treatment of CP. Clear expectations and open treatment aims should be discussed before the final decision step.
