Neurosurgery for children

To remove as much of your child’s tumour as possible, the neurosurgeon needs to have access to your child’s brain. During surgery a ‘bone flap’ will be removed from your child’s skull. This type of operation is known as a ‘craniotomy’.

• Your child will be given a general anaesthetic to fall asleep
• A small area of their head may be shaved and they may be given an local anaesthetic to part of their scalp
• An incision (cut) is made in their scalp and a small part of their skull (‘bone flap’) will be removed
  Your child will not experience any pain during this as they will be under anaesthetic
• As much of the tumour as is safely possible will be removed
• The bone flap will be replaced and the wound closed using stitches or metal clip
• They are likely to be given steroids to help with any swelling

If possible, the whole tumour will be removed. This is known as ‘total resection’. It is not always safe, or possible, to remove all of the tumour. This will depend on you child’s type of tumour and where it is in the brain. In this case, as much of the tumour as safely possible will be removed. This is known as ‘partial resection’ or ‘debulking’.

Not all brain tumours can be operated on. If the tumour is too near a sensitve area of the brain, such as the brain stem which controls breathing; or if it is slow growing and causing relatively minor symptoms, then trying to remove the tumour is likely to cause more harm than not operating. If this is the case, your child will be actively monitored. (This is sometimes called ‘watch and wait’.)

In order to decide on the best course of treatment for your child, their health team needs to make an exact diagnosis of the type and grade of your child’s tumour. An exact diagnosis can also help if you want your child to take part in a clinical trial.

Where possible, an exact diagnosis involves taking a small sample of tumour tissue. This is done either during the operation known as a craniotomy, or during a different operation called a ‘biopsy’ or a ‘burr hole biopsy’.

Biopsy procedure

After having an MRI scan or CT scan to show exactly where the tumour is, your child may need a biopsy to identify the type of tumour.

Firstly, they will be given a general anaesthetic to fall asleep and a very small ‘burr hole’ will be drilled into their skull by the neurosurgeon. Then a needle is passed through the hole to take a small sample of the tumour before the hole is close using staples or stitches.

Your child may be given steroids to help with any swelling.

Headaches are a common symptom of brain tumours, often caused by a build-up of the cerebro-spinal fluid (CSF) due to the tumour blocking its flow around the brain. This build-up of CSF, known as ‘hydrocephalus‘, causes the pressure inside the skull top rise, causing the headache.

To reduce the pressure, neurosurgeons can insert a tube called a ‘shunt‘ (which may also be called a ‘ventricular catheter‘) into your child’s skull to drain some of the excess fluid away. The shunt is not a cure for a brain tumour, nor does it treat the tumour itself, but it can ease the symptoms.The shunt may stay in place for some time.

Your child will be woken up in an intensive care unit (ICU) or a high dependency unit (HDU) to allow for closer monitoring. Visiting hours are usually very flexible, especially for young children, so you will be able to be with them.

If they have a dressing on their wound, this is likely to stay on for around 5 days after surgery. Stitches are usually removed 5-14 days afterwards and may be dissolvable. They may have some swelling and bruising on their face.

They will have a number of tubes coming in and out of their body. These are to help with:

• Draining fluids
• Monitoring their progress
• Giving your child water, nutrients and medicines

Your child will need to rest for a number of days afterwards, but will not be kept in bed any longer than is necessary. Hospitals like to get their patients up and get moving as soon as is safe.

Advice about hair washing, going back to school and taking part in sports will be given by your child’s healthcare team when your child is discharged from hospital.