Neurosurgery for children

If your child is diagnosed with a brain tumour, one of the treatments they may need to have is an operation on their brain (neurosurgery). This can be a scary time for parents, but understanding why this is needed, what it involves and what to expect afterwards, can help you to prepare yourself and your child.

There are two main aims of neurosurgery for brain tumours in children:

  • To remove a small part of the tumour in order to make a diagnosis
  • To remove as much of the tumour as is safely possible.

Other reasons that surgery may be used are:

  • To put chemotherapy drugs directly into the brain
  • To reduce associated symptoms, such as headaches, that are due to increased pressure in the brain caused by a build-up of the cerebro-spinal fluid (CSF).

Making a diagnosis

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.

Where possible, this involves taking a small sample of tumour tissue. This is done via an operation known as a 'biopsy' or a 'burr hole biopsy'.

A burr hole is a small hole that is created in the skull to allow a sample of the tumour to be taken using a needle. The hole will then be closed.

Biopsy procedure

  • A very small 'burr hole' will be drilled into their skull by the neurosurgeon
  • A needle is passed through the hole to take a small sample of the tumour
  • The hole is then closed using staples or stitches
  • Your child may be given steroids to help with any swelling.

The sample is then sent to the laboratory to be analysed under a microscope by a neuropathologist.

Removing as much of the tumour as possible

To remove as much of your child's tumour as possible, the neurosurgeon needs to have greater 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'.

Craniotomy procedure

  • As much of the tumour as is safely possible, will be removed
  • If all is removed, this is known as 'total resection'
  • If part is removed, this is known as 'debulking'
  • 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'.

Insertion of chemotherapy directly into the brain

During a craniotomy, your child may have chemotherapy drugs inserted directly into their brain as some chemotherapy drugs are not able to cross the blood-brain barrier. This is usually done via an 'Ommaya reservoir' inserted under your child's scalp.

Reducing associated symptoms

Headaches are a common symptom of brain tumours, often caused by a build-up of the cerebro-spinal fluid (CSF) in the brain. To reduce the pressure this causes, 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 may stay in place for some time.

Immediately after neurosurgery

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 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

Many factors will influence how your child feels after surgery. They may:

  • Feel sick
  • Feel tired – do not be alarmed if your child sleeps more than normal
  • Have a sore throat or difficulty swallowing, as a result of the tubes used during surgery
  • Headaches, caused by swelling in the brain as a reaction to the surgery
  • Momentary phases of feeling dizzy
  • New symptoms e.g. personality changes, speech or co-ordination problems, epileptic seizures (fits)

These effects usually disappear shortly after surgery. If you are worried about any symptoms, speak to your child's health team.

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.

Follow-on treatment

Immediately after surgery, your child may be given the following medications:

  • Steroids - to reduce swelling and, therefore, pressure on the brain
  • Anti-epileptic drugs - to prevent the risk of seizures, which can be caused by increased pressure on the brain

Your child is likely to have a brain scan soon after surgery to see if any, or how much, of the tumour remains, and to see how much swelling there is.

Your child may then be given chemotherapy and/or radiotherapy, to get rid of any remaining tumour cells.

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