Hearing your child needs brain surgery can feel very daunting and upsetting. A team of experts will care for your child before, during and after surgery.
You will meet the surgical team and have a chance to go over worries or questions before surgery. If your child is old enough, or able to, you might want to encourage them to ask questions too. Sometimes what they are imagining is different and scarier than what actually happens.
The Brain Tumour charity has produced an animation for children following Jake, who is having neurosurgery.
Why does my child need brain surgery?
Your child might have surgery to find out what the type of brain tumour they have is. Looking at the cells under a microscope is the only way to be sure of the diagnosis. This is called a biopsy.
Other reasons they might have surgery are to:
- try and remove the whole tumour
- remove as much of the tumour as possible to slow its growth and improve symptoms
- relieve symptoms, such as a build-up of fluid in the brain
- help give other treatments such as chemotherapy, but this is rare in children
Removing some of the tumour can also help other treatments such as radiotherapy or chemotherapy to work better.
Treatment without surgery
Surgery isn’t suitable for every child with a brain tumour.
Sometimes the tumour is in a very delicate area of the brain and surgery to try and remove the tumour would cause more harm than good. This might be the case if the tumour is in the brainstem.
The brainstem controls body functions we don’t think about including:
- blood pressure
- heart rate
Your child’s team will talk with you about different treatment options if surgery isn’t suitable for them.
Slow growing tumours
Some children with slow growing (low grade) tumours don’t need surgery straight away. Your child will have regular scans and assessment of their symptoms to look for any further tumour growth.
Who does my child's surgery?
Brain tumour surgeons are called neurosurgeons. And children’s brain surgeons are called paediatric neurosurgeons. These are highly skilled and specialised doctors.
Your child’s operation might involve a team of neurosurgeons. The team on the day is led by their consultant neurosurgeon.
You might have other specialists working with the team. For example, there might be an Ear, Nose and Throat (ENT) surgeon if your child has a pituitary tumour.
Your child will usually go into hospital at least the night before their operation. This is so their team can check if they are okay to have surgery. This is known as being fit for surgery.
To check this, your child has some tests. Your child might have had some of these tests already, and not every child has all of them. They include:
- blood tests – including one to check their blood type and assess how well their blood is clotting
- an ECG to check that their heart is healthy
- an echocardiogram (a painless test of their heart using sound waves)
- a chest x-ray to check that their lungs are healthy
Nearly all children having brain surgery have a general anaesthetic. This means they are asleep and can’t feel any pain during the operation. It’s important that your child doesn’t eat anything, or have any milk, for 6 hours before a general anaesthetic. They can drink water or clear fluids until a couple of hours before the operation, your team will tell you exactly when.
The anaesthetist gives your child the anaesthetic and looks after their breathing throughout the operation. You will meet the anaesthetist before the operation.
Your child’s surgeon will ask you to sign a consent form before the operation. This is a good time to ask any questions you have about during, or after, the operation. They can give you written information, so you can look back over it to make sure you understand and remember everything.
This can be a very difficult time, it might be good to have a friend or family member with you when you get this information.
Older teenagers are able to sign their own consent forms if they are able to understand all the information and what it means.
Different types of surgery
There are different types and ways of doing of brain surgery. What exactly happens in the operation depends on where the tumour is and the safest way to try and remove it. Your child’s surgeon might use different scans and instruments to make sure the operation is as successful as possible.
Ask your child’s surgeon exactly what the operation involves.
Going to sleep
Your child’s nurse or doctor puts a small tube (cannula) into your child’s hand or arm. The nurse puts some local anaesthetic cream on the area first, to numb the area. Your child might still feel the needle go in, but it shouldn’t be painful.
You can usually go with your child to theatre before the operation. You wait with your child in a room next to the theatre, called the anaesthetic room. You can give your child a cuddle and reassure them until they are beginning to fall asleep ready for the operation.
The anaesthetist gives your child their anaesthetic through the cannula in their hand. Or, they gently place a mask over your child’s mouth and your child breathes the anaesthetic gas until they fall asleep. The team then take over and a member of the team lets you know when the operation has finished.
It’s not unusual to feel very emotional. The theatre or ward team will take your mobile number to call you as soon as the surgery is over. As a guide, neurosurgery can take up to 6 hours. And sometimes much longer. Children can also take time to wake up from their anaesthetic. This is all normal.
Try and get some rest, take a shower or eat something during this time. It’s good to try and get some fresh air if you can. The team will get in touch with you once surgery is complete.
What happens during a craniotomy
A craniotomy is the most common type of operation for a brain tumour.
Your child’s surgeon cuts out an area of bone from the skull. This gives an opening so that the surgeon can operate on the brain itself.
The scans your child had before their operation helps the surgeon know where exactly the tumour is.
Scans are also sometimes carried out during surgery. Some surgeons use an image guided system where the scans are loaded into a computer to give the precise position of the tumour.
After removing the brain tumour, the surgeon puts the area of bone (called a flap) back. They secure the flap with permanent tiny metal brackets. Then stitch the scalp in place over it. In most cases, your child’s hair will hide the operation scars.
Very rarely older teenagers have an awake craniotomy. This might be because they have a tumour that is near part of the brain that involves speech, movement or hearing.
During an awake craniotomy, the surgeon asks your child to do tasks while they check the function of different parts of the brain. For example, they might ask them to speak. Or move part of their body, or check what they can feel. This is called function mapping. The surgeon can make sure that these functions are harmed as little as possible, if at all.
These older teenagers are well prepared by specialist members of the multi disciplinary team (MDT) for an awake craniotomy. They don’t feel any pain.
Surgery to drain fluid
Your child might have surgery to drain a build up of fluid in the brain. The surgeon puts a device called a shunt in. This might be during your operation to remove your tumour, or as a separate operation.
Build up of fluid
The fluid around the brain and spinal cord is called cerebrospinal fluid (CSF). Some brain tumours block the normal circulation of this fluid. Because it cannot drain away, the fluid builds up inside the skull and around the spinal cord.
This increases the pressure inside the head (intracranial pressure). This fluid on the brain is called hydrocephalus. It can cause symptoms, such as headaches and sickness.
A shunt is a drainage tube. Shunts are usually plastic and small, about 0.3cm (3mm) across. Another name for them are ventricular catheters.
They have valves so that fluid can flow down from the brain but not back the other way.
Shunts drain away the extra fluid from the ventricles of the brain, to other parts of the body, where it is absorbed.
The most common type is the ventriculoperitoneal shunt. This is a tube from the brain ventricles into the abdomen (tummy). Another type drains the fluid into the chest cavity.
You can’t see it’s there from outside the body. Some children have a shunt for a short time and then it’s removed. Other children have them for much longer, as part of their treatment plan.
We have information on what happens straight after surgery and longer term recovery from brain surgery. You can read about the possible side effects of surgery and shunts.