Tumor Resection

Brain tumors, either malignant (cancerous) or nonmalignant (not cancerous), are abnormal growths of tissue that originate in the cells of the brain.

A nonmalignant tumor does not contain cancerous cells and, once removed, typically does not come back. Most nomalignant or benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can cause symptoms similar to cancerous tumors because of their size and location within the brain. It’s important to note that some lower-grade tumors can turn into higher-grade tumors over time.

Malignant brain tumors contain cancer cells. They are usually fast growing and invade surrounding tissue. Malignant brain tumors rarely spread to other areas of the body, but they may grow back after treatment.

Brain tumors are the most common solid tumors in children. Approximately 4,000 children and adolescents in the U.S. are diagnosed with primary brain tumors (tumors that originate in the brain) each year. Those that occur in infants and children are different from adult brain tumors, both in terms of the type of cells and the responsiveness to treatment.

There are many types and subtypes of brain tumors. Some of the more common ones that we treat include:

The exact cause of brain tumors is not fully understood. Researchers have found that some of the chemical changes that occur in normal brain cells may lead to brain tumors. Most brain tumors involve abnormalities in genes that control the cell cycle (when cells grow, divide and die). These abnormalities cause uncontrolled cell growth.

Other than exposure to radiation, there are no known lifestyle-related or environmental causes of childhood brain tumors. If your child has a brain tumor, it is important to remember that there is nothing you or your child could have done to prevent it.

Symptoms of a brain tumor depend on the size, type and location of the tumor. Symptoms may be caused by a tumor pressing on a nerve or harming a part of the brain. They may also be caused by a tumor blocking the fluid that flows through and around the brain or brain swelling because of the buildup of fluid.

Some of the most common symptoms of brain tumors include:

Many other conditions can cause the same symptoms, so it is important to check with your child’s doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate a brain tumor can make a firm diagnosis.

Diagnosis of a brain tumor starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose a brain tumor including detailed neurological exam , head CT , magnetic resonance imaging ( MRI ) scan or lumbar puncture/ spinal tap (although rarely performed before the tumor is removed).

A customized treatment plan is put together for your child based on:

Treatment for a brain tumor may include one or a combination of the following options:

Rehabilitation includes treatment to help your child recover lost or diminished physical functions caused by the brain tumor or its treatment. Rehabilitation may include speech-language, physical or occupational therapy.

Follow-up care includes regular monitoring for worsening of symptoms, effectiveness of treatment and, if the tumor was removed, recurrence of the tumor by means of follow-up brain MRI studies.

Your child’s prognosis (long-term outlook) depends on:

Each child’s prognosis is unique to his or her individual situation. Prompt and aggressive treatment based on an accurate diagnosis gives your child the best chance to overcome the tumor and any damage it may have caused. Treatment sometimes causes side effects, and these also affect your child’s prognosis. Recurrence of the tumor is sometimes possible, and this can have a significant effect, as well.

Risks of the surgery include but are not limited to:

Risks without surgery include:

If your child is diagnosed with brain tumor, the pediatrician will refer them to a pediatric neurosurgeon for consultation. You will then meet with the neurosurgeon to discuss the brain tumor and need for treatment. Questions and concerns regarding the type(s) of treatment offered will be addressed at that appointment. If any additional tests are needed, they will be explained and ordered at that time.

Our brain tumor program at Goodman Campbell Brain and Spine provides patients with a multidisciplinary approach to personalized care and a depth of expertise. New patients and those with progressive tumors are presented at a weekly tumor board in which we work together to confirm diagnoses and develop comprehensive treatment plans. Our hospital team is made up of pediatric oncologists, neurologists, neurosurgeons, pathologists and neuroradiologists, rounded out by pediatric nurse practitioners, child life specialists, and physical, speech and occupational therapists.

You will receive communication before coming to the hospital with specifics on where to go the day of surgery and instructions for the day before and day of surgery. This information will include details about home medications and when to stop eating and drinking.

The length of surgery will depend on the degree of difficulty of the surgery for removal of the brain tumor. Your child will spend at least 2 – 3 nights in the hospital. The first night will be in the pediatric intensive care unit (PICU) for close monitoring. Your child will come out of surgery very sleepy and their medical team will likely give them medicine that makes them extra sleepy for the first 12 hours after surgery to help with pain control.

Your child will be given intravenous (IV) fluids, pain medications and anti-nausea medication until they are able to take medications by mouth. IV antibiotics will be given for 24 hours after surgery. Steroids will be ordered for the first 48 hours through the IV. Due to the fact steroids can upset the stomach, your child will be given medication to help to decrease stomach upset while they are receiving the steroids. Your child will be started on a stool softener immediately after surgery to prevent constipation. A seizure medication is also given to protect against possible seizures. Your child may go home on this medication and may need to continue it for several months.

Your child will have a rubber tube in their bladder (Foley catheter) to drain their urine while sedated and also additional monitoring devices to closely monitor their blood pressure and heart rate. The Foley catheter will remain in place until the child can get out of bed to go to the bathroom.

In some circumstances, your child may have a cerebrospinal fluid drainage tube connected to a sterile collection bag to relieve pressure on the brain, depending on whether there was hydrocephalus present before the surgery. This external ventricular drain (EVD) helps to regulate the pressure caused by an increase in CSF. We will start to raise the drain within a few days, and remove it if your child’s brain is able to maintain a normal pressure.

Your child will be allowed to drink and eat slowly as soon as they are able, and they will be allowed to get up out of bed as soon as they are awake and the extra monitoring devices and bladder catheter have been removed.

Your child will be discharged from the hospital once their pain is well controlled with oral pain medications, and they are able to eat and drink, go to the bathroom and walk around the room.

The pediatric neurosurgery providers at Goodman Campbell Brain and Spine are specially trained on this diagnosis and are experts in the care of brain tumors. We know it can be a scary time, and we have a team of medical professionals who are available to answer any questions or discuss any concerns that you might have.

In order to be discharged from the hospital, your child will need to be able to:

The course and length of stay is variable for these patients. It can range from 3 – 5 days to up to a month, depending on any complications that were present prior to or after the surgery.

Your child may need to go to outpatient physical, occupational and/or speech therapy once discharged from the hospital. The social worker will help to set this up as close as possible to your home.

A child is usually out of school for at least two weeks while they heal. Some children may require a more specialized time frame.

A child is not to participate in any sports, and must keep their feet on the ground at all times (no swinging, jumping, climbing or running) for 4 – 6 weeks after surgery, until they are cleared to do so during a followup visit.

There will be a follow-up appointment with neurosurgery two weeks after the surgery or sooner if needed.

Reasons to call the neurosurgery office include:

The region of the incision is typically sore after surgery. This should gradually improve and be relieved by the oral pain medications prescribed for your child.

Tiredness and fatigue are also very common and will gradually improve with time. It is common for it to take up to three months before your child feels “back to normal.” Make sure they have plenty of rest during the day and eat healthy foods (avoid candy, soda and fast food). Set regular bedtime and wake-up times to ensure they get plenty of sleep.