Brain surgery for children

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 the chance to go over worries or questions before surgery. If your child is able to, you might want to encourage them to ask questions too. Sometimes what they’re imagining is different and scarier than what actually happens.

The Brain Tumour charity has made an animation for children following Jake, who is having neurosurgery.

Watch the animation here

Before surgery and what to expect

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 (ECHO) - a painless test to check the structure and nearby blood vessels of their heart and how well it’s pumping. It uses sound waves to create this information

• a chest x-ray to check that their lungs are healthy

• tests such as swabs to check for infection

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 few hours before the operation. Their team will tell you exactly when.

The anaesthetist gives your child the anaesthetic. They look after them and their breathing throughout the operation. You and your child 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 that 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 can sign their own consent forms if they are able to understand all the information and what it means.

Preparing your child’s skin before surgery

The skin is the largest organ of the body. It has several roles and one of these is to protect the inside of the body from harmful things such as germs. The skin is not sterile. So before surgery your child usually has a shower or bath to help lower the risk of getting an infection. Some places may give you an antiseptic soap to wash with. Others may ask you to use your own soap.

Hair removal for your child’s surgery

Most children have a small area of their hair shaved. This is so your child’s surgeon can have clear access to the part of the brain they need to operate on. Some children have all their head shaved.

It depends on where the tumour is and the type of operation they have. Your child’s surgeon will explain what to expect.

The operating nurse usually removes the hair when your child is under anaesthetic in the operating room.

Do not shave your child’s head before you come to hospital for the operation. This could increase the risk of a wound infection.

Your child won't need to have their head shaved if they’re going to have an operation to remove a pituitary tumour. The surgeon removes this type of tumour through the nose.

For tumours in the brainstem or back part of the brain (cerebellum), your child’s surgeon might only need to shave a small area at the back of their head.

Different types of surgery

There are different types and ways of doing 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. They will go into as much or as little detail as you want. It’s important that you and your child voice any concerns you have before the operation.

Surgery to drain fluid build up in the brain

The cerebrospinal fluid (CSF) is the fluid that surrounds the brain and spinal cord. Some brain tumours block the normal circulation of this fluid. Because it can’t drain away, the fluid builds up in the skull and around the spinal cord (hydrocephalus).

This increases the pressure inside the head (intracranial pressure). It can cause symptoms, such as headaches and sickness.

Your child might have surgery to drain a build up of fluid in the brain. The surgeon puts in a device called a shunt. This might be at the same time as their operation to remove the tumour, or as a separate operation. They have this under general anaesthetic.

Some children have an external ventricular drain (EVD) in place after surgery to help remove extra CSF. 

Shunts

A shunt is a drainage tube. Shunts are usually plastic and small, about 0.3cm (3mm) across. Another name for them is 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’s 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.

External ventricular drain (EVD)

This is a temporary drain that allows extra cerebrospinal fluid from the ventricles to drain into a container. The container is attached to a soft flexible tube that is held in place in the ventricles of the brain with stitches.

This drain is kept at a certain height so there is a steady flow. The fluid that is collected is measured, checked and recorded carefully. 

Your child is closely monitored while they have this drain in place.

Surgery to give chemotherapy

During brain surgery, your child's surgeon might put in a ventricular access device (an Ommaya reservoir). This device allows chemotherapy to be put straight into the fluid filled spaces of the brain (ventricles).   

We have information about these in the chemotherapy section.

Find out more about chemotherapy for children’s brain tumours

What next?

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.

Find out more about what happens after surgery