Surgery for Brain & Spinal Cord Tumors in Children

At Hassenfeld Children’s Hospital at NYU Langone, surgery is most often the first and most critical step in the diagnosis and treatment of a childhood brain or spinal cord tumor. Removal of the tumor allows our neuropathologists to analyze the tissue and identify the type of tumor. This helps doctors determine if additional treatment, such as chemotherapy or radiation therapy, may be needed after surgery.

Occasionally, tumors can form in the brain or spinal cord when other types of cancer spread there. This is called secondary, or metastatic, cancer, and it’s treated differently from primary cancer, when tumors originate in the brain and spinal cord. Although common in adults, metastatic brain and spinal cord tumors are rare in children.

Our surgeons almost always use a stereotactical navigation system—a sort of GPS that uses CT and MRI scans—to navigate safely through the brain and spinal cord and remove tumors completely.

For benign and some slow-growing malignant brain and spinal cord tumors, surgery very often may be the only treatment needed. For fast-growing cancerous tumors, surgery may be followed by chemotherapy, radiation therapy, or both, depending on the diagnosis.

Stereotactic Craniotomy

Stereotactic craniotomy allows surgeons to remove tumors deep in the brain that were once considered inoperable, and helps to preserve a child’s ability to participate in everyday activities.

During a craniotomy, a pediatric neurosurgeon makes an incision in the scalp and creates an opening in the skull with special surgical tools. The size of this opening depends on the size and location of the tumor. The surgeon and neurophysiologists, doctors who specialize in the nervous system, map the brain using MRI-guided tractography. The map shows the location of nerve fibers controlling speech, movement, and other vital functions, as well as the tumor. It helps the surgeon plan the surgery, precisely locate the tumor, and remove it with minimal effects to surrounding tissues.

Older children with a tumor near speech and motor centers of the brain may remain awake during surgery to help the doctor test brain functions.

After the surgery, your child stays in the hospital for a few days to recuperate. Most children recover at home for several weeks, including healing of the surgical incision. Your child may feel tired and weak and have a headache. A doctor may prescribe corticosteroid medications to prevent swelling in the brain. Brain tumor surgery does not require that the head be shaved.

Many children experience no complications, but there are risks, depending on where in the brain the surgery is performed. Your child’s doctor discusses these risks with you. Children who need rehabilitation after this surgery may be transferred to NYU Langone’s Rusk Rehabilitation.

Endoscopic Brain Tumor Surgery

Some tumors are in areas of the brain that can be safely reached by an endoscope and may be removed less invasively, through an opening in the skull that’s the size of a nickel. Your child’s surgeon inserts a straw-like device into this opening and then guides a small endoscope, a tube with a lighted end, into the brain’s ventricles. The neurosurgeon can see the tumor through the endoscope and, using images from previously taken CT or MRI scans as a guide, removes the tumor through the “straw.”

Your child stays in the hospital for several days after the surgery and may feel tired and weak. Headaches are a common side effect, and the doctor may prescribe corticosteroids to prevent brain swelling. With this procedure, a child may have a shorter recovery time and less scarring than with a craniotomy.

Spinal Cord Surgery

The primary goal of surgery for a spinal cord tumor is to remove or reduce the size of the tumor and alleviate pain and pressure on the spinal cord. Sometimes, the surgeon has to remove a part of a spinal bone, or vertebra, in spinal cord surgery. If so, a bone graft is used to stabilize the vertebrae. A graft consists of bone taken from another part of the child’s body or from a deceased donor.

Screws or metal plates may also be used to stabilize the spine permanently. Screws or a rod may be inserted into the back to help prevent a curvature of the spine called scoliosis.

Managing Side Effects

Surgery can cause short-term side effects, such as brain swelling or seizures. To reduce the risk, your child’s doctor may prescribe corticosteroids and antiseizure medications.

These operations may affect certain brain functions, including memory, speech, or coordination. To prevent this, the pediatric neurosurgeon removes only as much tissue as necessary.

If rehabilitation services, such as physical, occupational, or speech therapy, are required, your child’s doctor may refer him or her for an evaluation by one of our pediatric rehabilitation doctors at Rusk Rehabilitation. The doctor may restrict or prohibit vigorous physical activities, such as sports and unsupervised swimming, for up to a year after surgery to allow the brain to heal.