Pediatric Neurosurgery

Brain Tumors

Answers to frequently asked questions on pediatric brain tumor or brain tumor symptoms on this page are based on current general medical knowledge. Every patient is unique and the treatment of choice should be tailored for each patient. You should consult with your primary physician for the most appropriate and detailed answers to your questions.

The answer to this question depends on many different parameters such as symptoms of the patient, neurological examination, findings in radiological investigations, preference of parents, and according to the surgeon’s experience. Since the tissue dealt with in neurosurgery – the brain – is very vulnerable and the risks are relatively higher than compared to other disciplines, FOLLOWING A PATIENT may always be a good option. If the patient is free of symptoms and the findings in other examinations are not severe, your doctor can decide to follow-up your patient with serial examinations and try to see how or if the disease progresses throughout time.
On the other hand, if your patient has symptoms related to the disease (i.e. epileptic seizures, visual deficits, motor problems…) or radiological findings demonstrate a dangerous situation, your doctor will decide on surgery. Every patient is evaluated in its own circumstances and not a single patient is similar to another one. Your neighbour’s son with similar problems may be followed up, while doctors offer surgery for yours.

Radiological images taken from patients give much more detail and information than the techniques used 10 to 20 years ago, thanks to the technological developments in the field. However, unfortunately, no other technique than surgical biopsy and pathological investigation of the specimen under a microscope does not give certain information about the disease. For this reason, for patients requiring intervention and a definitive diagnosis, biopsying or surgical resection of the pathological tissue is very important. This will also help to shape the rest of the treatment for the patient.

I am personally a doctor who encourages my patients to seek advice from other doctors in non-urgent situations. The most important point to remember is that in medical science, two times two may not always be four. The tissue dealt with is the human body and the nervous system tissue is one of the most sensitive tissues of the human body. Each doctor will give you their opinion based on their knowledge and previous experience. One doctor may suggest surgery while another may suggest waiting a little longer, or one doctor suggests another surgery while someone else suggests another type of surgery, and neither is medically wrong. What matters is your belief in the doctor you can trust for your decision and treatment. Your trust in your doctor is an important decision that will affect the course of your illness.

The main principle of neurosurgery, like other medical disciplines, is not to cause any harm to the patient. For this reason, for brain tumors, there is a concept of “maximum safe resection”.Technically, every pathology inside the brain can be totally excised, but if the patient will experience any significant neurological deficits after this resection such as motor problems, visual problems, or more seriously consciousness problems then we do not force to remove all of the tumors. Your surgeon may not excise all of the tumor to protect your patient from such devastating complications. All information regarding the extent of resection will be given to you before the surgery by your surgeon.

As you already know, every single surgery has its own risks. Risks may range from simple ones such as allergic reactions to anesthesiological agents and wound infections to severe ones such as coma and death. In neurosurgery, there are significant other risks that may decrease the quality of life of a patient. Weakness in arms or legs, facial paralysis, visual problems, long-lasting coma state are among those. We are lucky that complications like coma and death are extremely rare with the help of modern medical and surgical techniques.

Failure to completely remove a tumor by surgery does not mean that this disease is incurable. The branch of neurosurgery works closely with radiation oncology and medical oncology branches, and depending on the tumor type of the patient, radiation and drug treatments may be considered after surgical treatment.

In malignant tumors, most of the current guidelines recommend adjuvant therapies to prevent tumor recurrences and dissemination. Gross total resection of a tumor means excision of the tumor which is visible in radiological images. However, most tumors – especially the malign ones – will have microscopic remnants behind after the surgery. The main aim of adjuvant therapies are to kill those microscopic remnants and try to prevent future recurrences. Also in some benign tumors that can not be completely resected, those additional therapies may be used..

Most brain tumors are different from other organ tumors. Benign tumors that are completely resected may rarely recur in the future. This problem mandates long follow ups of the patients.

The answer to this question is no. Of course, solving big problems takes more time however, you should not forget that every time spent in the OR does not mean that the surgeon is operating on your child. There are stages of surgery and in the case of little children, preparation of the patient for the surgical intervention takes a long time. Additionally, after the surgery, it may take significant time to prepare the patient for transfer.

Your doctor will explain everything you need to know. I generally do not impose any serious restrictions for my patients after brain surgery, unless something to be particularly careful about is present. The fact that children start school as soon as possible will help them get rid of the psychology of illness. Suggestions about eating and drinking are given to you. He explains how he should use his medicines and when he will come to the controls.

After brain operations, skull is reconstructed – closed – with very powerful tools. A minor head trauma will not be a problem in most of the cases. But if there is something that concerns you, contacting your doctor will be the best thing to do.