Before the operation
If accessible, surgery will be recommended to attempt removal of as much tumour as is feasible. The duration of surgery is dependent on the size and position of the tumour and your child’s surgeon will discuss this with you prior to the operation.
The ward staff will prepare you and your child for surgery explaining the most likely course of events related to your child.
During surgery specimens of tumour are analysed to discover the likely nature of the cells involved. This initial analysis is performed quickly and is not always accurate. For this reason the doctors will not give you a firm diagnosis following the operation. The cells need several days' worth of tests performed on them before a definite conclusion can be made.
Once a firm diagnosis is reached it will be discussed with you. This can take up to a week and we know this can be an agonising time for you. However, it is not advisable for you to be told the provisional diagnosis because an inaccurate premature result could cause unnecessary anguish or false relief.
In certain situations much of a tumour may not be able to be removed so a biopsy may be offered to aid diagnosis and further treatment. This is where a small piece of tumour tissue is extracted with minimal amount of interference to the surrounding brain tissue. This will involve an anaesthetic and a small incision on the head or an operation known as a craniotomy. Children usually make a rapid recovery from this procedure.
After the operation
Most children are nursed in the high dependency bay on Koala Ward following the operation. They will be monitored closely for at least 24 hours and the nurse caring for your child will explain all their post-operative care and monitoring to you.
Your child is likely to have several monitors and infusions attached to him or her, which may appear daunting. Please ask us about them. Your child will be given regular medications to control pain, nausea and vomiting.
Following certain neurosurgical operations, some children are not allowed to eat or drink for at least 24 hours or until their swallowing ability has been checked by a doctor.
Initially it will be necessary for the nurse to wake and check your child as frequently as every 15 minutes. This can seem like it is disturbing your child’s rest and recuperation. However it is vital so that any changes in their consciousness level, which may be a sign of complications, can be detected and treated as early as possible.
Diagnosing the tumour type
This will be done in the pathology department using all available modern methods.
You will be asked for your consent to save some of the tumour samples taken at the time of the operation. Some of this will be stored in case it is needed for future tests if your child’s clinical condition needs it.
If you agree, we will store any tumour that is ‘left over’ for research purposes. This work will not directly benefit your child now but may help other children in the future. Your consent is entirely voluntary and you not have to give your permission. If you decline, it will not affect your child’s medical care in any way.
On receiving the official diagnosis, a decision will be made as to what further treatment will be recommended. Surgery may have resulted in a good removal of the tumour, but there is always a risk of a few (malignant) cut cells being left behind.
Subsequent treatment may be essential to eliminate these stray cells and help prevent their re‑growth, as it is in any situation where the definite presence of tumour is known. Further treatment involves the use of radiotherapy or chemotherapy or both. The doctors will explain to you which they recommend and why.
In some situations the doctors will decide to delay ongoing treatment for a period of several months. This may be because the tumour is ‘benign’ and has been fully removed, in which case a cure is assumed. Or, despite an incomplete removal, the surgeons want to wait to see if further growth will occur.
Last reviewed by Great Ormond Street Hospital: October 2007
Ref: F070324 © GOSH Trust October 2007
Compiled by the neuro-oncology team in collaboration with the Child and Family Information Group, GOSH.
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.