What happens during neurosurgery?
Meet Jake, who can tell you all about neurosurgery for children.
Your child's medical team will decide the best treatment for them. Treatment for medulloblastoma is likely to include surgery, radiotherapy and chemotherapy.
The initial treatment for a child diagnosed with a medulloblastoma is surgery. However, if your child's tumour has caused a build-up of CSF, the surgeon may firstly need to perform an urgent operation to divert the flow of fluid to the abdomen, to reduce the pressure. There are different ways this can be done, from inserting a small, temporary drain, a more permanent shunt or a camera procedure to make a hole at the bottom of the brain (also known as a ventriculostomy). If a shunt is inserted, it may stay in place after surgery to prevent future fluid build-up.
If your child is treated for hydrocephalus, they will then require a second surgery to remove the tumour. To remove as much of your child's tumour as possible, the neurosurgeon needs to have greater access to your child's brain. During surgery a 'bone flap' will be removed from your child's skull. This type of operation is known as a 'craniotomy'.
Following surgery, radiotherapy is often used to destroy any remaining tumour cells. It is normally given to the whole brain and spinal cord as this tumour type may travel through the CSF to the spinal cord. However, if a child is aged under three, whole brain radiotherapy is avoided. As their brains are still developing, they are open to the long term side-effects of radiotherapy.
In children under three, high dose chemotherapy may be used to delay or eliminate the need for radiotherapy. In some cases, radiotherapy may be given just to the part of the brain where the tumour is located. In children older than 3, several cycles of high-dose chemotherapy may be given before or after radiotherapy.
Chemotherapy drugs destroy tumour cells by stopping their ability to grow and divide, hence reducing the risk of them spreading through the spinal fluid. A combination of chemotherapy drugs will be used to kill as many cells as possible. The choice of drugs and how and when they will be given will be discussed with you by your child's oncologist and will be based on your child's age.
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