Surgery for Pediatric Cancer and Brain Tumors

Surgery can be required for multiple reasons:

• As part of diagnosis: There are many instances where surgical intervention, such as a biopsy or sampling of involved tissues, is required to define the exact type of cancer, to determine the true nature of the tumor (malignant or benign), and to appropriately determine if the tumor has spread to other organs or areas in the body.
• In support of treatment: Surgery may be needed to prepare patients for treatments that require chemotherapy or drugs by providing a route of access (intravenous [IV]) by placement of a central venous line or port-a-cath to administer these agents, or to help address complications of treatment, such as infections or obstructions.
• As a primary component of treatment: Sometimes surgery is the best option in the treatment of a child’s tumor, or it may be part of a multi-modality approach (in combination with chemotherapy, radiotherapy, immunotherapy, etc.) to the global treatment of a cancerous tumor. Our pediatric oncologic surgeons are skilled in minimally invasive and open surgical procedures for removing all types of tumors in the body, and they have dedicated their entire clinical practices to the treatment of children with tumors. They are skilled in complex surgeries, including liver resection, nephrectomy, rotationplasty, limb-salvage surgery, and more. Furthermore, they are active in all major local, regional, national and international clinical cooperative trials to ensure your child receives the best and most current therapies.

One of the many benefits we offer patients is a state-of-the-art anesthesiology department available for all peri-operative care and needs (preoperative evaluation, postoperative intensive care unit medicine, pain management, etc.). Prior to surgery, the surgeon and anesthesiologist will visit with the child and her parents to discuss the surgical procedure and answer any questions they may have regarding the pre-, peri-, and postoperative care. After surgery, patients go to a post-anesthesia care unit or the intensive care unit (ICU) depending on the type of surgery and medical complexity involved. Generally, you and your child will experience one of several options after a surgical procedure:

• The recovery room or post-anesthesia care unit (PACU) for several hours and then be sent home (generally for minor procedures including biopsies and venous access placement)
• A hospital in patient unit to recover for 24 hours or less for more invasive procedures or for the initiation of postoperative treatments
• A hospital unit to recover for a few days for more invasive or involved operations
• An intensive care unit for a few days followed by transfer to an inpatient hospital unit until your child is ready for discharge home (can be up to 7-10 days) for major operations

In some cases, children can go home the same day they have a minor surgical procedure. After major surgery, however, the child may need to stay in the hospital for a few days or sometimes longer. When the surgeon determines the child can be discharged, the medical team and your surgeon will discuss home care and provide parents with clear instructions for care and any prescriptions that are needed.

Brain tumor patients in need of surgery at Dana-Farber/Boston Children’s are treated by pediatric neurosurgeons who are experts in minimally invasive surgical procedures. Using advanced endoscopic techniques, our neurosurgeons can surgically remove brain tumors in a manner that minimizes impact to surrounding brain structures, shortens operating times and reduces recovery times for our patients. Intra-operative magnetic resonance imaging (MRI) also lets our neurosurgeons perform precise and complete tumor resections, which can mean fewer surgeries.

A reputation for innovation and achievement helps us attract some of the world’s most skilled and accomplished neurosurgery professionals. Our neurosurgeons are integral members of our multidisciplinary brain tumor treatment teams. Visit our Brain Tumor Center homepage to learn more about our expertise in diagnosing and treating pediatric brain tumors.

Neurosurgery Innovations

Our neurosurgeons are involved in research that offers new hope for children with brain, spine or central nervous system tumors. We developed and refined some of the most influential advances in pediatric neurosurgery, including:

• linear accelerator radiosurgery, a highly efficient form of radiotherapy that targets tumors in the brain while minimizing damage to surrounding healthy tissue
• intraoperative MRI, the introduction of magnetic resonance imaging in a neurosurgical operating room, allowing doctors to view detailed, “real-time” images of the brain and spine while performing surgery

Our laboratory research focuses on the basic mechanisms of common neurosurgical conditions, such as:

• the genetic makeup of brain tumors 
• measuring certain enzymatic compounds as markers of tumor growth and recurrence
• detailed genetic analyses of malignant and non-malignant brain tumors in children

Breakthroughs in our laboratories and clinics play a critical role in children’s health by improving brain surgery and making the experience easier for children and their families.

Our team is actively involved in research to improve understanding of why brain diseases occur and to develop better methods of early detection to ensure that these conditions have as little impact as possible on the developing brain.