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This is neurosurgery in children, and requires dedicated paediatric neurosurgeons with experience of operating on the developing nervous system working in close collaboration with paediatricians to achieve the best outcome for each child. The London Neurosurgery Partnership has assembled just such a group.
Although brain tumours are rare in childhood, they are now the commonest solid cancer seen in children in the UK. There are 300 new cases in the UK every year and thanks to ongoing research, advances in both survival and quality of life continue.
Tumours can present with a variety of symptoms, partly depending on the child’s age. These symptoms include headaches, usually early morning, nausea and vomiting, fits or seizures, focal neurological deficit (weakness of limb or numbness), balance problems, increasing head size (babies from 0-18 mths), failure to put on weight and regression of milestones.
If there is any question of a neurological problem in a child then a CT or MRI scan is mandatory. For babies the scan can be done under oral sedation. Beyond six months children will need a general anaesthetic (GA) for a scan and from 6-12 years old one may be able to MRI the child without any sedation or GA.
Following admission to a neurosurgical unit all children must have a brain and spine MRI and blood should be sent for tumour markers. Steroids may be commenced to reduce swelling around the tumour and any hydrocephalus treated (by shunt or ventriculostomy or removal of tumour).All cases should be discussed with an oncologist and a plan should be made for excision or biopsy of the tumour. Occasionally some tumours may be treated with chemotherapy or radiotherapy as a first line.
