Pediatric Neuroendoscopic Surgery

Neuroendoscopic surgery is a minimally invasive procedure used to remove tumors located deep within your child’s brain, utilizing a surgical instrument called an endoscope that has a light and a camera at its tip.

Your child’s pediatric neurosurgeon will utilize CT or MRI (stereotactic) guidance and intraoperative GPS technology to identify the safest path to access the tumor. This imaging minimizes the risk of damage to brain regions responsible for speech, movement, and other vital functions.

What are the benefits of neuroendoscopic surgery?

Neuroendoscopic surgery is performed through a dime-sized channel in your child’s skull, making it a less-invasive option than traditional brain surgery.

As a result, neuroendoscopic surgery may provide several benefits when compared to traditional brain surgery, including:

• Faster recovery times.
• Less trauma to nearby brain tissue and nerves.
• Minimal scarring.
• Reduced risk of side effects and complications.

After your child has been registered, he or she will be taken to a “holding area” where you will meet your child’s pediatric anesthesiologist and neurosurgeon. The pediatric anesthesiologist — a doctor who specializes in anesthesia for children — will give the medications that will make your child sleep during the surgery. At this time, you may ask any questions about the procedure.

After your questions are answered and the operating room is prepared, your child will be taken into the operating room and given an anesthetic to make them go to sleep. When your child is asleep, the surgery will begin.

Your child’s neurosurgeon will:

• Load your child’s CT or MRI images into the image-guidance system. These images help your child’s doctor plan the procedure, create a precise surgical channel, insert the endoscope, and see the location of the surgical instruments in real-time throughout the procedure.
• Remove a small piece of your child’s skull and open the tough protective covering over the brain called the dura.
• Create a dime-sized surgical channel through the brain using a device called a tubular retractor. The tubular retractor gently separates brain tissue and creates a pathway for the neurosurgeon to access the tumor.
• Insert the endoscope through the tubular retractor. The endoscope has a light and a camera at the end that allow your surgeon to see a real-time video of the surgical area on a screen.
• Use specialized tools to remove the tumor through the tubular retractor.
• Take a CT or MRI image to verify that as much of the tumor as possible has been removed.
• Remove the tubular retractor, close the opening in your child’s skull, and place a bandage over the area.

What are the risks of neuroendoscopy?

UPMC Children’s takes every precaution to ensure your child's safety.

Risks associated with neuroendoscopic surgery include:

• Bleeding in your child’s brain.
• Cerebrospinal fluid leak.
• Increased pressure inside your child’s skull.
• Infection.
• Seizures.
• Stroke.

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery.

One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.

The nurse will give you specific eating and drinking instructions for your child based on your child’s age.

The following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse.

For children older than 12 months

• After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, coffee, and chewing gum or candy.

For infants under 12 months

• Up to six hours before the scheduled arrival time, formula-fed babies may be given formula.
• Up to four hours before the scheduled arrival time, breastfed babies may nurse.

For all children

• Up to two hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid®, and juices you can see through, such as apple or white grape juice. Milk is not a clear liquid.
• In the 2 hours before the scheduled arrival time, give them nothing to eat or drink.

Once your child has been registered for the surgery, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight, and medical history.

A pediatric anesthesiologist — a doctor who specializes in anesthesia for children — will meet with you before the surgery. They will ask questions about your child’s health and about when your child last ate.

Because your child may have eaten more recently than is usually advised for surgery, the anesthesiologist may make adjustments to your child’s anesthesia. Once admitted, your child will not be able to have anything to eat or drink until after the operation.

• As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
• If your child is very scared or upset, the doctor may give a special medication to help them relax. This medication is flavored and takes effect in about 10 to 15 minutes.
• If you wish, you may be allowed to go with your child to the room where the surgery will be done and stay while the sleep medication is given.
• Younger children will get their sleep medication through a “space mask” that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake.
• Older children may choose between getting their medication through a mask or directly into a vein through an intravenous (IV) line.
• When your child has fallen asleep, you will be taken to the waiting room. If it has not already been done, an IV will be started so that medication can be given to keep your child sleeping throughout the surgery.

While your child is asleep, their heart rate, blood pressure, temperature, and blood oxygen level will be checked continuously. Your child will have a breathing tube placed while they are asleep. Your child might have a sore throat after the surgery.

To keep your child asleep during the surgery, they might be given anesthetic medication by mask, through the IV tube, or both. When the surgery is over, the medications will be stopped, and your child will begin to wake up.

After surgery, your child will be moved to the recovery room to allow the anesthetic to wear off. You will be called so that you can be there as they wake up.

• Children coming out of anesthesia react in different ways. Your child might cry, be fussy or confused, feel sick to their stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off.
• While your child is in recovery, your surgeon will talk to you about the surgery. This is a good time to ask questions about pain medications, diet, and activity.
• When your child is awake enough, they might be given a Popsicle® or “slushy” to drink in the recovery room.
• Once the anesthesiologist sees that your child is recovering and their pain is controlled, they will be moved to their hospital room. This usually takes about an hour, but every child is different, so times may vary.

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.

• You are encouraged to talk to your child or hold their hand before the surgery, while sleep medication is given, and while in recovery.
• You may bring along a “comfort” item — such as a favorite stuffed animal or “blankie” — for your child to hold before and after the surgery.

Your child will be given pain medication after the surgery, which will help with discomfort when the anesthesia wears off. Your child’s doctor will give you instructions for how to administer pain medication at home after your child is discharged from the hospital.

Your child will need to spend at least one night in the hospital after neuroendoscopic surgery. After your child is transferred to a hospital room, they might still be groggy and should take it easy.

Diet

In the hospital, your child’s diet will be restricted to liquids, such as water, Gatorade®, Popsicles® or Kool-aid® for a couple of hours to ensure their stomach is settled after the surgery. If your child does well with liquids after a couple of hours, they may try a light diet and soft foods, such as applesauce, soup, toast, bananas, rice, or hot cereal. Your child may resume a normal diet the next day.

Bathing

• Your child should avoid getting their head wet or washing their hair for about a week after the procedure. This will give the scalp and skull time to heal.
• Have your child take baths instead of showers to minimize the risk of water getting on your child’s scalp.

Activity

Following the operation, activity needs to be somewhat restricted. Your surgeon will let you know when your child may resume normal activities, including returning to school and participating in sports.

To minimize the risk of a spinal fluid leak, your child will need to avoid activities that increase pressure of spinal fluid inside their head, such as bending, lifting, straining, or nose-blowing, for a month after surgery.

Recovery time

Your doctor will let you know about your child’s expected recovery time after neuroendoscopy. Most children can resume their normal activities within six to eight weeks after the procedure.

Follow-up care

Your doctor will let you know when to schedule a follow-up appointment. If additional treatments are needed, your care team will assist you with scheduling appointments for your child.

Call the doctor right away if your child has:

• A fever higher than 101.4° F.
• Bleeding or drainage from the surgical site.
• Increased tenderness near the surgical site.
• Increased swelling or redness near the surgical site.
• Increased pain that is unexplained.
• Nausea, vomiting, diarrhea or constipation that is not improving.

If your child develops symptoms of confusion, weakness on one side of the body, drooping face, difficulty with movement or walking, or problems with vision or speech, dial 911. These could be a sign of a stroke or bleeding in your child’s brain.

If you have any specific questions about your child’s surgery, you should discuss them with the surgeon before the surgery. You may call the Pediatric Neurosurgery Division at UPMC Children’s and ask to speak with your child’s surgeon or speak with them during the presurgical examination on the day of the surgery. Call the division at 412-692-5090.

If your child has any special needs or health issues that the doctor should be aware of, please call the Pediatric Neurosurgery Division at UPMC Children’s before the surgery and ask to speak with a nurse. It’s important to notify us in advance about any special needs your child may have.