Senior Director & HOD, Neurosurgery, Fortis Hospital, Noida
Part 7 of 9 in Diagnosis and Management of Brain Tumour
Brain Tumour Surgery in Children: Two Cases That Show What Changes
September 6, 2026
Dr. Rahul Gupta's masterclass gallery of recovered patients, as he put it, ran from young children to the very elderly. Two paediatric cases he described in detail show where the surgery genuinely differs for a child, starting with the tools themselves: a frameless neuronavigation biopsy, for instance, is often preferred to a rigid stereotactic frame precisely because a child's skull and cooperation make a fixed frame harder to use.
A choroid plexus papilloma with hydrocephalus
A child arrived with the classic signs of raised intracranial pressure from hydrocephalus: a sunsetting-eyes appearance and a bulging fontanelle. The MRI showed a brightly enhancing lesion within the ventricle, described as prawn-like in appearance, diagnostic of a choroid plexus papilloma. Surgery removed the relevant bone and excised the tumour, confirmed on a post-operative CT scan.
A posterior fossa tumour operated on during the pandemic
Posterior fossa tumours are common in children, and this particular child presented with drowsiness, vomiting and headache from hydrocephalus, requiring an external ventricular drain before the main surgery. The case fell during the COVID-19 pandemic, and the child tested positive for the virus; because the child was unconscious, Dr. Gupta operated immediately regardless, in full protective equipment. The tumour was near-totally excised, the ventricular drainage tube was visible on the post-operative CT scan, and the child was seen well at follow-up.
What these cases show
Neither case involved an unusual technology so much as a judgement call: recognising raised pressure early, prioritising drainage before definitive surgery when needed, and treating an unconscious child's tumour as urgent even in genuinely difficult circumstances. Dr. Gupta was clear that medicine is a constant learning process, that not every case succeeds, and that some tumours remain very high risk or inoperable even with every tool available.
This guide is based on a live Jivo Masterclass: Dr. Rahul Gupta taught doctors across Africa on February 9, 2025.
FROM THE LIVE Q&A
Moderator
After surgery, do all patients systematically need rehabilitation?
Dr. Rahul Gupta
Yes. All patients need post-operative care from a team of physiotherapists and rehabilitative support. About 90 percent of patients who arrive without deficits leave hospital without one, but even they need psychological support, and patients with malignant tumours need considerably more of it given the chemotherapy and radiotherapy ahead. Patients need to see the neurosurgeon and physiotherapist regularly for at least 3 to 6 months, and continue lifelong follow-up MRIs.
Frequently Asked Questions
What surgical technique is used for this kind of procedure?▼
The full presentation covered the range of techniques used, from neuronavigation and awake craniotomy to fluorescence-guided resection and endoscopic approaches, depending on the tumour's location and type.
Is a drain placed after surgery?▼
Yes, in around 80 percent of cases.
In the event of cerebral edema, what technique should be used?▼
Elective ventilation is used, along with decongestants such as mannitol or 3% saline. Sometimes the bone flap is deliberately not replaced immediately after surgery and is put back one to two months later.
What is the definitive test for brain tumours?▼
The definitive test is the histopathological examination of the biopsy sample taken during surgery.
What are the post-operative complications of brain tumour surgery?▼
The most important are seizures and post-operative brain edema. There can be neurological deficits if the motor cortex or another important area was operated on, and nerve injury if the surgery involved the skull base. Uncommonly, there can be post-operative hemorrhage or infection.
What are the signs of hydrocephalus in a child with a brain tumour?▼
A sunsetting-eyes appearance and a bulging fontanelle are classic signs, along with drowsiness, vomiting and headache.
Was surgery delayed for a COVID-positive child with a brain tumour?▼
No. Because the child was unconscious from raised pressure, surgery went ahead immediately, with the surgical team in full protective equipment.
Why is neuronavigation biopsy often frameless in children?▼
A rigid stereotactic frame is harder to use on a child's skull, so a frameless, neuronavigation-guided biopsy is often preferred instead.
In This Series: Diagnosis and Management of Brain Tumour
- 1.Diagnosis and Management of Brain Tumours
- 2.Recognising a Brain Tumour Early: Symptoms and Diagnostic Workup
- 3.The Principles Behind Every Brain Tumour Operation
- 4.Awake Craniotomy and Neuronavigation for Tumours in the Brain's Eloquent Areas
- 5.Fluorescence-Guided Surgery and Real-Time Imaging Inside the Operating Theatre
- 6.Reaching Pituitary and Vascular Brain Tumours Without a Wide Craniotomy
- 7.Brain Tumour Surgery in Children: Two Cases That Show What Changes
- 8.Recovery, Follow-Up and Prognosis After Brain Tumour Surgery
- 9.Delivering Safe Brain Tumour Surgery Where Resources Are Limited