When a Brain Tumour Strikes a Child: A Surgeon's Story

Last week, a family walked into my clinic carrying the weight of the world on their shoulders. They were seeking a second opinion for their 10-year-old daughter, who had recently suffered two seizures.

An MRI from another hospital had shown a tumour on the left side of her brain. We immediately arranged for a new, more detailed scan. The results confirmed my fears: the tumour was not just present; it was changing, growing more aggressive. I suspected it was transforming into a high-grade, malignant tumour—a dangerous growth that was, in a very real sense, eating her brain alive.

We had to have one of the most difficult conversations a doctor can have with a family.

I sat with them and laid out the choice, a choice no parent should ever have to face. Without surgery, her life expectancy might be as short as six months. With surgery—a high-risk procedure, as the tumour was located in the dominant hemisphere of her brain—we could potentially give her another two years of life after the necessary chemotherapy and radiotherapy.

If she were just a few years older, I would have performed an awake craniotomy, allowing me to map her brain functions in real-time. At her age, that wasn’t an option. The risks were significant.

We also spoke about the cost, a tremendous burden. But I reminded them of a simple truth: you can always find money, but you only have one life. Seeing their resolve, they placed their complete trust in my hands, a responsibility that is always humbling.

The day of the surgery, the operating theatre was a symphony of focused expertise and advanced technology. We embarked on a four-hour procedure: a left temporal lobectomy, amygdala resection, and a careful sparring of the hippocampus to preserve as much of her memory function as possible.

We threw everything we had at it. The room was packed with equipment and a dedicated team, including two anaesthetists. We used image-guided surgery for pinpoint accuracy, continuous motor cortex monitoring, EMG, and phase reversal to safeguard her neurological function with every move I made.

Alhamdulillah, the surgery went smoothly. We achieved a gross total resection—removing all visible traces of the tumour—without any new neurological deficit.

The true victory, however, came the next day. I walked into her room to find her sitting up, speaking clearly, eating, and even getting up to walk to the toilet on her own. The wave of relief that washed over her parents was a moment I will not soon forget.

One battle is over, but her journey continues. She now begins six weeks of chemotherapy and radiotherapy, the next critical phase in her fight. Her courage is a profound reminder of why we do what we do—for children like her, and for families who choose hope in the face of impossible odds.

Frequently asked questions

What are the warning signs of a brain tumour in a child? New or worsening seizures, morning headaches with vomiting, unsteady gait, sudden vision or speech changes, and unexplained personality or behavioural changes all warrant prompt neurological evaluation and imaging. Seizures, as in this case, are often the first noticeable sign.

Can awake craniotomy be performed on children? Awake craniotomy, which allows real-time mapping of brain function during surgery, generally requires the patient to be old enough to cooperate with intraoperative testing — typically adolescence or older. In younger children, surgeons rely instead on image-guided navigation and continuous neurophysiological monitoring (motor cortex monitoring, EMG, phase reversal) to protect brain function during surgery.

What is a gross total resection? A gross total resection means the surgeon has removed all visible traces of the tumour on imaging and under direct visualisation during surgery. It is the surgical goal for most brain tumours, as it improves outcomes and reduces the chance of early recurrence, though it must be balanced against the risk to surrounding functional brain tissue.

What treatment follows brain tumour surgery in children? Depending on the tumour grade and pathology, surgery is often followed by chemotherapy and radiotherapy to address microscopic tumour cells that surgery alone cannot remove, particularly for high-grade or malignant paediatric brain tumours.