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Potential side effects of surgery for childhood brain and spinal cord cancer
Side effects can occur with any type of treatment for childhood brain and spinal cord cancer, but not every child has them or experiences them in the same way. Side effects of surgery will depend mainly on:
- the type of surgery
- the location of the tumour
- how much of the tumour is removed
Side effects can happen any time during surgery. Some may happen during, immediately after, or a few days or weeks after surgery. Many side effects go away after surgery. Late side effects can occur months or years later. Some side effects may last a long time or become permanent.
It is important to report side effects to the healthcare team.
Some swelling along and around the incision can happen as part of the body's normal healing process. The swelling is usually the greatest 2–7 days after surgery. It can vary from minimal swelling to an area of swelling that is the size of a fist. Swelling around the incision will go away on its own.
Some children develop a wound infection after surgery. Signs of infection, such as redness, increased warmth, increased swelling or tenderness of the incision, pus or foul-smelling drainage or fever, should be reported to the child's doctor right away. Infections along the incision line can usually be treated with antibiotics. In rare cases, the skull bone can become infected. If antibiotics do not help, surgery may be needed to remove the infected bone. Once the area has healed and there is no sign of infection, the doctor may replace the removed bone with a synthetic material.
Sometimes a child will develop a fever that does not go away after surgery. This can be caused by an infection or by the presence of blood around the brain. Report fever to the child's doctor right away so that the cause of the fever can be found and treated.
Posterior fossa syndrome (PFS) is also known as cerebellar mutism. PFS is the name given to a number of specific neurological problems that could occur after surgery. The main problem is the child's inability to speak (mutism). Other problems could include rapidly changing emotions (emotional lability), diminished muscle tone (hypotonia) and lack of muscle coordination (ataxia). It is not known why PFS develops, but it occurs to some degree in up to 25% of surgeries to remove posterior fossa tumours (medulloblastomas, ependymomas, and astrocytomas).
PFS usually develops within the first few days after surgery. It may take weeks or months for the child's speech to return and sometimes parents say their child's speech sounds different than it did before surgery. A speech therapist can help children with PFS regain their speech. Many children with PFS experience significant, if not complete, recovery.
Surgery for a brain tumour often changes the normal flow of CSF in and around the brain. CSF can leak out through the incision in the dura mater until it heals completely. It may also drain out through the incision in the scalp, the nose or down the back of the throat. CSF can also build up in certain areas, including the following:
- CSF can build up around the incision, creating a spongy or boggy feeling in the area. This usually resolves on its own after a few weeks. A doctor should be notified if the area becomes red or if any drainage from the area becomes cloudy.
- CSF can build up in the ventricles (hydrocephalus) due to a blockage in the flow between the ventricles. The blockage may be temporary or permanent. A shunt may be needed to help drain the extra fluid.
- CSF may build up between the scalp and the bone or between the scalp and the dura mater (if the bone wasn’t replaced after surgery). This is called a pseudomeningocele. It usually resolves on its own after a few weeks.
- CSF can also build up between the dura mater and the surface of the scalp (subdural hygroma). If the hygroma becomes too large, it may put too much pressure on the brain. The doctors may insert a temporary drain or permanent shunt to drain the fluid and relieve the pressure.
Meningitis is an inflammation of the surface covering the brain (the meninges). Signs and symptoms include fever, irritability, stiff neck and a decreased level of consciousness.
There are 2 types of meningitis:
- Aseptic meningitis is caused by irritating chemicals or materials released from the tumour during surgery. An infection is not usually present in aseptic meningitis. Steroid therapy may be used to reduce the inflammation and relieve the symptoms.
- Bacterial meningitis is caused by bacteria that enter the incision and spread to the tissues deeper in the brain. Antibiotics are needed to treat the infection.
Surgery may interrupt or cause abnormal electrical signals within the brain. These abnormal signals can cause seizures. Medications called anti-convulsants or anti-epileptics may be given to prevent seizures from occurring or reduce their frequency. Seizures may become a long-term problem and the child may have to take the anti-seizure medication for months or years after surgery.
Jaw pain may happen if the doctor needed to cut a muscle in front of the ear during surgery. The muscle is sewn back together after the tumour is removed. However, it may take a few weeks for the muscle to heal and the jaw pain and locking to go away. The child's surgeon should be told about the jaw pain, but there is usually no need to consult a dentist or oral surgeon.
In rare cases, blood clots (hematomas) can occur in the brain or between the dura mater and the surface of the brain (subdural hematoma) after surgery. These clots are usually small and can be absorbed by the body over a number of months. Surgery may be needed if the clot is large and puts pressure on the brain.
Vision problems, including blindness, may occur if the nerves of the eyes are affected by the tumour or by increased pressure inside the skull (intracranial) after surgery. This may be a temporary problem that goes away once the tumour is removed and the pressure returns to normal. Sometimes the blindness progresses and becomes permanent if the nerves are too badly damaged.
Symptoms, such as difficulty walking or double or blurred vision, may actually get worse after surgery. This is often caused by the normal swelling that takes place after any operation. As the area heals, the swelling goes down and the symptoms usually improve.