Problems, or complications, after brain tumour surgery are divided into two categories: unexpected complications that require immediate attention from the treatment team and expected problems associated with certain types of surgery, such as mutism, swallowing problems, neurological deficits, or hormonal problems.
Unexpected complications
To be safe, you should watch for certain symptoms in your child after the operation, and when you go home. These symptoms might mean that your child has a complication. Contact the treatment team right away if you notice any of these symptoms:
- fever (a temperature of 37.8°C / 100.0°F taken under the arm, or 38.5°C / 101.3°F taken in the mouth)
- redness or swelling along the surgical incision (cut)
- fluid coming from the incision
- headaches
- vomiting
- any other concerns you have
Swallowing problems
Your child may have swallowing problems after surgery, or with certain types of tumours, such as brainstem tumours. Usually swallowing problems connected with surgery improve with time. If the tumour is causing swallowing problems, then the problem can improve after radiation therapy, which shrinks the tumour.
How will swallowing problems affect my child?
Swallowing involves many muscles in different parts of our bodies, such as the tongue, the pharynx and the trachea. The pharynx is the part of the body leading from the mouth to the esophagus, which goes to the stomach. The trachea is the airway leading to the lungs. If your child loses coordination or strength in these muscles, it may affect their ability to swallow. In some cases, their ability to swallow may be lost. This is called dysphagia. There are two problems that might occur.
- Your child may not eat enough to keep up their health.
- Your child may be at risk for aspiration. This means that food or fluid goes into the lungs instead of the stomach, because the trachea (airway) does not close. If this happens often, it can cause pneumonia.
Signs of swallowing problems include:
- choking or coughing during eating
- a wet-sounding voice and cough
- frequent chest infections
- being afraid to eat or drink
- avoiding certain foods
- complaints of food getting stuck or going the wrong way
- drooling
- pocketing of food in the mouth
If your child is having any of these problems, they should be referred to an occupational therapist to assess their swallowing. The occupational therapist will watch and listen while your child is eating or drinking and may also ask your child to move the muscles of their tongue, lips, and cheeks. In some cases, the occupational therapist may recommend a feeding study. A feeding study is an X-ray called a videofluoroscopy that finds out what your child can drink and eat safely. The videofluoroscopy is a movie of what happens inside your child’s mouth and throat from when food enters your child’s mouth until after your child swallows.
What can be done?
The solution to your child’s swallowing problem will be based on the condition. Your child will probably need a special diet. Some children will need a feeding tube, such as an NJ-tube or a G-tube.
Diet for swallowing problems
The occupational therapist will work with you to make sure your child can safely eat certain textures. The dietitian will help make sure your child’s nutritional needs are being met. A child having problems may do better with thicker liquids, purees, or soft foods. These are highlighted in the table below.
| Food thickness | Examples |
|---|---|
| thin fluids (difficult to swallow) | water, milk, juice |
| thick fluids | buttermilk, cold tomato juice |
| purees | apple sauce, yogurt, food processed in a blender, baby food |
| soft foods | mashed cooked vegetables, custard, mousse, soufflé, quiche |
| firm foods (difficult to swallow) | apple pieces, roast meat |
Mutism
Transient cerebellar mutism is a potential complication for children who undergo surgery for a posterior fossa tumour. This type of tumour is located in the back part of the brain. Mutism occurs in about one out of every five to 10 cases of an operation to a tumour in this part of the brain resulting in your child being unable to speak.
This mutism will improve over time. However, it is often frustrating and difficult for your child and for you. It is important to know that others have been through the same experience. You may find it helpful to get in touch with other parents for support.
Mutism is part of a larger set of problems. This is called a syndrome. Some of the other symptoms you may notice in your child are:
- changes in behaviour
- emotional difficulties
- cortical blindness: the eyes may work fine, but the brain isn’t seeing images
- they may not be able to balance while walking
- extreme irritability: they may kick and scream for hours, even though you try hard to calm them down
How long will the mutism last?
While the other symptoms described above may improve, mutism can last much longer- possibly many months. As soon as your child does start to say some words — even if they are hard to understand — it will not be long before they will be able to speak in sentences again.
Will my child recover completely?
All children will be able to speak again, but they may not speak in the same way as they did before the operation. There may be some problems such as slurred speech, slowness, or stuttering. A speech-language pathologist will work with your child to help them improve.
How do I communicate with my child?
It is best not to try and force your child to speak. They may not be physically able to say any words. Forcing speech will only frustrate them. You can find other ways to communicate. A speech-language pathologist or other experts may be available to help you.
Often, you can begin by finding a signal that your child can use that means “yes” and “no.” For example, one thumb up could mean “yes” and a thumb down could mean “no.” Another example is getting them to squeeze your hands. (One time for “yes,” two times for “no”). It is also helpful for you to speak to your child in simple sentences that ask for a “yes” or “no” answer, such as “Are you cold?” or “Do you want a blanket?”.
Your child’s treatment team may provide a picture board so that your child can communicate by pointing to pictures, or spell out words by pointing to letters. These picture boards can be created and changed to meet the needs of your child.
Speech and language test
Your child may have had a half-day speech and language test conducted before and after the operation, to see if the way your child talks or listens has changed. A speech assessment is a complete test of your child’s ability to talk, listen and move the muscles of the face needed for talking. Another speech and language test may be done again in the future to make sure that they are getting better.
Preparing for a speech and language test
Tell your child that the speech-language pathologist is coming to help them talk and listen. Tell them that they will do some tasks with the speech-language pathologist, and that they must try to do their best. The jobs are a little bit like school work. Your child will get to look at pictures, tell stories, and make funny faces with the speech-language pathologist.
Here are some of the things that are part of the test.
- You as parents will be asked questions about your child.
- Your child’s facial muscles will be examined. The examiner will test the strength, speed and muscle movement of your child’s tongue, jaw and lips. Your child may be asked to smile, pucker their lips, move their tongue around and say some funny sounds.
- Your child’s ability to tell stories, explain things, and their vocabulary knowledge may also be tested.
- Sometimes your child will be videotaped or audiotaped.
Neurological deficits
Sometimes surgery can result in weakness or problems with balance. If your child experiences this, they will require help and support from the rehabilitation team (occupational therapists and physical therapists).
For more information, see the pages on "Occupational therapy" and "Physiotherapy."
Hormone problems
For craniopharyngiomas, hypothalamic gliomas, and supracellar germ cell tumours, surgery can damage the pituitary gland. Damage to the pituitary gland can lead to hormone problems.