About Your Brain Tumor Surgery for Pediatrics

About Your Surgery

This guide will help you prepare for your brain tumor surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect after your surgery. For the rest of this resource, our use of the words “you” and “your” refers to you or your child.

Your Brain

Your brain is an organ that controls different functions in your body, such as:

  • Thought
  • Memory
  • Speech
  • Vision
  • Emotion
  • Hunger
  • Movement

If you have a tumor in your brain, it can affect the way your body normally functions. It can cause headaches, dizziness, vomiting, vision problems, poor balance, unsteady walking, or weakness.

There are many other functions that can be affected by a brain tumor. Your surgeon or nurse practitioner (NP) will talk with you about what functions may be affected by brain tumor removal surgery.

Brain Tumor Removal Surgery

Figure 1. Brain tumor removal surgery

Your surgeon will make an incision (surgical cut) through your scalp, then pull back the skin (skin flap) and muscle covering it (see Figure 1). Your surgeon will use special tools to make an opening in your skull bone. Your surgeon will remove the bone flap, then open your dura to see your brain. Next your surgeon will use a special computer system to remove all, or part of, the tumor in your brain and send it to the Pathology department for testing. Your surgeon will close the dura. The bone flap may or may not be replaced. Your surgeon will close your incision with stitches or staples.

There are 2 different types of surgeries to remove brain tumors.


A craniotomy is a surgery to remove a part of the bone from the skull to see the brain. Special tools are used to remove the section of the bone. The section that is removed is called a bone flap (see Figure 1). Once the bone flap is removed, the dura (tissue covering the brain) is opened and the tumor is removed. Once the tumor is removed, the dura will be closed and the bone flap is replaced. The scalp is closed with sutures or staples and a dressing is placed on the head to cover the incision.


If the bone flap is not replaced, the surgery is called a craniectomy. Craniectomies are done:

  • To relieve pressure
  • To give the brain space to swell after surgery
  • If the bone flap is involved with the tumor

In these cases, the opening in the skull is closed with mesh and bone substitutes. The scalp is closed with sutures or staples and a dressing is placed on the head to cover the incision. A helmet may need to be worn to protect your head from injury until the bone is replaced.

Both surgeries will relieve the pressure from the tumor and may also help to relieve symptoms caused by the tumor.

They will also provide tumor tissue for biopsy. Your surgeon will send this tumor tissue to the Pathology department to find out what type of tumor you have. Your treatment options will depend on the type of tumor you have and whether the tumor was completely removed or if any tumor cells remain after surgery.

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Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare for your surgery.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medicines to help prevent them.
  • If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include: bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.

Here are things you can do to prevent problems before your surgery:

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you cannot stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.

At MSK, we want to keep you safe during your surgery. You can help by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take prescription medications, including patches and creams.
  • I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia in the past.
  • I have allergies, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.
  • I have a programmable ventriculoperitoneal (VP) shunt.

About Smoking

People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing

Before your surgery, you will have an appointment for presurgical testing (PST). Depending on your age, your testing can take place in a variety of places. The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

Use this area to write your presurgical testing appointment information:

You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medication to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.

Your nurse practitioner will talk with you about which medications you should take the morning of your surgery.

It is very helpful if you bring the following with you to your PST appointment:

  • A list of all the medications you are taking, including patches and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).
  • Your insurance card.

Please be aware that your presurgical appointment may take several hours.

Parking at the PDH

The Pediatric Day Hospital (PDH) is located at the main hospital.
Memorial Hospital
1275 York Avenue
(between East 67th and East 68th Streets)

New York, NY 10065

Parking at the main hospital is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital. If you have questions about prices, call 212-639-2338.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Parking at PST

PST is located in the Rockefeller Outpatient Pavilion, also known as MSK 53rd Street.
Rockefeller Outpatient Pavilion
160 East 53rd Street (at Third Avenue)

New York, NY 10022

There are several options for parking during your PST appointment. The Bristol Garage offers discounts to patients. To receive the discount, have your parking ticket validated at the concierge desk in the Rockefeller Outpatient Pavilion. There is a shuttle that goes from the Bristol Garage to the Rockefeller Outpatient Pavilion every 20 minutes.

The Bristol Garage
300 East 56th Street (between First and Second Avenues)

New York, NY 10022

There are additional parking garages located at East 53rd Street between Second and Third Avenues and East 54th Street between Second and Third Avenues.


The Ronald McDonald House provides temporary housing for out-of-town pediatric cancer patients and their families.

MSK also has arrangements with several local hotels and housing facilities that may give you a special reduced rate. Your social worker can discuss your options and make reservations.

Tell Us if You’re Sick

If you develop any illness before your surgery, call the doctor who scheduled your surgery. This includes a fever, cold, sore throat, or the flu.

10 Days Before Your Surgery

Stop Taking Certain Medications

If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin, and vitamin E can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

7 Days Before Your Surgery

Stop Taking Herbal Remedies and Supplements

Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment.

2 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

1 Day Before Your Surgery

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on Monday, you will be called on the Friday before. If you do not receive a call by 4:00 pm, please call 212-639-7056.

Both locations are at 1275 York Avenue between East 67th and East 68th streets.

You may need to have magnetic resonance imaging (MRI) or a CT scan for treatment planning (brain lab MRI or brain lab CT) the day before your surgery.

The Night Before Your Surgery


Unless you are given other instructions, you may shower and wash your hair. Do not apply any hair products such as hair spray or hair gel.


Go to bed early and get a full night’s sleep.


You will need to follow nothing by mouth (NPO) guidelines the night before your surgery. Do not eat or drink anything for a certain amount of time before your surgery. This exact period of time is based on your age and any other medical problems that you may have. Your nurse practitioner will talk with you about what you can and cannot eat before surgery.

If you do not follow the NPO guidelines, your surgery may be cancelled.

The Morning of Your Surgery

Take Your Medications as Instructed

If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications. Do not take any medications 2 hours before your surgery.

Do not eat or drink anything the morning of your surgery. This includes water, hard candy, and gum. Take any medication as instructed with a small sip of water.

Things to Remember

  • Wear loose-fitting clothing.
  • Do not put on any lotions, creams, nail polish, powders, deodorants, makeup, or perfumes.
  • Do not wear any metal objects. Remove jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Leave valuables, such as credit cards, jewelry, or your checkbook at home.
  • Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles (such as a rosary).
  • If you wear contact lenses, wear your glasses instead.

What to Bring

  • Only the money you may need for a newspaper, bus, taxi, or parking costs.
  • CD player and CDs, iPod or iPad, if you choose. However, someone will need to hold these items for you when you go into surgery.
  • Your Health Care Proxy form, if you have completed one.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Parking When You Arrive

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to state and spell your name and birth date many times. This is for your safety. People with the same or similar names may be having surgery on the same day.

Meet With Your Nurse

Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Get Dressed for Surgery

You will be given a hospital gown, robe, and non-skid socks.

Meet With Your Anesthesiologist

He or she will:

  • Review your medical history with you.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you will receive.
  • Answer any questions you may have about your anesthesia.
Prepare for Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery.

You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your stay and after you leave. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

What to Expect

When you wake up after your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). As soon as you are settled in the PACU, a nurse will bring your family member in to be with you. You may have a mask over your face that will give you air and help you wake up after surgery. You will be attached to machines that will monitor your heart rate and blood pressure. It is normal to feel very tired after surgery. Your PACU nurse will make sure you are comfortable and answer any of your questions.

Once your anesthesia has worn off, you will be taken to your hospital room. Depending on your age and condition, you may be taken to the Pediatric Intensive Care Unit (PICU), the Adult Intensive Care Unit (ICU), or the Neurology Observation Unit (NOU) for close observation and monitoring.

After 24 hours you will be taken to the pediatric or neurology floor for continued care. You will be asked to move your arms, fingers, toes, and legs frequently. Your nurse will check your pupils with a flashlight and ask questions such as “What is your name?” Depending on your treatment plan, a physical therapist may begin to work with you. Over the next couple of days, you will increase your activity until you are ready to go home.

Commonly Asked Questions

How long will I be in the hospital?

Most people stay in the hospital for 3 to 5 nights, but your stay will depend on how fast you recover.

Can family and friends visit me in the hospital?

Your parents, other family members, and friends are welcome to visit you during your hospital stay as long as they in good health. No one with any signs of sickness such as fever, cough, congestion, sore throat, or rash is allowed to visit. Since visiting hours may vary, depending on where you will be staying, please check with your nurse regarding the visitation policy. Visitors on the Pediatric Unit are limited to parents and 2 other visitors daily.

Parents may call the inpatient unit at any time. Ask your nurse for the phone number. Because of privacy concerns, staff will only give information to parents or spouses. Please tell friends and other relatives not to call the inpatient unit for information.

When will I be able to eat and drink?

You will most likely be allowed to drink liquids after a few hours, and your diet will advance with each meal.

Do I need to change my diet?

When you return home, you may resume your normal diet. However, your pain medication can cause constipation.

How can I prevent constipation?

Your doctor may prescribe a stool softener to help. To prevent constipation:

  • Exercise if you can. Walking is an excellent form of exercise.
  • Drink plenty of liquids daily, if you can. Drink water, juices, soups, ice cream shakes, and other drinks that do not have caffeine.

  • Slowly increase the amount of fiber in your diet. Fruits, vegetables, whole grains (wheat, oats, barley), and cereals have fiber.

If these methods do not help, talk with your doctor or nurse. He or she may give you other suggestions, adjust your medication, or recommend prescription medication.

Will I have pain?

Some pain near your incision (surgical cut) and soreness in your neck and skull is normal after surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to control your pain as needed. If your pain is not relieved, please tell your doctor or nurse. You will be given a prescription for pain medication to take when you are at home.

You may be dizzy and nauseous, and have a headache after your surgery. You will be given medication to help with these symptoms.

Will I have to take medication after my surgery?

Your doctor may give you any of the following medications after your surgery:

  • Pain Medication
    • May be prescribed for headaches and pain relief
  • Steroids
    • May be prescribed to decrease brain swelling
  • Antacid
    • May be prescribed to protect your stomach while you are taking steroids
  • Antiseizure medications
    • May be prescribed for people who are at risk for seizures
    • If you were taking antiseizure medication before your surgery, you should continue to take it unless you have been given other instructions
  • Stool softener
    • Can help prevent constipation

You can take your usual medications immediately after your surgery, but do not take aspirin, products containing aspirin, or NSAIDs (e.g., ibuprofen). For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Your surgeon will tell you when it is okay to take these medications.

Will my head be shaved?

Only the hair along your incision will have to be shaved, so your entire head will not be shaved. You will have a turban-like head wrap or soft bandage placed over your incision. This is usually removed after 48 hours. Your incision will be left uncovered.

How do I care for my incision?

Your incision does not need to be covered. However, you should protect it from the sun by wearing a hat or scarf and using sun block. Mild swelling around your incision is normal. As your incision heals, it may burn, itch, or feel numb. Do not apply any creams, ointments, hair products, or use a hair dryer on your incision until they are completely healed. This may take about 6 weeks.

When can I shower?

You can shower when you get home. However, for the first 5 days after your surgery, you must wear a shower cap to protect your incision from getting wet.

Five days after your surgery, you should begin to wash your hair daily. This helps to loosen up the crusting on your incision and will make it easier for your surgeon or nurse to remove your staples or sutures.

When you wash your hair, use a gentle shampoo, such as baby shampoo. You can gently massage the area near your incision to wash off any dried blood or drainage. Clean your incision with soap and water and pat it dry with a clean towel. You can let the shower water run over your incision. You do not need to put another bandage on your incision after you shower.

Do not let your incision soak in water. Avoid baths, hot tubs, and swimming pools for at least 2 weeks after your surgery.

When can I resume my normal activities?

You can resume most activities right after your surgery. However, do not lift objects heavier than10 pounds (4.5 kilograms) until your doctor says it is safe. This is usually 6 weeks after your surgery. This includes a large purse or bag, backpack, or briefcase. It may be helpful to use a wheeled backpack for heavy textbooks.

Your doctors and nurses will give you instructions on what exercises and movements you can do while your incision is healing. Check with your doctor or nurse before starting any gym activity, such as running, jogging, or lifting weights. You may exercise by walking.

When can I go back to school or work?

You may return to school or work as soon as you feel ready.

If your work requires heavy physical activity, you may need more time to recover. Talk with your doctor about when it would be safe to return to school or work.

When can I go to my gym class in school?

You cannot participate in gym class for at least 6 weeks after your surgery. It will take at least 6 weeks for your skull to heal.

When can I swim?

Do not swim for at least 2 weeks after your surgery. If your incisions need more time to heal, you may need to wait longer. Your neurosurgeon or nurse practitioner will tell you when it’s okay to swim at your first follow-up appointment after your surgery.

When can I drive?

Do not drive:

  • For 2 weeks after your surgery.
  • If you are having problems with your vision or memory.
  • While you are taking the prescription pain medication given to you after your surgery. These medications can make you drowsy and make it unsafe for you to drive.

If you are taking antiseizure medications, do not drive until your neurologist gives you permission.

How soon after surgery can I start or resume chemotherapy or radiation therapy, if needed?

This will vary for each person. Please ask your surgeon before you leave the hospital.

When is my first appointment after my surgery?

You will have your first follow-up appointment with your surgeon or nurse practitioner 10 to 14 days after your surgery. Call your surgeon’s office to schedule the appointment before you leave the hospital. Depending on how you are healing, some or all of your stitches or staples will be removed during this appointment.

What if I have other questions?

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm. Call the office directly at 212-639-7056.

After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the pediatric neurosurgery fellow on call.

  • A temperature of 100.4° F (38.0° C) or higher
  • Drainage from your incision
  • Shortness of breath
  • Severe swelling or redness around your incision
  • Increased pain
  • Seizures
  • Increased sleepiness
  • Severe worsening speech, strength, vision, or sensation
  • Change in your mental status
  • Lack of bowel or bladder control
  • Pain in your calf
  • Severe headaches, nausea, and vomiting
  • Any other concerns
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This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.

MSK Resources


Call with questions about anesthesia, the medicines used to make you sleepy for your surgery.

Blood Donor Room

If you are interested in donation blood or platelets call for more information.

Bobst International Center

MSK welcomes patients from around the world. If you are an international patient, call the International Center for help coordinating your care.

Chaplaincy Service

At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Integrative Medicine Service

Offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Patient Billing

Call Patient Billing with any questions about preauthorization from your insurance company. This is also called preapproval.

Patient Representative Office

Call if you have any questions about the Health Care Proxy form or if you have any concerns about your care.

Perioperative Nurse Liaison

Call if you have any questions about MSK releasing any information while you are having surgery.

Social Work

Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help with referrals to community agencies and programs, as well as financial resources and support groups eligible.

Tobacco Treatment Program

If you want to quit smoking, MSK has specialists who can help. Call for more information

Additional Resources

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