There are three surgical procedures that are typically performed on patients with AT/RT. All of these are best performed by highly skilled pediatric neurosurgeons with experience in rare brain tumors in children. (See Doctors Who Treat AT/RT.)
Surgical biopsy: Depending on the location of the tumor, the first surgery a patient is likely to have is a biopsy, to extract a sample of the tumor tissue to determine what kind of tumor it is. The sample may be extracted with a needle if possible, Some tumors are in difficult-to-reach locations in the brain and are not biopsied in advance of resection surgery – samples are sent to a pathology lab during the surgery to remove the tumor.
Resection (removal): A highly skilled pediatric neurosurgeon will perform a craniotomy or craniectomy to remove a portion of the skull to gain access to the tumor to remove it. The goal of the surgery is to remove as much of the tumor as possible without damaging healthy brain tissue. In other areas of the body, surgeons remove not just the tumor but a small margin of healthy tissue around it to capture any stray cancer cells. That’s not possible in the brain, where removing healthy tissue can cause neurological deficits (motion, speech, or other functions). The skill and training of the neurosurgeon is critical to how much of the tumor can be removed. Since AT/RT grows and spreads so quickly, removing as much of it as possible can help delay any recurrence of the tumor.
Shunt placement/revision: A tumor may be blocking the normal flow of cerebrospinal fluid (CSF), leading to a buildup of pressure in the brain (hydrocephalus). A pediatric neurosurgeon can place a temporary drain, called a ventriculostomy or external ventricular drain (EVD), to relieve pressure. An internal shunt is a more permanent solution – it drains CSF into the patient’s abdomen, where it is absorbed into the body. Shunts may sometimes need to be repositioned to continue to drain effectively, which is called a shunt revision.
At Weill Cornell Medicine Neurological Surgery, our pediatric neurosurgeons are highly skilled in the most advanced procedures for treating pediatric brain tumors.
Reviewed by: Jeffrey Greenfield, MD/PhD
Last reviewed/last updated: March 2021