Treatment approaches for brain tumors vary depending on the type, location and stage of the tumor. The age and general health of the child are also considered. Treatment may include surgery, radiation therapy, and/or chemotherapy. Sometimes steroids are given to reduce swelling. Scientists are currently trying to find treatments that stimulate the body's own immune system to destroy tumor cells. Gene therapy is another treatment option being studied.

Surgery
If the tumor is located in a area of the brain that will allow access to the tumor, a surgical biopsy or a needle biopsy will be done to remove a sample of tumor tissue so that doctors can study its characteristics. Some tumors are not biopsied prior to surgery. Instead, samples may be sent to pathology for analysis during the surgery for tumor removal.

To gain access to the brain, surgeons perform a craniotomy or craniectomy. "Cranio" means skull. "Otomy" means surgical incision. "Ectomy" means surgical removal. For a craniotomy, the surgeon creates a "bone flap" in the skull which is removed and put back in place when the operation is over. For a craniectomy, the bone is removed in pieces and not replaced.

If the tumor is located in a area of the brain where it's blocking the flow of the cerebrospinal fluid (CSF) pathway, removing the tumor will correct the problem. Sometimes, however, even when the CSF pathway is open, it doesn't function properly. In that case, the surgeon may insert a small plastic tube called a ventriculostomy or external ventricular drain (EVD) to avoid the buildup of fluid. Later, a more permanent internal shunt may be inserted to keep the fluid circulating around the brain. Sometimes steroids are given to reduce swelling before, during and after surgery.

The brain is a complex, sensitive organ, and doctors and parents must understand and deal with the risks of brain surgery. Despite the risk, surgery may be essential to remove as much of the tumor as possible. Studies show that two out of every 10 children who have brain surgery may develop serious after-effects. Examples include loss of speech, balance difficulties, hormonal disorders, or growth disorders. These problems may last for weeks, months, or longer. Speech therapy, physical therapy or occupational therapy can help restore function to maximum potential.

The ability of the pediatric neurosurgeon to remove as much of the tumor as possible is the first line of defense against a recurrence. Neurosurgeons commonly designate the extent of surgical resection (removal of tumor) as being total, near total, subtotal, partial, or biopsied only.

Total resection means that there are no visible residual tumor cells under the operating microscope or on the postoperative MRI, although there are always some tumor cells left behind. Therefore, some neurosurgeons refer to this as a "gross total" resection to distinguish it from the rare instances of a true total resection, in which the tumor as well as a margin of normal tissue are removed (which is rarely safe in the brain). 

Near total means a small amount (less than 10%) of residual tumor is left behind. Subtotal means 50% to 90% tumor removal, and partial means less than 50% tumor removal.