Prof. Roth Jonathan

I see nothing unusual about asking for another opinion. It does not mean you distrust the first neurosurgeon.

Brain surgery is a major decision. A tumor, cyst, hydrocephalus, or epilepsy surgery can affect a person’s life for years to come.

When I review a case, I am not only asking, “Can this be operated on?” I want to know whether surgery is needed now. Is there another option? What are we trying to achieve, and what risks are we accepting?

Sometimes I agree completely with the plan already suggested. Sometimes I see room for observation or would choose a different surgical approach.

My job is not to persuade someone to have surgery with me. I want the patient to understand why they are making that decision.

No. Many brain cysts do not need surgery.

The word “cyst” is frightening for parents, especially when it suddenly appears in an MRI report. But I regularly see children whose cyst was found by chance and has nothing to do with the symptoms that led to the scan.

Where is it? Is it putting pressure on the brain? Does it interfere with cerebrospinal fluid flow? Could it actually explain the child’s symptoms?

If the answer is no, observation may be all that is needed.

Sometimes a patient arrives and says straight away, “I only want endoscopic surgery.”

I understand why. Online, it is often described almost as brain surgery “without opening the skull.” That is not quite accurate.

An endoscope is a surgical tool. A very useful one, but still a tool. For certain tumors, cysts, and other conditions, it may allow us to reach the target through a smaller route and disturb less healthy tissue.

If an endoscopic approach is the better option, I use it. If another operation is safer, I choose the other operation. A technique should fit the patient, not the other way around.

No. Most children with epilepsy are treated by a pediatric neurologist and will never need brain surgery.

We usually start discussing surgery when seizures continue despite properly selected medication. Another situation is when testing identifies a specific area of the brain that may be causing the seizures.

Even then, nobody goes straight to the operating room. MRI, EEG, the seizure pattern, and sometimes additional studies all need to fit together.

Surgery is not right for every child. For a carefully selected patient, though, it can make a major difference.

Not necessarily.

For some patients, a shunt remains the safest and most reliable solution. In other cases, an endoscopic procedure may create a new pathway for cerebrospinal fluid and avoid placing a shunt.

Whether this is possible depends on why the hydrocephalus developed and where the fluid flow is blocked. Age also matters.

Two people may both have “hydrocephalus” written in their medical records and still need completely different treatment.

The first thing I usually say is: try not to spend the entire night searching for it on Google.

I know. Easier said than done.

But the name written in an MRI report is only part of the picture. Where is the lesion? How large is it? Has it changed compared with an older scan? Does it explain the symptoms? Does anything need to be done now?

I have seen patients arrive convinced they need urgent surgery and eventually continue with follow-up. I have also seen the opposite.

I need to see the actual images. I do not make serious surgical decisions from one line in a radiology report.

Because a disease does not always check the date of birth in your passport.

Some conditions occur in both children and adults. Tumors of the brain ventricles, certain cysts, and craniopharyngiomas are good examples.

Pediatric neurosurgery teaches you to work in very small spaces, around delicate structures, where every millimeter matters. That experience does not disappear when the patient on the operating table is 30, 40, or 60.

I do not treat an age. I look at the neurosurgical problem in front of me.

Of course.

Sometimes that is exactly why a consultation is needed.

A person may already have an MRI or CT scan, a written report, and perhaps opinions from several doctors, yet still not understand the basic question: what did they find, and what happens next?

We can open the scan and go through it properly. In some cases, the answer after the consultation is quite simple: no surgery now, continue follow-up.

That is also a useful outcome.

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It depends on why the operation was recommended.

There are urgent situations. If waiting could be dangerous, I tell the parents clearly that there is no time for a long decision-making process.

But that is not every case.

Families often hear “brain surgery” and feel they must decide by tonight. Sometimes there is time to review the scans again, ask questions, hear another opinion, and prepare properly.

I prefer parents to understand why we are operating and what we hope to achieve. The fear may still be there. That is natural. But confusion should not be.

I would ask about the surgeon’s experience with your specific condition.

Not simply, “Do you operate on brain tumors?” That question is too broad. If you have a colloid cyst, a craniopharyngioma, or a ventricular tumor, ask how often the surgeon sees cases like yours and what surgical approaches are used.

There is something else as well. After speaking with the doctor, you should understand your situation better.

Not a promise that “everything will be fine.” A clear explanation of what is happening, what the options are, and where the risks lie.

For me, that matters far more than reassuring phrases.

No.

“Tumor” and “cancer” do not mean the same thing.

Children can develop very different types of brain tumors. Some grow slowly. Others behave more aggressively. Some are followed with regular imaging, while others need treatment.

I try not to label the situation too early. First, we need to understand what kind of tumor we are dealing with.

Usually, I listen first.

When did the symptoms begin? Why was the MRI ordered? What has changed recently? What have other doctors already told you?

Then we look at the scans. The scans themselves, not only the radiologist’s written report.

What happens next depends on what we see. One patient may only need follow-up. Another may need more tests. With someone else, we may discuss surgery and the possible approaches.

There is no standard script for my consultations.

No. A recommendation for surgery does not automatically mean every alternative has been ruled out.

Sometimes surgery really is the most reasonable choice. In other situations, observation, medication, or radiation treatment may be considered, depending on the disease.

Before an operation, I ask myself a fairly simple question: does this patient actually need surgery now?

Only after the answer is yes do we move to the next question — how to perform it as safely and precisely as possible.