Neurooncology & Paediatric Neurosurgery

Advanced brain and spinal tumour surgery. Specialist paediatric neurosurgical care. Precision neurooncology with minimally invasive techniques. Oxford-trained. KPJ Tawakkal Specialist Hospital, Kuala Lumpur.

Neurooncology Surgery

→ Brain Tumour Surgery in Malaysia — full overview

What is Neurooncology?

Neurooncology is the surgical specialty focused on diagnosing and treating tumours of the brain and spinal cord. As an Oxford-trained neurosurgeon, I combine cutting-edge surgical techniques with precision-driven care to achieve the best possible outcomes for patients with complex neurological tumours.

Brain Tumours We Treat

Meningioma

Benign or malignant tumours arising from the meninges (brain lining).

• Symptoms: Headaches, vision changes, hearing loss
• Approach: Gross total resection when safely possible
• Outcome: Generally excellent prognosis with surgery

→ Full Meningioma guide — treatment, surgery & recovery

Glioma & Glioblastoma

Tumours arising from glial cells within the brain.

• Grade System: Low-grade (I–II) vs High-grade (III–IV)
• Treatment: Surgery + Radiation ± Chemotherapy
• Surgical Goal: Maximum resection while preserving function

→ Full Glioma & Glioblastoma guide

Medulloblastoma

Most common malignant paediatric brain tumour.

• Presentation: Headache, vomiting, balance problems
• Multimodal Treatment: Surgery + Chemotherapy + Radiation
• Prognosis: Improved with modern molecular protocols

→ Brain Tumour in Children — a Malaysian parent’s guide

Central Neurocytoma

Rare benign tumour of the lateral ventricles.

• Approach: Endoscopic resection when possible
• Outcomes: Generally excellent

Brainstem Gliomas

Challenging location; requires specialised approach.

• Technique: Frameless stereotactic navigation
• Goal: Safe debulking while preserving brainstem function

Surgical Techniques

Awake Craniotomy

For tumours near eloquent cortex (speech, motor, vision areas):

• Patient remains conscious during surgery
• Real-time neurological monitoring
• Preserves brain function while removing tumour
• Allows maximum resection safely

Frameless Stereotactic Navigation

3D imaging-guided surgery for precision:

• Real-time tracking of surgical instruments
• Reduced invasiveness
• Better outcomes for complex cases

Neuromonitoring

Continuous monitoring during surgery:

• Electromyography (EMG)
• Motor evoked potentials (MEP)
• Somatosensory evoked potentials (SSEP)
• Motor pathway mapping
• Ensures functional preservation

Symptoms That Require Evaluation

• Persistent or worsening headaches (especially new pattern)
• Vision changes (blurring, visual field loss)
• Balance problems or vertigo
• Weakness or numbness
• Speech or language difficulties
• Seizures
• Cognitive changes or memory loss
• Unexplained nausea/vomiting

If you experience these symptoms, seek neurological evaluation promptly.

Diagnostic Workup

MRI of the Brain (gold standard)

• High-resolution imaging of tumour location, size, and extent
• Helps guide surgical planning

CT Scan (for bone detail if needed)

PET/SPECT (for grading and prognosis)

Molecular Testing (for grade and prognosis)

Treatment Goals

1. Diagnosis Confirmation — Biopsy or resection for pathology
2. Maximum Safe Resection — Remove as much tumour as possible while preserving function
3. Symptom Relief — Address pressure effects, reduce oedema
4. Functional Preservation — Maintain neurological function
5. Prognosis Optimisation — Set stage for adjuvant therapy if needed

Recovery Timeline

• Hospital Stay: 2–4 days post-op
• Return to Light Activities: 2–4 weeks
• Full Recovery: 6–12 weeks
• Full Neurological Recovery: 3–6 months (sometimes longer)
• Follow-up: Regular imaging and neurosurgical follow-up essential for detecting recurrence

Prognosis by Tumour Type

Individual prognosis varies based on patient factors, tumour characteristics, and treatment response.

Paediatric Neurosurgery

Children are not small adults. Their brains are still developing, their tumours behave differently, their skulls are still growing — and the decisions made in the operating theatre carry consequences that stretch across a lifetime.

Paediatric neurosurgery demands a different kind of surgical discipline: smaller anatomy, less physiological reserve, and a family in the waiting room who trusted you with the most important person in their world.

Dr Nor Faizal trained in paediatric neurosurgery during his tenure at the Division of Neurosurgery, University of Malaya Medical Centre (UMMC) — one of Malaysia’s foremost academic neurosurgical centres. His training encompassed the full spectrum of paediatric neurological disease: brain tumour surgery using intraoperative MRI (iMRI) guidance, CSF diversion procedures, craniofacial reconstruction, and spinal anomaly repair.

His commitment to paediatric neuro-oncology extends internationally. In 2019, he was selected to attend the St. Jude Global Academy Neuro-Oncology Training Seminar at St. Jude Children’s Research Hospital, Memphis, Tennessee, USA — one of the world’s foremost paediatric cancer centres — under the Department of Global Pediatric Medicine, directed by Dr Carlos Rodriguez-Galindo. This programme represents the highest level of international paediatric neuro-oncology training available outside of formal fellowship.

He is an Active Member of the Asian-Australasian Society for Pediatric Neurosurgery (AASPN) and completed the Asian Australasian Advanced Course in Pediatric Neurosurgery (AAACPN) Part 1 in Seoul, Republic of Korea, in December 2017.

This training underpins a clinical philosophy: that a child with a brain tumour, hydrocephalus, or craniosynostosis deserves the same precision-led, outcome-focused care as any adult patient — and that their parents deserve a surgeon who communicates clearly, honestly, and with compassion.

Conditions Treated in Children

Brain tumours in children

Paediatric brain tumours differ significantly from their adult counterparts in location, biology, and treatment approach.

Medulloblastoma — the most common malignant brain tumour in children, arising in the cerebellum. Presents with headache, vomiting, and progressive balance disturbance. Treatment combines maximum safe surgical resection with craniospinal radiation and chemotherapy. Molecular subtyping (WNT, SHH, Group 3, Group 4) now guides prognosis and adjuvant therapy decisions. Five-year survival with modern protocols: 70–80%.

Ependymoma — arising from cells lining the ventricles or spinal canal. The extent of surgical resection is the strongest independent predictor of outcome. Recurrence requires early surveillance MRI.

Low-grade glioma (paediatric LGG) — the most common overall brain tumour in children. Many are managed with surgery alone; molecular profiling (BRAF fusion, IDH status) increasingly guides adjuvant decisions.

Craniopharyngioma — a benign but clinically challenging tumour near the pituitary and hypothalamus. Can significantly impair vision, hormonal function, and quality of life if not managed carefully.

Intracranial germ cell tumours — more common in Asian children than in Western populations. Requires a multidisciplinary team approach with paediatric oncology. Dr Nor Faizal contributed to a 20-year retrospective review of childhood intracranial germ cell tumour management in Malaysia, and co-authored research demonstrating improved medulloblastoma survival with structured MDT implementation at UMMC.

Hydrocephalus

Hydrocephalus — accumulation of cerebrospinal fluid causing raised intracranial pressure — is one of the most common conditions requiring paediatric neurosurgical intervention. Dr Nor Faizal has performed endoscopic third ventriculostomy (ETV) in children as young as one year old.

Treatment options:

• Endoscopic Third Ventriculostomy (ETV) — preferred first-line in suitable candidates; creates a natural CSF drainage pathway, avoiding the long-term burden of shunt dependency
• Ventriculoperitoneal (VP) shunt — for cases where ETV is not feasible; redirects CSF from the ventricles to the abdominal cavity
• ETV with Choroid Plexus Cauterisation (ETV/CPC) — particularly effective in infants under 12 months

Spina bifida and neural tube defects

Myelomeningocele (spina bifida) is a congenital anomaly in which the spinal cord fails to close normally during fetal development, leaving neural tissue exposed. Surgical repair protects the spinal cord and prevents infection. Associated hydrocephalus and Chiari II malformation often require concurrent or staged neurosurgical management.

Craniosynostosis

Craniosynostosis — premature fusion of one or more skull growth sutures — restricts normal brain growth and causes characteristic head shape deformities. Left untreated, it can lead to raised intracranial pressure and developmental delay.

Dr Nor Faizal has surgical experience in craniosynostosis repair and has contributed to published research on Crouzon syndrome — the most common craniosynostosis syndrome — including distraction osteogenesis for complex craniofacial correction.

Procedures include:

• Cranial vault remodelling — reshaping the skull to allow unrestricted brain growth
• Endoscopic strip craniectomy — minimally invasive early intervention requiring post-operative helmet therapy
• Posterior calvarial vault distraction — for complex cases with raised intracranial pressure and restricted cranial volume

Chiari malformation and foramen magnum decompression

Children with Chiari malformation — in which brain tissue herniates through the foramen magnum into the spinal canal — may develop occipital headache (worsened by coughing or straining), neck pain, balance difficulties, and syringomyelia. Surgical decompression relieves pressure on the brainstem and restores normal CSF flow.

Surgical Approach in Children

1. Pre-operative planning is non-negotiable. Advanced imaging — including MRI with DTI fibre tracking and intraoperative MRI (iMRI) — defines the surgical corridor before the first incision. Dr Nor Faizal contributed to outcomes research using the UMMC Siemens 1.5T iMRI suite, one of the few such installations in Southeast Asia.

2. Maximum safe resection, not maximal resection. The goal is to remove as much as can be safely achieved without sacrificing neurological function. A child’s quality of life after surgery matters as much as the extent of resection.

3. Multidisciplinary care from day one. Paediatric brain tumours require neurosurgery, paediatric oncology, radiation oncology, neuropathology, and neuroradiology working in concert. Dr Nor Faizal has participated in paediatric neuro-oncology MDT meetings and contributed peer-reviewed research on their impact on outcomes in Malaysia.

4. The family is part of the team. Parents and caregivers need clear, honest communication — not false reassurance, and not clinical jargon. Every family deserves to understand what is being planned, why, and what to expect.

Professional Credentials in Paediatric Neurosurgery

Research in Paediatric Neurosurgery

Karuppiah R, Munusamy T, Bahuri NFA, Waran V. “The utilisation of 3D printing in paediatric neurosurgery.” Child’s Nervous System 37, 1479–1484 (2021). doi.org/10.1007/s00381-021-05123-w — Review of 3D-printed biomodels for surgical simulation and pre-operative planning, including simulated ETV with pineal biopsy.

Rajagopal R et al. (incl. Nor Faizal Ahmad Bahuri). “Conduct of neuro-oncology multidisciplinary team meetings and closing the gaps in the clinical management of childhood central nervous system tumors in a middle-income country.” Child’s Nervous System (2021). doi.org/10.1007/s00381-021-05080-4 — 20-year retrospective review (UMMC); demonstrated improved medulloblastoma survival with structured MDT implementation; identified infrastructure and cultural barriers to paediatric CNS tumour care in Malaysia.

Nor Faizal Ahmad Bahuri et al. “Intraoperative MRI (iMRI) in paediatric cranial neuro-oncology — outcomes review.” University of Malaya Medical Centre, Siemens 1.5T iMRI suite (acquired September 2015).

Co-author, Crouzon syndrome distraction osteogenesis case series. Six paediatric patients with Crouzon syndrome treated with distraction osteogenesis for complex craniofacial correction — functional outcomes and rehabilitation strategy.

Google Scholar: 290 citations. Verified affiliation: University of Malaya.

When to Seek a Paediatric Neurosurgical Opinion

Seek specialist evaluation for your child if they experience:

• Headaches that are new, worsening, or present on waking
• Nausea, vomiting, or lethargy without a clear cause
• Changes in vision, balance, coordination, or gait
• Abnormal head shape or rapid head circumference growth in infants
• A bulging fontanelle in newborns or infants
• Back deformity, leg weakness, or bladder issues with a known spinal anomaly
• A diagnosis of brain or spinal tumour, hydrocephalus, or craniosynostosis
• Seizures with an identified or suspected structural brain lesion

Common Questions (Paediatric)

Q: My child has been diagnosed with a brain tumour. What happens next? The first step is a comprehensive assessment — reviewing all imaging, understanding the tumour’s location and likely biology, and staging the full extent of disease. I will explain what we know, what we don’t yet know, and what the surgical plan entails — in plain language, not clinical shorthand.

Q: Does my child need surgery immediately? Not always. Some tumours can be monitored with serial imaging. Others — particularly posterior fossa tumours causing hydrocephalus and raised intracranial pressure — require prompt intervention. The urgency is determined by clinical presentation and imaging, not by the diagnosis alone.

Q: What is the difference between a VP shunt and an ETV for hydrocephalus? A VP shunt is an implanted device that drains CSF to the abdomen — reliable but with long-term risks of infection, blockage, and revision. An ETV creates a natural internal drainage channel within the brain itself — no device, no external hardware. ETV is preferred when anatomy is suitable, particularly in older infants and children.

Q: Can craniosynostosis be left untreated? It depends on which suture is fused and whether intracranial pressure is elevated. Craniosynostosis syndromes (Crouzon, Apert) typically require early multidisciplinary intervention to protect brain development and manage orbital and craniofacial complications.

Common Questions (Neurooncology)

Q: Do all brain tumours need surgery? Not necessarily. Treatment depends on tumour type, grade, location, and patient factors. Some may be monitored; others require surgery, radiation, chemotherapy, or combinations.

Q: Will surgery affect my thinking or personality? Neurosurgical techniques are designed to minimise functional impact. Neuromonitoring during surgery helps preserve brain function. Some patients experience temporary confusion post-op, but most recover fully.

Q: What about chemotherapy and radiation after surgery? Depends on tumour type and grade. Your oncology and radiation oncology teams will discuss this based on pathology results.

Q: Can brain tumours come back? Some tumours have higher recurrence risk than others. Regular imaging follow-up is essential to detect early recurrence.

Next Steps

If you or your child has been diagnosed with a brain or spinal tumour, hydrocephalus, craniosynostosis, spina bifida, or any condition requiring neurosurgical evaluation:

Schedule Your Evaluation →

A comprehensive neurological assessment, imaging review, and management plan — explained clearly, from a surgeon trained at Oxford, UMMC, and St. Jude Children’s Research Hospital.

Discipline · Simplicity · Elegance

Precision neurosurgery for the brain. For every age.