Recovery After Surgery for Dandy-Walker Syndrome in Children

Patients should be monitored after the operation to ensure a decrease in ICP and thus success of the operation. If the ICP is stable, patients can be discharged and followed periodically in clinic.

Postoperative Orders 

• ICU vs. standard care unit: Patients with shunts typically recover on the standard unit. Patients with fenestration recover in the ICU.
• Routine postoperative monitoring
• CSF drainage parameters/drainage bag setup: Aggressive drainage should not be used. Normal pressure should be maintained. Drainage can end if the CSF is nonhemorrhagic and the ICP is normalized.
• Radiologic studies: Radiology follow-up is deferred for several months, allowing the anatomy to reach a steady state. However, if problems are suspected, a CT scan may be rapidly obtained.

Postoperative Morbidity

• Headaches: Headaches may occur as the patient becomes acclimated to the new lower ICP. Hydration, nonsteroidal agents, and gradual elevation of the head of the bed may help ameliorate the headaches. Severe or worsening headaches should prompt a CT scan to evaluate for treatable causes such as hemorrhage or intracranial air.
• Disfigurement due to decrease in head circumference: Overriding sutures may be seen in infants if the relief of hydrocephalus is significant. In these cases, the patient may be kept flat and the head of the bed gradually elevated.