Complications of Therapies for Cerebellar Astrocytomas in Children

Surgical

• Postoperative hematoma: A hematoma may arise rapidly, becoming life-threatening in the posterior fossa. It should be evacuated immediately when it is large and/or causes symptoms.
• Acute hydrocephalus: Hydrocephalus may result from cerebellar swelling or obstruction of CSF pathways by blood products or residual tumor.  If the patient is symptomatic, immediate ventriculostomy placement should be performed.
• Infection/meningitis
• Vascular injury: Vascular injury can occur to the PICA, vertebral artery, or transverse sinus.
• Cranial nerve injury: Injury to a cranial nerve may result in abducens palsy, facial weakness, hearing loss, or vocal cord paralysis.
• Brainstem injury: Brainstem injury can lead to cranial nerve palsy and/or hemiparesis.
• Pseudomeningocele and/or CSF leak: When this occurs, hydrocephalus needs to be suspected and evaluated for.
• Cerebellar injury: Cerebellar injury can result in ataxia, dysmetria, or nystagmus.
• Refractory nausea/vomiting: This is possibly from irritation of the area postrema.
• Posterior fossa syndrome (also known as cerebellar mutism): This syndrome typically develops 1 to 4 days after surgery, even after patients demonstrate normal speech postoperatively. It can include mutism, emotional lability, and possibly other neurological deficits. Mutism is typically transient and resolves after several weeks, although not always completely (13). Multiple etiologies for this syndrome have been proposed, but none have been definitively proven (14).