Recovery from Surgery for Infratentorial Ependymomas in Children

Postoperative Orders

• Admit to an ICU: This is done to allow for hourly neurological checks, close monitoring of vital signs, and laboratory examinations as needed.  End-tidal PCO2 monitoring may be considered to monitor the risk of swelling in the brainstem due to CO2 retention.
• Postoperative intubation: Prolonged intubation may be considered for patients who required long operations, received multiple units of blood, or had extensive manipulation of cranial nerves. Patients with these risk factors for brainstem and cranial nerve dysfunction may not be able to protect their airways.
• Urgent evaluation of worsening examination results: Rapid evaluation including CT imaging should be done for progressive lethargy or neurological changes in the immediate postoperative period to rule out hemorrhage or acute hydrocephalus.
• Transfer to regular floor: Generally the patient can be transferred after 24–48 hours in the ICU. At the point of transfer, the patient can be mobilized.
• Dexamethasone taper: Steroids are tapered and then discontinued over approximately 7–10 days if patient is doing well clinically and the postoperative MRI scan demonstrates complete or near-complete tumor resection.
• Assessment of surgical resection: A postoperative brain MRI should be obtained within 48–72 hours after surgery, if possible, because enhancement thereafter may not represent residual disease (23).
• Oncology consultation: Assistance is needed from the oncologist for postoperative staging and planning for adjuvant therapy.