Preoperative Orders
Medications
- Anticonvulsants: Children with such hemispheric/intraventricular tumors are started on prophylactic anticonvulsants even if they have not had a seizure. (They are maintained on this regimen for 1 week postoperatively). Phenytoin sodium and, more recently, levetiracetam have been used.
Anesthetic Considerations
- Standard
Devices to Be Implanted
- EVD: EVD may be instituted as a prelude to the main craniotomy if the child is in poor general condition and has features of grossly elevated ICP.
Ancillary/Specialized Equipment
- Intraoperative monitoring equipment: IOM is considered when the tumor is located in an eloquent region. It must be remembered that evoked potential monitoring requires a reduction in the level of inhalation agents, whereas motor mapping requires a reduction in the level of paralysis.
- Neuronavigational instruments: Frameless stereotaxy is considered when the tumor is small. Endoscope: The neuroendoscope is required for minimally invasive approaches.
- Laser: Use of intraoperative laser during neuroendoscopic removal of these tumors has been described (25).
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