Recovery From Surgery for Supratentorial Central Neurocytomas in Children

Postoperative Orders 

• ICU vs. standard care: The patient is routinely sent to the ICU after surgery.
• Ventilator support: Ventilator support may be necessary in cases where marked brain swelling develops during surgery, often as a sequella to tumor bleeding.
• ICP parameters: In patients on elective ventilation, monitoring of ICP assumes importance.
• CSF drainage parameters/drainage bag setup: An EVD may be left in cases where there is significant ventriculomegaly, or where there has been some intraventricular bleeding during surgery.
• Radiologic studies: The author routinely obtains an early (within 24 hours) postoperative MRI to assess residual tumor.

Postoperative Morbidity

• Intraventricular blood: Intraventricular bleeding may present with seizures or deterioration in level of consciousness. Intraventricular hematoma is potentially a significant morbidity after resection of intraventricular neurocytomas. For endoscopic approaches, the absence of hydrocephalus does not seem to affect the incidence of postoperative intraventricular hemorrhage (32, 33), although the procedure is certainly easier in the presence of ventricular dilation. Intraventricular hemorrhage often necessitates insertion of an EVD, but evacuation of the clot is rarely required (34).