Recovery From Surgery for Supratentorial Choroid Plexus Tumors in Children

Postoperative Orders 

• ICU recommended: Usually, an important CSF/pressure shift occurs during the operation, and electrolytes should be monitored carefully. There is also a high risk of brain collapse into the ventricle and creation of a subdural collection.  Therefore, it is important to recognize any change in neurological status, and a change should trigger some form of imaging.
• BP parameters: Hemorrhage is a risk after surgery, particularly if the tumor resection was incomplete, because these tumors tend to be quite vascular. The blood pressure should be kept within the normal range to avoid a postoperative hemorrhage.
• HOB positioning, activity, bathing: The HOB should be at approximately 20 degrees. Consider conservative HOB elevation to lessen the risk of subdural collections. Mobilization can then start progressively at day 2 or 3 postoperatively.
• CSF drainage parameters/drainage bag setup: If the patient has an EVD, it should be weaned progressively to see whether the patient needs a shunt or not. Avoid overdraining with the EVD to decrease the risk of subdural collections. Keep EVD around 15 cm H₂0.

Laboratory studies

• Electrolytes: Since there is complete replacement of CSF by lactated Ringer’s solution or saline during the operation, serum electrolytes have to be monitored closely in the first 24 hours.

Radiology studies

• MRI within 72 hours: A postoperative MRI should be done within 72 hours to assess for residual tumor. If there is a subdural collection at that time, repeated images should be acquired to be sure that the collection doesn’t enlarge rapidly.

Rehabilitation

• Hemiparesis: When hemiparesis is present, physiotherapy and orthotics are generally required to help mobilization and to avoid contractures. Later, rehabilitation might be required in a specific center.

Postoperative Morbidity

• Hemiparesis, developmental delay, and death: The morbidity and mortality rates associated with choroid plexus tumors remain relatively high. Series report mortality rates of 8–9% (4, 5), mostly in patients younger than 2 years. Morbidity includes hemiparesis and developmental delay in 26–30% of cases (3, 5).