Only routine orders for a tumor patient are required.
- Pain: Most children do not suffer sever pain after craniotomy for DNET. Standard regimens of analgesic medication, using paracetamol or tramadol, generally suffice.
- Nausea and vomiting: This is generally only mild and rarely needs to be treated with serotonin receptor antagonists such as ondansetron.
- Pseudomeningocele and CSF leakage: The risk for CSF leakage and pseudomeningocele must be limited with careful surgical technique. The role of fibrin sealant and commercially available patches composed of fibrinogen, thrombin and collagen is not yet fully established. Mildly compressive head bandaging may be used for a few days.
- Postoperative hematoma: As for any craniotomy, there is a risk of postoperative hemorrhage in the brain, the resection cavity, or the extradural space. Careful hemostasis after tumor resection is important in prevention. Routine imaging with CT or MRI 24 hours after surgery can allow the timely detection of clinically present but not yet symptomatic hematoma.
- Postoperative seizures: This is the most important risk in children with DNET and long-standing epilepsy. Intensive care monitoring for 48 hours or longer may be warranted in selected children at high risk for continuing seizures.
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