Recovery From Surgery for Supratentorial Pleomorphic Xanthoastrocytomas in Children

Postoperative Orders 

• ICU or step-down unit recommended: Usually, an important CSF/pressure shift occurs during the operation, since by the time of diagnosis the tumor is of considerable size. Electrolytes should be monitored carefully. There is also a high risk of brain collapse into the surgical cavity and creation of a subdural collection (especially in younger children).  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. 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.

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.

Postoperative Morbidity

• Dependent on the location of the tumor. Quadrantanopia with temporal and parietal tumors is possible, as well as language deficits in the dominant hemisphere. Because PXA is a rare tumor, specific morbidity and mortality rates are not available but should be consistent with other low-grade astrocytomas in the same location.