Recovery for Dural Arteriovenous Fistulas in Children

Postoperative Orders 

• Normotension and normovolemia: Normal range MAPs and adequate hydration should be maintained during the postoperative period.
• ICU: Overnight observation at the PICU is recommended for frequent neurological evaluation.
• Activity and diet: If extubation is tolerated, activity out of bed is encouraged and diet should be resumed with a successful swallow study.
• Seizure treatment: Continue antiepileptic medical treatment if the patient presented with seizures.
• Testing: Blood count and basic metabolic panel should be ordered on day one.
• Imaging: If any change in neurological status is present, emergent CT without contrast should be obtained.
• Anticoagulation treatment: Consider anticoagulation if venous thrombosis is present. Consult Hematology.

Postoperative Morbidity

• Neurological deficits: In addition to the common surgical complications, venous infarction can develop if normal venous drainage is accidentally interrupted.
• Cranial nerves palsy: Ligation of feeding arteries, especially if very proximal, could theoretically damage cranial nerves, as a significant part of their vascularization originates from dural branches.