Recovery From Surgery for Subependymal Giant Cell Astrocytomas in Children

Postoperative Orders 

  • ICU: ICU can be arranged for the immediate postoperative period, but a standard care unit can suffice depending on institutional practice.
  • ICP parameters: Steroids and osmotic agents can be administered to decrease ICP.
  • CSF drainage parameters/drainage bag setup: In case of hydrocephalus and blood in the ventricles, external CSF drainage can be helpful.
  • Radiological studies: A plain CT scan should be done if postoperative hemorrhage is suspected. An MRI can be obtained to look for completeness of resection.
  • Physical therapy and orthotics: Rehabilitation is needed in cases of severe disabling neurological deficits.
  • Consultations: Pediatrics and rehabilitation services may be consulted.

Postoperative Morbidity

  • Postoperative headaches: Headaches are common and can usually be managed with analgesics on a short-term basis.
  • Fever or meningism: These can occur and are typically due to blood in ventricles. They are self-limiting and respond to symptomatic treatment in most cases[16]. Short course of steroids can be administered if chemical meningitis is suspected. When they persist, one should suspect meningitis or thrombophlebitis. A systemic infection also should be considered.
  • Intraventricular blood: Intraventricular blood is best managed with an EVD. Rarely, urokinase instillation in ventricles to lyse the clot can be considered.