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.

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.

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.

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.

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).