With few exceptions, the authors observe patients in the ICU for the first 24 hours postoperatively. Many of the specifics of management will vary depending on the location of the tumor, degree of resection, and overall difficulty of the operation.
- Vital signs: Vital signs and neurological checks should be at least every 2 hours in the immediate postoperative period.
- Blood pressure: BP should be maintained in the normal range. If a subtotally resected lesion was very hemorrhagic, there might be a consideration for hypotension.
- IVs: There can be a tendency towards electrolyte imbalance; euvolemia should be maintained with normal saline or lactated Ringer’s solution.
- Ventilator: In general, patients will be extubated at the completion of surgery. If ventilator support is required, it will need to be tailored to the individual patient.
- ICP monitoring: ICP parameters are generally not an issue, and most patients will not have an ICP monitor. This is similarly true for CSF drainage.
- Diet: Diet should be advanced as tolerated, unless the lesion involved the lower cranial nerves and swallow or gag may be affected.
- Positioning: HOB at 30 degrees for the first 24 hours is prudent.
- Medications: Medications should include routine perioperative antibiotics, a steroid taper, and anticonvulsants.
- Laboratory studies: Laboratory studies will include CBC, coagulation profile (especially for large or hemorrhagic tumors), and electrolytes. Anticonvulsant levels may need to be monitored.
- Radiologic studies: A baseline MRI should be obtained within 48 hours of surgery.
- Physical therapy and orthotics: These are provided as needed.
- Consultations: Consultations from radiation therapy and neuro-oncology should be standard after surgery. Other consultations are requested as needed.
- Seizures: There is a potential for seizures and seizure prophylaxis may be needed in the early post-operative period.
- Brain edema: There is a potential for brain edema and this possibility must be carefully followed with good examination.
- CSF leakage: At times, there may be a CSF leak: lumbar drain, dural reconstruction of the skull base, sealants such as fibrin glue etc may be needed in such situation.