Recovery From Surgery for Supratentorial Pleomorphic Xanthoastrocytomas in Children
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.
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.
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.