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.