Perioperative management of pediatric giant supratentorial tumors: Challenges and Management strategies

Abstract

Background:Intracranial tumors are the most common pediatric solid tumors. Only one-third of these tumors arise from the supratentorial compartment. The abnormal intracranial tumors are unusual but can bleed to an extent causing hemorrhagic shock necessitating blood transfusion in the perioperative period. The perioperative management of these subset of patients poses a unique challenge to both the neurosurgeons and the neuroanesthetic team.Materials and Methods:This study included a case series of 30 patients with giant supratentorial neoplasms who underwent craniotomy and tumor resection from 2014 to 2017 in our Tertiary Care Institute. The clinical data were collected from the patient’s records obtained from the Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India. The aim of this case series was to characterize the perioperative challenges, management strategies, course, and outcome in 30 children who were operated for elective or emergency resection of giant supratentorial lesions in our hospital. We also reviewed the literature available to guide the anesthetic management of pediatric patients with intracranial tumors.Results:Among the 30 patients, four had significant intraoperative fluid shifts necessitating massive blood transfusion perioperatively. The overall incidence of mortality in our study cohort was 16.67% (5/30).Conclusion:The maintenance of systemic physiological homeostasis by anticipation of complications, vigilant monitoring, and prompt resuscitation is critical to foster favorable outcomes in unison with optimal and safe surgical extirpation of the primary cerebral lesion.

Advanced intraoperative MRI in pediatric brain tumor surgery

“…These seizures have been associated with hemorrhage in the resection cavity ( Chassoux and Landre, 2017 ; Samudra et al, 2019 ; Ersoy et al, 2020 ). As the onset of seizures in children has been associated with cortical hyperperfusion ( Oishi et al, 2012 ; Keil et al, 2018 ), intraoperative perfusion imaging with ASL might be an early predictor for seizures and even lead to intraoperative monitoring and prevention ( Palaniswamy et al, 2019 ). APTw images could have a similar effect due to the association of seizures with a reduced pH that could be picked up by a reduced APTw signal ( Magnotta et al, 2012 ; Jin et al, 2017 ).…”