Procedure for Supratentorial High Grade Gliomas in Children
Steroids: Intranavenous steroids can be started before surgery, or days before if there is a supratentorial significant neurological deficit or if there are obvious signs and symptoms of an increase in intracranial pressure.
Medications
Anticonvulsants. Intravenous anticonvulsants are recommended for children with seizures. They can be administered immediately upon admission Craigslist Harrisburg to those who have brain irritation or transcortical seizures.
Supratentorial Intravenous fluids
Rate: IV fluids can be given at maintenance, ugly nail usually 1/2 NS + 20 mg KCl. This is based on the child’s weight: 0-10kg, 10 ml/kg/hour, 11-20kg, 40 ml/hour+2ml/kg/hour, and > 20kg, 60 ml/hour+1ml/kg/hour.
Rehydrating: It is important to make arrangements for fluids that are based on the dehydration or drainage large quantities of CSF in infants.
CSF Drainage: Clamp Time
If surgery is performed, it is important to monitor the condition. If necessary, EVDs can be clamped before the procedure supratentorial . If the ventricle needs to be dilated for intraventricular navigation/exploration/access, the drain should be clamped 8 hours prior to skin incision and drained as needed for symptomatic increased ICP. Monitoring the pressure of the drain can be helpful, but it is important to assess the child’s tolerance.
Scrub the surgical site
Preoperative shampoo: You can shampoo your hair and scalp the night before surgery. No special agents are required.
Hair objects should be removed: EEG electrodes and metallic jewelry must be removed.
Informed Consent Supratentorial
While not all possible complications can be discussed during and after surgery, family members, guardians, and children should be aware that there are common concerns about supratentorial brain tumour surgery. There are also concerns specific to the anatomic location and neurocognitive and cognitive impairments. Patients and their families should pay extra attention to language preferences and have an interpreter available for consent.
Ancillary/Specialized Equipment Required supratentorial
Microscope: Magnification and illumination are required, especially for intraventricular or deep lesions that can be accessed via small corridors. Two surgeons can work together depending on the patient’s position, tumor location and surgeon preference.
Ultrasound: This intraoperative ultrasound is able to identify deep tumors and assess their progress, locate cysts or other nearby structures, and identify important changes during surgery such as the collapse of the brain that was not exposed by craniotomy, or the development a hematoma.
Endoscope: This can be used in lieu of a standard craniotomy to biopsy or in certain cases to resect intraventricular or extraventricular tumors. This will reduce cortical injury and retraction for children with supratentorial brain tumours. It also allows for the management of hydrocephalus using an ETV. You can also use the endoscope to augment open tumor removals, inside and outside of the ventricle.
