Management of postoperative swallowing dysfunction after ependymoma surgery

This study aims to share a new postoperative care technique team approach for the management of children after they have recovered from the anesthetic and has passed through the immediate postoperative period of a day or so from their posterior fossa ependymoma surgery.

A team approach was developed consisting of a neurosurgeon, an otolaryngologist, an intensivist, and a speech pathologist/swallowing specialist. Patients were extubated 24 h after their surgery. Vocal cord function was assessed by fiberoptic exam after extubation. Tracheostomy was occasionally necessary to secure the airway. Swallowing was assessed via modified barium swallow. Aspiration with feeding was occasionally detected early and managed with a gastrostomy tube.

Forty-five patients have undergone posterior fossa surgery at our institution and were managed by our team. Nine have had sufficient vocal cord dysfunction to require a tracheostomy. Eleven have required a gastrostomy. None developed respiratory distress and none developed aspiration pneumonia.

A team approach, delayed airway evaluation, and modified swallowing exams have benefited our patients after posterior fossa ependymoma surgery. We have prevented any cases of respiratory distress or aspiration pneumonia.