Related Experiment Video
Updated: Jun 15, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Is postoperative high dependency care really needed for children undergoing supratentorial brain tumour surgery?
Iris-Elena Feodor1, Ronak Ved1,2, Anthony Jesurasa2
1Cardiff University School of Medicine, Cardiff University, Cardiff, Wales.
Insights
Most children undergoing paediatric supratentorial tumour surgery do not require intensive care. Revising admission policies for Paediatric High Dependency Units (HDU) can optimize resource use and reduce costs.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Critical Care Medicine
Background:
- Paediatric High Dependency Unit (HDU) admission policies require review.
- Supratentorial tumour surgery in children presents unique post-operative care challenges.
Purpose of the Study:
- To analyze current Paediatric HDU admission policies.
- To propose revisions for paediatric supratentorial tumour surgery admissions.
Main Methods:
- Retrospective review of a 15-year database of paediatric supratentorial tumour resections.
- Assessment of post-operative HDU needs and specialist input.
Main Results:
- 43 children underwent surgery; 42 did not require HDU monitoring.
- Only 1 child (2%) had significant post-operative HDU needs (invasive monitoring, transfusions).
- The single patient requiring HDU had a large, vascular, invasive tumour.
Conclusions:
- A nuanced approach to predicting paediatric HDU needs post-supratentorial craniotomy is advocated.
- Policy rationalization can improve resource availability.
- Optimized admissions can reduce financial burdens on paediatric neurosurgical units.
Purpose:
We present our analysis of the existing Paediatric High Dependency Unit (HDU) admission policy at our institution and discuss our thoughts for its revision in the context of paediatric supratentorial tumour surgery.
Materials And Methods:
We screened our prospectively maintained database of all children undergoing supratentorial craniotomy for resection of paediatric brain tumours over a fifteen-year period. The post-operative course of each patient was reviewed, assessing the number of patients who had true HDU needs in the immediate post-operative period, and the relative depth of input from paediatric HDU specialists that each patient received.
Results:
Forty-three patients underwent craniotomy for supratentorial tumour resections during the study period. The median age of the children was 8 years old. Forty-two patients in the study cohort did not require any HDU-level monitoring or treatment post-operatively; all these patients were able to be discharged from HDU to a standard ward bed very rapidly post-operatively. Only one patient (2%) from the study cohort had any tangible HDU needs in the acute post-operative period, comprising of invasive cardiovascular monitoring and repeated blood transfusions. This child's tumour was known to be large, highly vascular, and invasive pre-operatively.
Conclusions:
We would advocate a rational and nuanced approach with regards to predicting which children are most likely need paediatric HDU care following supratentorial craniotomy for resection of a brain tumour. This rationalisation could improve resource availability and reduce financial burdens upon paediatric neurosurgical units.
