SURG-16. SURGICAL TECHNIQUES TO AVOID COMPLICATIONS DURING REPEAT RESECTIONS FOR PEDIATRIC BRAIN TUMORS

Abstract

Complications due to repeat resection for recurrent pediatric brain tumors remain unclear. The present study focused on surgical techniques to avoid surgical morbidities during repeat resections for pediatric brain tumors. This study included 57 consecutive repeat resections for 28 pediatric patients under the age of 15 with recurrent brain tumors. Resections were performed 2–14 times for each patient by the senior author (TK). Reviewed factors were wound-related complications, bleeding/ischemic complications, and Eastern Cooperative Oncology Group performance status (PS) before and after surgery. No patients presented any complications to decrease PS, postoperatively. No wound-related complications were worthy of special mention. Surgical techniques to prevent wound-related complications are as follows: 1) shaving the hair around the previous skin incision just before the surgery; 2) washing and disinfecting around the skin incision using chlorhexidine soap and an alcohol swab, followed by Povidone-Iodine solution; 3) after craniotomy, removing all granulation tissues, residual titanium plates, and screws; 4) brushing all surgical fields and a bone flap before opening the dura mater using Povidone-Iodine solution followed by normal saline; 5) maintaining a bone flap in normal saline with antibiotics; 6) changing all the surgical instrument and gloves; 8) closing the dura mater completely to prevent CSF leakage, and 8) using postoperative antibiotics for six days. Meticulous dissecting postsurgical adhesion of brain and dura mater, arteries and nerves; usage of neuronavigation system and neuromonitoring to understand the anatomy radiologically and functionally; applying papaverine hydrochloride for spastic arteries, are important to avoid complications during the intracranial procedure.