Postoperative problems are very stressful for the child and family. Symptoms that the child had prior to surgery are usually worse following the operation because of swelling or surgical trauma. This is normal. Less common complications after surgery are:

• Paralysis in arm(s) and/or leg(s)
• Seizures
• Loss of blood supply to an area of the brain (stroke)
• Hydrocephalus that requires another surgery to place a shunt or make a detour via an anterior third ventriculostomy
• Loss of bowel and bladder control
• Leakage of fluid from the incision
• Infection at site of incision
• Memory problems

The majority of postoperative complications are not permanent; they can be reversed with additional surgical, medical, or rehabilitative treatment.

Three less common but more serious complications are discussed next.

Aseptic meningitis

Aseptic meningitis can occur in the first few weeks following surgery, usually when steroids (medications used to decrease swelling and inflammation) are reduced. It is thought that aseptic meningitis is caused when blood and cells from the tumor removal get into the CSF, causing chemical irritation. Symptoms of aseptic meningitis include fever, headache, and stiff neck. If your child has any of these symptoms, the doctor usually asks for a sample of CSF to test for a bacterial infection. This sample is obtained from a spinal tap (see Chapter 6, Coping with Procedures) or from fluid near the incision. All cultures that test for the presence of bacteria are negative if your child has aseptic meningitis. The symptoms usually improve when the child is given a short course of additional steroids.

Cranial nerve deficits

Cranial nerves control movement of the eyes, face, and throat. The control center for the cranial nerves is located in the brainstem. Problems with the cranial nerves can be caused by tumors in the brainstem, tumors pressing on the brainstem, or hydrocephalus. Surgery in the posterior fossa (cerebellum or brainstem) can also result in temporary or permanent cranial nerve problems. Some of the deficits that may develop include:

• Double vision
• Bouncing of eyes
• Inability to look up or to one side
• Inability to close one eyelid
• Pain in the jaw
• Weakness, droop, or asymmetry of face
• Hoarse or raspy voice
• Difficulty swallowing and coughing
• Respiratory problems, such as difficulty breathing, pneumonia, and frequent respiratory illnesses

If these symptoms are present prior to surgery, they may get worse after surgery. However, recovery of cranial nerve function is possible over a long period of time. If eye and facial cranial nerve problems persist, surgery can correct some of them. Children who can’t swallow are given nutrition through an NG or gastrostomy tube. Children with severe respiratory problems have a tube inserted into their throat (tracheostomy) that is connected to a respirator to help them breathe.

Posterior fossa syndrome

Posterior fossa syndrome (also called cerebellar mutism) is a complication of posterior fossa (cerebellum or brainstem) surgery. The most common tumors in this area are medulloblastomas, astrocytomas, and ependymomas. Most children wake up from the surgery moving their arms and legs and responding to questions. In some cases, 24 or more hours later the child stops talking, may develop weakness of arms and legs, and cranial nerve deficits appear. Emotionally, the children seem disconnected from their environment and may respond by simply crying.

These symptoms improve over a period of days in the minimally affected child, but improvement may take months in the severely affected child. Physical, occupational, and speech therapy should be started immediately. Children who have severe posterior fossa syndrome require transfer to an inpatient rehabilitation facility to facilitate quicker recovery.