CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e180-e182
DOI: 10.1055/s-0042-1742430
Case Report

Dealing with a Pediatric Posterior Fossa Tumor after COVID-19 Infection: Report of One Case

Manejo de um tumor da fossa posterior em paciente pediátrica após infecção por COVID-19: Relato de um caso
1   Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
,
1   Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
,
Alireza Liaghat
1   Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
› Author Affiliations

Plain Language Summary

Having the issue of coronavirus disease 2019 (COVID-19) in mind, there is always a dilemma surrounding elective and non-urgent neurosurgical operations. The unanswered question is regarding whether there is any post-COVID-19 complications that hinder a patient from becoming a candidate for a neurosurgical operation. If that is the case, what should we do?

In the present article, we report our single-center experience with an unusual bleeding during the operation of a huge cerebellar tumor in a girl previously infected with COVID-19. In the end, we recommend our experience to our colleagues.

Abstract

There are still some conditions that pediatric neurosurgeons may face in the context of coronavirus disease 2019 (COVID-19) which have not been fully addressed so far. Authors have postulated an ongoing inflammatory myocardial status in a significant proportion of patients who have recovered from COVID-19. We report our experience with a 10-month-old girl who had recovered form COVID-19 and had a case of fourth-ventricle mass in the midline of the posterior fossa. She was scheduled for microneurosurgical resection of the mass following the insertion of a ventriculoperitoneal shunt. There were no significant issues regarding the induction of anesthesia. A midline suboccipital approach was chosen, and the patient was fully prepared and draped. Suboccipital soft tissues and muscles were dissected layer by layer through the midline avascular line. A marked gush of blood off the midline was observed during the opening in Y of the dura mater. Then, we started to approach the occipital sinus. However, there was an unusual loss of ∼ 200 mL of blood lost from this area. Despite the proper packed-cell transfusion, the patient developed bradycardia and a sudden rhythm of asystole. The cardiopulmonary cerebral resuscitation (CPCR) was initiated immediately. Despite the maximal effort, the heart rate did not change and remained asystole. We recommend that pediatric neurosurgeons postpone the procedures to be performed in patients who have recovered from COVID-19 for more than one month after a thorough preoperative cardiac evaluation has been performed.

Resumo

Ainda existem algumas condições que os neurocirurgiões pediátricos podem enfrentar no contexto da doença por coronavírus 2019 (COVID-19) que não foram totalmente abordadas até agora. Os autores postularam um estado inflamatório miocárdico contínuo em uma proporção significativa de pacientes que se recuperaram da COVID-19. Relatamos nossa experiência com uma menina de 10 meses que se recuperou da COVID-19 e teve um caso de massa no quarto ventrículo na linha média da fossa posterior. Ela foi programada para ressecção microneurocirúrgica da massa após a inserção de uma derivação ventrículo-peritoneal. Não houve problemas significativos em relação à indução da anestesia. Uma abordagem suboccipital na linha média foi escolhida e a paciente foi totalmente preparada e coberta. Tecidos moles e músculos suboccipitais foram dissecados camada por camada através da linha avascular da linha média. Durante a abertura em Y da dura-máter observou-se um jorro marcado de sangue na linha média. Em seguida, iniciamos a abordagem do seio occipital. No entanto, houve uma perda incomum de 200 ml de sangue perdido nesta área. Apesar da transfusão de hemácias adequada, a paciente evoluiu com bradicardia e ritmo súbito de assistolia. A ressuscitação cerebral cardiopulmonar (RCCP) foi iniciada.

Ethical Considerations

Approval from the institutional review boardd was obtained following the initial drafting of the present article.




Publication History

Received: 14 August 2021

Accepted: 13 October 2021

Article published online:
04 April 2022

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