Complications
Chemotherapy kills developing stem cells, resulting in pancytopenia.
Packed red blood cell and platelet transfusions may be necessary.
Patients with fever and neutropenia should be admitted to the hospital and given antibiotics until their neutrophil count recovers.
Occurs because of the damage to the DNA in the developing brain.
Includes measurable IQ decline which is related to age at time of radiation and radiation field and dose.[90]
Even in older children, deficits in attention, memory, visuospatial processing, and other cognitive functions have been reported.[91]
Referral for formal neurocognitive testing is recommended for all survivors who have received cranial irradiation.
Hypothalamic-pituitary axis is in the whole-brain radiation field.
Growth hormone is the most sensitive hormone.
Hormone function should be screened yearly in survivors who have received radiation to the hypothalamic-pituitary axis.
Referral to an endocrinologist for hormone replacement may be necessary.
For more information, see Growth hormone deficiency in children.
Radiation can cause meningiomas, sarcomas, and malignant gliomas.
Alkylating agents and etoposide may cause leukemia.
Radiation may cause damage to small intracranial blood vessels.
Acute loss is secondary to cisplatin; audiograms should be checked before each cisplatin dose and dosing modified if significant hearing decline occurs.
Late deficit secondary to posterior fossa radiation.
Relief of ventricular obstruction by resection of tumor may or may not relieve hydrocephalus.
In these circumstances, acute management may require administration of corticosteroids and acetazolamide and/or mannitol.
Placement of a ventriculostomy may be necessary prior to tumor resection.
Close early postoperative patient monitoring is needed to determine whether cerebrospinal fluid diversion is required.
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