Children who underwent posterior fossa tumor surgery are complex patients, and, in almost all cases, they need postoperative monitoring in an intensive care unit. They are, in fact, at high risk of hypotension, hypoxia, and intracranial hypertension.

Following the surgical procedure, they remain intubated and ventilated and are transferred to an intensive care unit (ICU) for extubation at a later time. In our department, during prone position surgery, a wire-reinforced endotracheal tube is usually used. It is necessary to replace this tube with a conventional tracheal tube, in order to reduce pressure sores during prolonged intubation and artifacts on postoperative MRI.

Most patients will be successfully extubated within the first 24 h postoperatively. Before awakening, MR imaging of the brain is obtained, to assess extension of surgery and presence of complications and brainstem edema that may affect respiratory and cardiovascular systems. In these cases sedation will be prolonged, until resolution of brainstem edema, as assessed by MRI obtained 3–4 days later.

Benefits of continuing postoperative intensive care are [1]: