Postoperative neurogenic pulmonary edema in pediatric neurosurgery - clinical presentation and management in 2 cases: A case report.

RATIONALE: Neurogenic pulmonary edema (NPE) is a rare but potentially life-threatening complication of severe central nervous system injury. Postoperative NPE is particularly uncommon in pediatric patients, and its pathophysiological mechanisms remain incompletely understood. Our objective is to review the perioperative management of such patients and provide recommendations and insights. PATIENT CONCERNS: We report 2 pediatric cases of NPE following neurosurgical procedures. The first case involved a 2-year-old girl who developed acute respiratory distress immediately after undergoing a suboccipital craniotomy. The second case involved a 6-year-old girl who presented with progressive respiratory failure 1 day after an endoscopic third ventriculostomy. DIAGNOSES: Both patients exhibited clinical and radiographic findings consistent with NPE, including acute-onset pulmonary infiltrates and hypoxemia in the absence of primary cardiac dysfunction. The diagnosis was established based on characteristic postoperative timing, imaging studies, and the exclusion of other causes of pulmonary edema. INTERVENTIONS: Both patients received timely mechanical ventilation and diuretic therapy. Supportive care, including oxygen supplementation and hemodynamic optimization, facilitated recovery. OUTCOMES: Both cases had favorable clinical outcomes, with resolution of respiratory symptoms and no long-term sequelae. LESSONS: The differing onset and presentations of NPE in these cases underscore potential variations in intracranial pressure dynamics and surgical factors. Early recognition, prompt diagnosis, and immediate intervention are essential for optimal patient outcomes. Pediatric neurosurgical patients require vigilant postoperative monitoring for respiratory complications, particularly in the context of intracranial pressure changes. Strategic intraoperative management and supportive care play a crucial role in improving prognosis.