Posterior Fossa Surgery

 

 

Background 

 

  • Posterior fossa contains: brainstem, cerebellum & cranial nerves IV to XII

  • Pathology requiring surgery usually includes: congenital lesions (e.g. Arnold-Chiari malformation), tumours, acoustic neuromas, vascular lesions

 

 

Considerations

 

  • Indication for procedure & status/complications of neurological disease (↑ ICP)

  • Considerations of patient positioning & potential complications (lateral, prone, sitting)

  • Anesthetic modifications for neuromonitoring: TIVA anesthesia, no paralysis

  • Facilitation of brain relaxation: TIVA, SjvO2 for titration, mannitol, hyperventilation

  • Complications:

    • Hemorrhage 

    • Venous air embolism (VAE)

    • Hemodynamic instability from brainstem manipulation

  • Limited access to patient (foresight required in planning airway, access, monitoring)

 

 

Goals

 

  • Maintenance of CPP

  • Facilitation of neuromonitoring

  • Optimal brain relaxation for surgical exposure

  • Rapid & smooth emergence

  • Stable hemodynamics on emergence

  • Vigilance & monitoring for VAE if high risk position

 All rights reserved 2017 © anesthesiaconsiderations.com

 Feedback & inquiries: