Perioperative Challenges During Posterior Fossa Surgery

Abstract

The posterior cranial fossa is a narrow compartment, containing vital and delicate structures and tracts. Surgical procedures are complicated by close proximity to vital centers, controlling hemodynamics and ventilation. If surgery is performed in the semi-sitting position, additional risks apply, notably venous or paradoxical air embolism, peripheral nerve injury, or mid-cervical quadriplegia. Safe management relies upon careful preoperative risk assessment and intraoperative safety monitoring, including appropriate use of PCD and TEE and postsurgical intensive care. Preoperative hydro- or postoperative pneumocephalus requires immediate attention. Crisis management requires excellent team-coordinated work, based on standardized anesthesia and neurosurgical protocols.