Anesthesiology pp 555-561 | Cite as

Anesthetic Management for Posterior Fossa Surgery

  • Naginder SinghEmail author


The posterior fossa (also known as the infra-tentorial fossa) is a defined space within the cranium that has relatively poor compliance and contains several vital structures that are densely compacted. Its contents include the cerebellum, midbrain, pons and the medulla where the lower cranial nerve nuclei and regulatory centers responsible for the control of cardiovascular and respiratory function are located. Surgery and pathology within the posterior fossa are therefore, associated with the potential for severe disruption to normal physiology. Challenges for anesthesiologists include the requirement for appropriate and meticulous positioning, the prompt recognition and management of perioperative complications as well as the use of anesthetic techniques that facilitate cardiovascular stability and early post-operative neurological assessment.


Posterior fossa Venous air embolism Sitting position Precordial doppler 


  1. 1.
    Greenberg MS. Handbook of neurosurgery. 7th ed. New York: Thieme Publishers; 2010.Google Scholar
  2. 2.
    Jagannathan S, Krovvidi H. Anaesthetic considerations for posterior fossa surgery. Contin Educ Anaesth Crit Care Pain. 2014;14(5):202–6.CrossRefGoogle Scholar
  3. 3.
    Jessop ZM, Kane AD, Menon DK. The role of early tracheostomy in patients with posterior fossa haemorrhage in neurocritical care. J Intensive Care Soc. 2012;13(4):293–6.CrossRefGoogle Scholar
  4. 4.
    Veenith T, Absalom AR. Anaesthetic management of posterior fossa surgery. In: Matta BF, Menon DK, Smith M, editors. Core topics in neuroanaesthesia and neurointensive care. Cambridge: Cambridge University Press; 2011. p. 237–45.CrossRefGoogle Scholar
  5. 5.
    Mirski MA, Lele AV, Fitzsimmons L, Toung TJK. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106:164–77.CrossRefPubMedGoogle Scholar
  6. 6.
    Porter JM, Pidgeon C, Cunningham AJ. The sitting position in neurosurgery: a critical appraisal. Br J Anaesth. 1999;82:117–28.CrossRefPubMedGoogle Scholar
  7. 7.
    Fathi A-R, Eshtehardi P, Meier B. Patent foramen ovale and neurosurgery in sitting position: a systematic review. Br J Anaesth. 2009;102(5):588–96.CrossRefPubMedGoogle Scholar
  8. 8.
    Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth. 2008;100(2):165–83.CrossRefPubMedGoogle Scholar
  9. 9.
    Pajewski TN, Arlet V, Phillips LH. Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon. Eur Spine J. 2007;16(Suppl 2):115–29.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Depth of anaesthesia monitors—Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M. National Institute of Clinical Excellence. 2012. Accessed 3 March 2018.
  11. 11.
    Webber S, Andrzejowski J, Francis G. Gas embolism in anaesthesia. Br J Anaesth. 2002;2(2):53–7.CrossRefGoogle Scholar
  12. 12.
    Gore PA, Maan H, Chang S, Pitt AM, Spetzler RF, Nakaji P. Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus. J Neurosurg. 2008;108(5):926–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Morad A, Winters B, Stevens R, White E, et al. The efficacy of intravenous patient-controlled analgesia after intracranial surgery of the posterior fossa: a prospective, randomized controlled trial. Anesth Analg. 2012;114(2):416–23.CrossRefGoogle Scholar
  14. 14.
    Furay C, Howell T. Paediatric neuroanaesthesia. Contin Educ Anaesth Crit Care Pain. 2010;10:172–6.CrossRefGoogle Scholar
  15. 15.
    Harrison EA, Mackersie A, McEwan A, Facer E. The sitting position for neurosurgery in children: a review of 16 years’ experience. Br J Anaesth. 2002;88(1):12–17.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation TrustBirminghamUK

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