Suboccipital Median Approach

Abstract

After orotracheal intubation of the patient, a central line is inserted usually via the right internal jugular or subclavian vein with the tip position just before (lateral and prone positions) or within the right atrium (semisitting position, SSP). Invasive blood pressure monitoring is performed throughout the entire procedure via a radial artery line. Routine monitoring includes electrocardiography, pulse oxymetry, invasive arterial blood pressure, and urine output. Indications for intraoperative electrophysiological monitoring (IOM) are large cerebellar lesions extending towards the pineal region as well as lesions close to or infiltrating the fourth ventricle or the medulla oblongata. IOM consists of standard somatosensory, motor, and brainstem auditory evoked potentials and cranial nerve monitoring. Direct intraoperative stimulation is performed during resection of lesions of the floor of the fourth ventricle.