Posterior Fossa

2019 ◽  
Author(s):  
Talia S. Vogel ◽  
Penny P. Liu
Keyword(s):  
Posterior Fossa ◽  
Preoperative Evaluation ◽  
Cranial Nerves ◽  
Air Embolism ◽  
Neurophysiological Monitoring ◽  
Posterior Fossa Surgery ◽  
Neurophysiologic Monitoring ◽  
Venous Air Embolism ◽  
Brainstem Stroke ◽  
Air Embolus

The posterior fossa houses essential brainstem nuclei, cranial nerves, cerebral vasculature, and mechanisms for cerebrospinal fluid drainage. Anesthetic considerations for posterior fossa surgery include thorough preoperative evaluation, intraoperative monitoring, and anesthetic planning to allow neurophysiological monitoring. Careful positioning is imperative to optimize surgical conditions and to risk stratify patients for complications, including venous air embolus. Venous air embolus is a common complication of posterior fossa surgery given the plentitude of venous channels in the posterior fossa, and rapid recognition is key to managing this complication.  Posterior fossa surgery also has a number of other known complications including postoperative apnea, prolonged ventilation, and possible brainstem stroke.  This review contains 4 tables, 1 video, and 31 references. Keywords: Posterior fossa surgery, Brainstem surgery, Neuroanesthesiology, Venous air embolism/embolus, Sitting craniotomy, Prone craniotomy, Transesophageal echocardiogram, Neurophysiologic monitoring

scholarly journals POGOSTOST ZRAČNE EMBOLIJE IN POOPERATIVNI ZAPLETI PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU Skrajšana verzija naslova: ZRAČNA EMBOLIJA PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU

2015 ◽  
Vol 84 (9) ◽  
Author(s):  
Alenka Spindler Vesel ◽  
Nina Pirc ◽  
Božidar Visočnik ◽  
Jasmina Markovič - Božič
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Spine Surgery ◽  
Air Embolism ◽  
Neck Surgery ◽  
Postoperative Treatment ◽  
Posterior Fossa Surgery ◽  
Cervical Spine Surgery ◽  
Venous Air Embolism ◽  
Doppler Probe

Background: Posterior fossa surgery and cervical spine surgery are at risk for venous air embolism (VAE) occurrence. Mostly air emboli are small and asymptomatic, but invasion of large quantity of air in the circulation is symptomatic and potentially lethal. Transesophageal echocardiography is the most sensitive method for detection of air emboli in the heart, followed by the precordial Doppler probe, end tidal carbon dioxide monitoring (etCO2) and others.Methods: In our 14- years retrospective review we evaluated the incidence of VAE and postoperative complications in patients with posterior fossa surgery or cervical spine surgery. VAE was recognized by using Doppler probe and/or drop of etCO2. If VAE occurred, aspiration of air through the CVC was used to prevent or to minimized VAE occurrence, the surgeon was warned about the incident. VAE treatment was supportive.Results: VAE was recognized in 74 patients. Two patients after head surgery and four patients after neck surgery needed postoperative treatment in intensive care unit and controled mechanical ventilation. In six patients after head surgery and in four patients after neck surgery new neurological symptoms occurred. Two patients after head surgery died due to complications of massive VAE.Conclusions: VAE is rare, but serious complication of neurosurgery in sitting position. Preventive treatment, early detection of VAE, supportive treatment and treatment of cardiovascular complications are necessary for survival of patients with VAE.

Neurosurgery

2018 ◽  
Author(s):  
Alex Manara ◽  
Samantha Shinde
Keyword(s):  
Air Embolism ◽  
Pituitary Surgery ◽  
Anaesthetic Management ◽  
Beating Heart ◽  
Vascular Lesions ◽  
Posterior Fossa Surgery ◽  
Intracranial Haematoma ◽  
Venous Air Embolism ◽  
Heart Donor

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.

scholarly journals Making the “inoperable” tumors “operable”: Harvey Cushing's contributions to the surgery of posterior fossa tumors

2014 ◽  
Vol 36 (4) ◽  
pp. E15 ◽  
Author(s):  
Mahdi Malekpour ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Surgical Technique ◽  
Posterior Fossa ◽  
Preoperative Evaluation ◽  
Pivotal Role ◽  
Surgical Removal ◽  
Posterior Fossa Surgery ◽  
Posterior Fossa Tumors ◽  
Harvey Cushing ◽  
Ventricular Puncture

Harvey Cushing played a pivotal role in establishing neurosurgery as a distinct surgical discipline. One of his most important contributions was defining the surgical removal of posterior fossa tumors. Compulsive preoperative evaluation followed by meticulous surgical technique as well as incorporation of maneuvers such as ventricular puncture and electrocautery further advanced resection of tumors in this region. Herein, the authors review Cushing's contributions to posterior fossa surgery.

The semisitting position in pediatric neurosurgery: pearls and pitfalls of a 10-year experience

2021 ◽  
pp. 1-10
Author(s):  
Fritz Teping ◽  
Stefan Linsler ◽  
Michael Zemlin ◽  
Joachim Oertel
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Pediatric Population ◽  
Clinical Status ◽  
Skull Fracture ◽  
Pediatric Neurosurgery ◽  
Time Frame ◽  
Special Focus ◽  
Posterior Fossa Surgery ◽  
Venous Air Embolism

OBJECTIVE The authors sought to investigate the pearls and pitfalls of using the semisitting position in pediatric neurosurgery, with special focus on related morbidity and surgical practicability. METHODS All pediatric cases at a single institution were evaluated retrospectively. Those patients who underwent procedures in the semisitting position between December 2010 and December 2020 were included in the final analysis. Results were compared with all children who underwent surgery in the prone position for posterior fossa lesions within the same time frame. RESULTS A total of 42 posterior fossa surgeries were performed in 38 children in the semisitting position between December 2010 and December 2020. The mean patient age at the time of surgery was 8.9 years (range 13 months–18 years). The data of 24 surgeries performed in the prone position in 22 children during the same time frame were analyzed in comparison. Three children (7.9%) were diagnosed with a persistent foramen ovale preoperatively. The surgery was completed in all cases. The incidence of venous air embolism (VAE) was 11.9%. There was no VAE-related hemodynamic instability, infarction, or death. Endoscopic techniques were applied safely in 14 cases (33.3%). Postoperative pneumocephalus occurred significantly more frequently in patients who had undergone procedures in the semisitting position (p < 0.05), but without the need for intervention. During 1 surgery (2.4%), the patient experienced a postoperative skull fracture and epidural bleeding due to the skull clamp application. Clinical status of the patients immediately after surgery was improved or stable in 33 of the 42 surgeries (78.6%) performed in the semisitting position. CONCLUSIONS With attentive performance and an experienced surgical team, the semisitting position is a safe option for posterior fossa surgery in the pediatric population. With a comparable complication profile, the semisitting position offers excellent anatomical exposure, which is ideal for the application of endoscopic visualization. Careful skull clamp application and appropriate monitoring are highly recommended.

scholarly journals NS-01PEDIATRIC INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING IN POSTERIOR FOSSA SURGERY

2016 ◽  
Vol 18 (suppl 3) ◽  
pp. iii127.1-iii127
Author(s):  
Franco Randi ◽  
Andrea Carai ◽  
Gionatan Amante ◽  
Alessandro De Benedictis ◽  
Raffaella Messina ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Posterior Fossa Surgery

Preoperative Evaluation for Risk of Venous Air Embolism in the Sitting Position

1995 ◽  
Vol 7 (2) ◽  
pp. 124-126 ◽  
Author(s):  
Takanori Sakamoto ◽  
Masahiko Kawaguchi ◽  
Hitoshi Furuya ◽  
Hideyuki Ohnishi ◽  
Jun Karasawa
Keyword(s):  
Preoperative Evaluation ◽  
Air Embolism ◽  
Sitting Position ◽  
Venous Air Embolism
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