Anaesthetic Considerations in Posterior Fossa Surgery
Posterior fossa lesions lead to significant neurological morbidity and mortality by virtue of various important structures housed within this location. The surgeries of this area are extremely challenging for both the surgeon as well as the anaesthesiolog
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Anju Grewal, Nidhi Bhatia, and Sandeep Kundra
17.1 Introduction Posterior fossa accords significant neurological status since it houses very important structures of the brain which are packed in a very constricted space. The lesions of this area, thus, cause significant morbidity and mortality just by virtue of being in a very adverse location [1]. However, with advances in medical and surgical technologies, increasingly large number of patients are undergoing successful surgeries for posterior fossa pathologies. These surgeries are extremely challenging for both the surgeon as well as the anaesthesiologist because of the demanding, delicate nature of the surgical procedure and the long hours involved. The main challenges faced by the anaesthesiologist are due to peculiar patient positioning, chances of excessive bleeding owing to venous sinus injury, intraoperative A. Grewal (*) Department of Anaesthesiology, Dayanand Medical College & Hospital, Ludhiana 141001, Punjab, India Journal of Anaesthesiology Clinical Pharmacology (JOACP), Dayanand Medical College & Hospital, Ludhiana 141001, Punjab, India DMCH-AHA Training Site, AHA -BLS & ACLS Courses, Dayanand Medical College & Hospital, Ludhiana 141001, Punjab, India
risk of cranial nerve dysfunction, high probability of venous air embolism and predisposition to upper airway oedema necessitating postoperative ventilatory support [2].
17.2
Posterior Fossa: Boundaries [3]
The base of the skull is divided into anterior, middle and posterior cranial fossae. Posterior fossa is the deepest cranial fossa and is surrounded anteriorly by the dorsum sellae and basilar portion of the occipital bone (clivus), posteriorly and inferiorly by the occipital bone, superiorly by the dural layer (tentorium cerebelli) and laterally there are the petrosal and mastoid components of the temporal bone. It is limited posteriorly and inferiorly by the foramen magnum, which is the largest opening of the posterior fossa. Other openings in N. Bhatia Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India e-mail: [email protected] S. Kundra, MD (ANES), PDCC Department of Anaesthesia, Dayanand Medical College & Hospital, Ludhiana 141001, Punjab, India e-mail: [email protected]
Joint Secretary, Association of Obstetric Anaesthesiologists (AOA), Udaipur 313003, Rajasthan, India e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 Z.H. Khan (ed.), Challenging Topics in Neuroanesthesia and Neurocritical Care, DOI 10.1007/978-3-319-41445-4_17
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the posterior fossa include the internal acoustic meatus, condylar canal and the jugular foramen. Important structures occupying posterior fossa include the cerebellum, pons, medulla oblongata and lower cranial nerves. The sigmoid, transverse and occipital sinuses also traverse the fossa.
17.2.1 Clinical Relevance of Posterior Fossa Anatomy The anatomical location of posterior fossa, also known as the infratentorial fossa, makes it a diffi
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