Some Problems in Surgery of the Posterior Fossa Lesions.

Lee, Hyun Koo; Choi, Kil Soo

Original Article

Journal of Korean Neurosurgical Society 1981;10(1): 173-180.

Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Korea.

ABSTRACT

The management of the patient undergoing posterior fossa surgery meets with various difficulties during and after the surgery due to the anatomical characteristics of the posterior fossa. Sitting position has been used popularly for its advantage of proper exposure of the posterior fossa lesions, but this position presents disastrous complications such as hypotension and air embolism not infrequently. Hydrocephalus, frequently complicating the posterior fossa lesions, also presents many problems during and after surgery. Postoperative brain swelling, CSF leakage and infection are other important problems of the posterior fossa surgery. The authors obtained following results with analysis of surgical results in 71 posterior fossa lesions. 1) The posterior fossa lesions are frequently present hydrocephalus and signs of increased intracranial pressure due to blockade of CSF flow. Their proper management such as steroid, diuretics and preoperative shunt made the operative manipulation easier and improved the postoperative course. 2) The major intraperative problems were air embolism and postural hypotension which were mainly related to th4 sitting position. To avoid these complications, the author propose lateral position for very old patients and those with cardiopulmonary disease or in surgery for CP angle lesion and cerebellar hemispheric lesion which can be exposed adequately with this position. 3) It way easy to detect and manage possible postoperative problems such as brain swelling, hematoma and persistent hydrocephalus with aid of CT scan and their serious outcome could be reduced.