Craniotomy or Craniectomy in Posterior Fossa Tumor Removal

Abstract

Introduction: Normalization of craniocerebral proportion and prevention of hypertension syndrome development is one of the important specific aspects of neurosurgery. One of the most effective mechanisms for prevention of hypertension-dislocation syndrome is external decompression. This is mainly due to undying relevance of decompressive craniotomy (craniotomy), declared by Cushing at the beginning of the last century. Particularly, it’s became popular with operations in the posterior cranial fossa (PCF). Aim: A comparative characteristic of craniotomies in posterior cranial fossa tumor removal. Materials and Methods: The results of 126 suboccipital craniotomies in children under 17 year-old were studied. Subdural pressure over the cerebellum surface and pressure-volume proportion, as well as patients’ conditions in the early postoperative period were monitored. Results: The results of uncomplicated operations were compared. In subtotal or total removal of PCF tumors were not observed cerebellar edema, compression and deformation of the brainstem, hence no need for external decompression. Over the past 10 years only 4% of cases it was necessary to carry out decompressive suboccipital craniotomy. Conclusion: Therefore, decompressive craniotomy should not be considered as an alternative method of approach for PCF tumor removal. So, suboccipital osteoplastic craniotomy is a method of choice. Under certain conditions craniotomy may be minimal (only occipital bone squama resection is sufficient) with involvement of foramen magnum edges and posterior arches of CI-II vertebras.