Perioperative Challenges During Posterior Fossa Surgery

Abstract

The posterior fossa contains vital brainstem centers for respiration, the ­cardiovascular system and consciousness as well the cranial nerves and their nuclei. This high concentration of delicate structures, added to the poor accessibility, makes posterior cranial fossa surgery a major challenge for the neurosurgeon. When such surgery is performed in the sitting position, additional neuroanesthesiological risks ensue, notably midcervical myelopathy and venous air embolism (VAE). This chapter is based on the authors’ personal experience with more than 2,500 posterior fossa procedures performed in the sitting or semi-sitting position.