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Perioperative Challenges During Posterior Fossa Surgery

  • Martin SchottEmail author
  • Dieter Suhr
  • Jan-Peter A. H. Jantzen
Chapter

Abstract

The posterior cranial fossa is a narrow compartment, containing vital and delicate structures and tracts. Surgical procedures are complicated by close proximity to vital centers, controlling hemodynamics and ventilation. If surgery is performed in the semi-sitting position, additional risks apply, notably venous or paradoxical air embolism, peripheral nerve injury, or mid-cervical quadriplegia. Safe management relies upon careful preoperative risk assessment and intraoperative safety monitoring, including appropriate use of PCD and TEE and postsurgical intensive care. Preoperative hydro- or postoperative pneumocephalus requires immediate attention. Crisis management requires excellent team-coordinated work, based on standardized anesthesia and neurosurgical protocols.

Keywords

Surgery: intracranial, posterior cranial fossa Surgery: position, semi-sitting Surgery: complications, air embolism, quadriplegia Complications: air embolism, venous, arterial, paradoxical, pneumocephalus, hydrocephalus Anesthesia: airway, intubation, ventilation Monitoring: capnometry, oximetry, evoked potentials Doppler sonography: echocardiography, transesophageal 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Martin Schott
    • 1
    Email author
  • Dieter Suhr
    • 2
  • Jan-Peter A. H. Jantzen
    • 3
  1. 1.Department of Anesthesiology, Intensive CareEmergency and Pain Management, DIAKOVERE FriederikenstiftHannoverGermany
  2. 2.Department of AnesthesiologyInternational Neuroscience Institute (INI)HannoverGermany
  3. 3.Department of Anaesthesiology, Intensive Care Medicine and Pain ManagementAcademic Teaching Hospital Hannover NordstadtHannoverGermany

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