posterior_fossa_decompression

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posterior_fossa_decompression [2025/07/10 14:03] administradorposterior_fossa_decompression [2025/07/10 14:04] (current) – [Indications] administrador
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 [[Posterior Fossa Decompression Indications]]. [[Posterior Fossa Decompression Indications]].
 +
 +===== Posterior fossa decompression Technique =====
 +
 +===== Surgical Technique =====
 +
 +==== 1. Patient Positioning ====
 +  * **Prone** or **Park bench** position
 +  * Head fixed in Mayfield clamp
 +  * Slight neck flexion to expose the occipitocervical junction without kinking the medulla
 +
 +==== 2. Incision and Exposure ====
 +  * Midline **occipital incision** from inion to C2 spinous process
 +  * Subperiosteal dissection to expose:
 +    - Occipital bone
 +    - Posterior arch of C1
 +    - Superior lamina of C2 (in extended decompressions)
 +
 +==== 3. Bony Decompression ====
 +  * **Suboccipital craniectomy**
 +    - Typically 2–3 cm wide, exposing the foramen magnum
 +  * **C1 laminectomy** (partial or complete)
 +    - Relieves compression at cervicomedullary junction
 +
 +==== 4. Dural Opening (optional, case-dependent) ====
 +  * Y- or U-shaped durotomy
 +  * Allows direct decompression of cerebellar tonsils and posterior fossa contents
 +
 +==== 5. Duraplasty ====
 +  * Performed using **autologous graft**, **synthetic patch**, or **pericranium**
 +  * Prevents postoperative CSF leak and improves subarachnoid flow
 +
 +==== 6. Tonsillar Reduction (select cases) ====
 +  * **Coagulation** or **subpial resection** of cerebellar tonsils
 +  * Only in symptomatic, obstructive cases or when syrinx persists
 +
 +==== 7. Closure ====
 +  * Watertight dural closure critical
 +  * Muscle and skin layers closed in standard fashion
 +  * Subfascial drain optional
 +
 +===== Postoperative Considerations =====
 +  * Monitor for CSF leak, pseudomeningocele, or infection
 +  * Serial MRI to assess decompression and syrinx resolution (if present)
 +  * Pain control and gradual mobilization
 +
 +===== Complications =====
 +  * CSF leak
 +  * Pseudomeningocele
 +  * Meningitis
 +  * Cerebellar ptosis (over-decompression)
 +  * Neurological worsening (rare)
  
  
  • posterior_fossa_decompression.txt
  • Last modified: 2025/07/10 14:04
  • by administrador