Posterior fossa tumor surgery [Neurosurgery Wiki]

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====== Posterior fossa tumor surgery ======

[[Posterior fossa tumor]] surgery refers to [[neurosurgical procedure]]s aimed at removing tumors in the [[posterior fossa]]. 

This area is critical for motor coordination, autonomic functions, and cranial nerve activity, making surgeries here highly delicate.

===== 🔬 Key Points about Posterior Fossa Tumor Surgery =====

📍 Common Tumor Types
Medulloblastoma (most common in children)

Ependymoma

Pilocytic astrocytoma

Hemangioblastoma

Metastases

Meningiomas (posterior fossa or cerebellopontine angle)

===== 🧠 Anatomical Considerations =====

Proximity to the brainstem = high risk for neurological deficits

Obstruction of CSF flow can cause hydrocephalus

Cranial nerves (especially V–XII) are often at risk

===== 🛠️ Surgical Approaches =====

Midline [[suboccipital craniotomy]] (for vermian/cerebellar tumors)

[[Retrosigmoid]] (lateral suboccipital) (for CPA tumors, like vestibular schwannomas)

[[Far-lateral approach]] (for foramen magnum and lateral brainstem lesions)

===== 🎯 Goals of Surgery =====

[[Maximal safe resection]]

Preservation of neurological function

Relief of hydrocephalus (sometimes requiring external ventricular drain or VP shunt)

===== 🧪 Adjuncts to Surgery =====

Neuronavigation

Intraoperative neuromonitoring (MEPs, SSEPs, cranial nerves)

Ultrasound/MRI guidance

Neuroendoscopy (in selected cases)

===== ⚠️ Potential Complications =====

[[Posterior fossa tumor surgery complications]].



===== 🧑‍⚕️ Postoperative Care =====

ICU monitoring

Imaging (CT/MRI within 24–48 h)

CSF diversion if hydrocephalus persists

Early physical and speech therapy
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[[Posterior fossa tumor]] [[surgery]] is associated with a significant risk of [[complication]]s, and the complications are typically more frequent than similar [[supratentorial]] surgeries. The primary objectives of the present study are to evaluate extent of resection and neurological outcomes and the secondary objective is to evaluate [[perioperative]] complications with using minimally invasive approaches for intra-axial posterior fossa tumors from our case series.

All consecutive patients who underwent non-biopsy surgery of a posterior fossa tumor using [[tubular retractor]]s and exoscopic visualization from January 2016 to May 2018 were prospectively identified and included.

15 patients underwent resection of an intra-axial posterior fossa tumor during the reviewed period. Eight (53%) were male and the median (interquartile range) age was 63.0 (45.0-67.5) years. The location of the pathology was the cerebellar hemisphere in 11 (73%), vermis in 3 (20%), and middle cerebellar peduncle in 1 (7%). The median pre and postoperative lesion volumes were 21.6 (10.1-33.0) 0 (0-1.2) cm3, respectively. The percent resection was 100% (92-100%). Following surgery, 12 (80%) had improved and 3 (20%) had stable KPS, where no patients had a decline in KPS postoperatively. No patients incurred other postoperative regional or medical complications.

Mampre et al. demonstrated the possible efficacy of a minimally invasive approach with the use of tubular retractors and exoscopic visualization for resecting posterior fossa intra-axial tumors with relatively high efficacy and low morbidity
((Mampre D, Bechtle A, Chaichana KL. Minimally invasive resection of intra-axial
posterior fossa tumors using tubular retractors. World Neurosurg. 2018 Aug 18.
pii: S1878-8750(18)31832-1. doi: 10.1016/j.wneu.2018.08.049. [Epub ahead of
print] PubMed PMID: 30130571.
)).