Anaesthetic management of posterior fossa surgery

Introduction Anaesthesia for the posterior fossa provides a unique challenge for anaesthetists and neurosurgeons. The most common surgical procedures are excision of posterior fossa tumours, correction of congenital and acquired craniovertebral junction anomalies, and surgical procedures to relieve pressure on the brainstem. Between 54 and 70% of all childhood brain tumours, and 15–20% of adult brain tumours, originate in the posterior fossa. In children <18 years, the majority of posterior fossa operations are for excision of tumours, of which the commonest are cerebellar astrocytomas, medulloblastomas and brainstem gliomas. The outlook for children with these tumours has improved since the advent of CT imaging of the brain, which enables early diagnosis and improved tumour excision during surgery. Improvements in mortality and morbidity following posterior cranial fossa surgery are also attributable to improved surgical and anaesthetic management.