Neurosurgery: Posterior fossa surgery
This chapter reviews the age-appropriate changes in the management of elderly patients scheduled to undergo posterior fossa surgery. The posterior cranial fossa is bordered anteriorly and laterally by the superior border of the petrous temporal bone, anteriorly and medially by the dorsum sellae of sphenoid bone, superiorly by the tentorium cerebelli and inferiorly by the foramen magnum. During posterior fossa craniotomies, the intraoperative risk of bleeding and venous air embolism is high in view of multiple large venous sinuses contained within the tentorial dural fold. Extra-axial tumours involving the posterior fossa consist mainly of meningiomas and neuromas encasing cranial nerve. Elderly patients diagnosed with acoustic neuromas are usually managed either conservatively or by radiosurgery. Cerebellar ischemic stroke and spontaneous cerebellar hemorrhage are another common entity causing major morbidity in the elderly population. Emergent surgical decompression is recommended by the American Stroke Association in patients with evidence of brainstem compression, hydrocephalus or clinical deterioration.