Complications of Posterior Cranial Fossa Surgery: A Report of 39 Cases and Literature Review

Objectives: This study aimed to report the main perioperative and postoperative complications specific to posterior cranial fossa (PCF) surgery based on a surgical series of 39 cases. Materials and Methods: This was a retrospective descriptive and analytical study conducted from January 2002 to December 2014, involving 120 medical records of patients operated on for PCF tumors at the Neurosurgery Department of Hassan II University Hospital in Fez. We analyzed the main perioperative and postoperative complications in this series. Results: The study included 39 patients, 22 males (56.41%) and 17 females (43.58%), with a mean age of 23.41 years. A suboccipital median approach in the prone position was performed in 32 patients (82.05%), while the retro-sigmoid approach in a lateral position was used in 7 patients (17.94%). Medulloblastomas were the most common lesions (51.28%), followed by vestibular schwannomas (17.94%). Intraoperative hemodynamic instability occurred in 8 cases (6.66%). Postoperatively, one or more complications were noted in all 39 patients. Hydrocephalus was the most frequent complication (14 cases), followed by infectious complications (13 cases). The mortality rate was 4.16%, with 5 deaths recorded. Conclusion: Recognizing the main complications of PCF surgery can help prevent, diagnose, and treat them early. Mortality is primarily due to severe surgical site hemorrhages, brainstem edema with softening, and pulmonary complications. Effective management requires full cooperation between anesthesiologists and neurosurgeons.