Anesthetic Management of Posterior Cranial Fossa Surgery

Background: The posterior cranial fossa is a compact anatomical region with vital structures, making surgical interventions particularly challenging. Anaesthetic management plays a crucial role in ensuring optimal surgical access, hemodynamic stability, and prevention of complications. Objectives: This prospective observational study aimed to evaluate perioperative anaesthetic management, methods of intracranial pressure (ICP) control, intraoperative complications, and postoperative outcomes in patients undergoing posterior fossa surgery. Materials and Methods: Fifty patients, aged 20–60 years, ASA grade I–II, undergoing elective posterior fossa surgery were included. Standard monitoring was used, and anaesthesia was induced with thiopentone/propofol, fentanyl, and vecuronium/atracurium. Maintenance included sevoflurane in O₂–N₂O mixture with mechanical ventilation. Hemodynamic variations, ICP management, intraoperative and postoperative complications were analyzed. Results: The majority were females (56%) with a slight preponderance in the 51–60 age group (30%). The most common pathology was cerebellopontine (C-P) angle tumors (38%), followed by brainstem tumors (28%). Prone positioning (68%) was most frequently used. Intraoperative complications included hypotension (16%), bradycardia (10%), and venous air embolism in one case (2%). Postoperatively, 34% required ventilatory support, 24% developed raised ICP, and 36% had cranial nerve palsy. Mortality was 4%. Conclusion: Posterior fossa surgeries pose high anaesthetic risks, particularly concerning hemodynamic instability, cranial nerve deficits, and ventilatory complications. Careful perioperative planning, vigilant intraoperative monitoring, and judicious postoperative care are essential to reduce morbidity and mortality