Chris.Rishel at 01:06, 16 August 2023

2023-08-16T01:06:33Z

← Older revision		Revision as of 18:06, 15 August 2023
Line 22:		Line 22:

	===Surgical procedure===		===Surgical procedure===
	A suboccipital craniotomy is performed an the posterior arch of C1 is removed. The dura is opened and the cerebellar tonsils are dissected and reduced. A shunt may be placed to allow CSF to flow from the fourth ventricle to the subarachnoid space. A dural patch may be used to expand the dural space at the foramen magnum. The dura is then closed and bone flap replaced.<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=6\|location=Philadelphia\|oclc=1117874404}}</ref>		A suboccipital craniotomy is performed and the posterior arch of C1 is removed. The dura is opened and the cerebellar tonsils are dissected and reduced. A shunt may be placed to allow CSF to flow from the fourth ventricle to the subarachnoid space. A dural patch may be used to expand the dural space at the foramen magnum. The dura is then closed and bone flap replaced.<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=6\|location=Philadelphia\|oclc=1117874404}}</ref>

	==Preoperative management==		==Preoperative management==

Chris.Rishel at 21:30, 24 July 2022

2022-07-24T21:30:37Z

← Older revision		Revision as of 14:30, 24 July 2022
Line 60:		Line 60:
	*Arterial line		*Arterial line
	*Large bore IV		*Large bore IV
			*Monitor for venous air embolism (EtCO2 and/or precordial doppler)

	===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===		===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===

Chris.Rishel: First draft

2022-07-24T21:25:16Z

First draft

New page

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = Arterial line
Large bore IV
| monitors = Standard
ABP
| considerations_preoperative = Neuro exam to characterize deficits
| considerations_intraoperative = Risk of venous air embolus
| considerations_postoperative = PONV
Airway protection reflexes
Respiratory depression
ICU for neuro checks
}}A '''craniocervical decompression''' is a neurosurgical procedure performed to decompress the craniocervical junction, most commonly to treat a [[Chiari malformation]].

==Overview==

===Indications===

*[[Chiari malformation]] (type I or II)
*Syringomyelia

===Surgical procedure===
A suboccipital craniotomy is performed an the posterior arch of C1 is removed. The dura is opened and the cerebellar tonsils are dissected and reduced. A shunt may be placed to allow CSF to flow from the fourth ventricle to the subarachnoid space. A dural patch may be used to expand the dural space at the foramen magnum. The dura is then closed and bone flap replaced.<ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=6|location=Philadelphia|oclc=1117874404}}</ref>

==Preoperative management==

===Patient evaluation===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Evaluate airway protection reflexes
|-
|Neurologic
|Focused neuro exam to characterize preexisting deficits
|-
|Pulmonary
|If dysphagia is present, may have recurrent aspirations
|}

===Labs and studies===

*MRI to characterize extent of herniation and any other intracranial abnormalities
*BMP
*CBC
*Type and screen

===Patient preparation and premedication===

*Increased risk of PONV from posterior fossa craniotomy
**Consider additional prophylaxis such as [[aprepitant]]

==Intraoperative management==

===Monitoring and access===

*Arterial line
*Large bore IV

===Induction and airway management===

* Avoid hypoventilation (→hypercarbia→cerebral vasodilation→increased ICP)

===Positioning===

*Prone or sitting
*Mayfield pin fixation

===Maintenance and surgical considerations===

*Avoid increased ICP
*Monitor for venous air embolism due to proximity of transverse sinuses
*Hemodynamic instability from brainstem manipulation
**Atropine for severe bradycardia
*Massive blood loss due to proximity to vertebral artery and transverse sinuses

===Emergence===

*Verify intact airway protective reflexes prior to extubation

==Postoperative management==

===Disposition===

*ICU for neuro checks

===Pain management===

*Acetaminophen IV prior to emergence

===Potential complications===

*Respiratory depression
*CSF leak

==References==

[[Category:Surgical procedures]]
[[Category:Neurosurgery]]
[[Category:Intracranial neurosurgery]]

Craniocervical decompression - Revision history

Chris.Rishel at 01:06, 16 August 2023

Chris.Rishel at 21:30, 24 July 2022

Chris.Rishel: First draft