Difference between revisions of "Craniocervical decompression"
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===Surgical procedure=== | ===Surgical procedure=== | ||
A suboccipital craniotomy is performed | 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== | ||
Latest revision as of 17:06, 15 August 2023
Craniocervical decompression
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
Arterial line Large bore IV |
| Monitors |
Standard ABP |
| Primary anesthetic considerations | |
| Preoperative |
Neuro exam to characterize deficits |
| Intraoperative |
Risk of venous air embolus |
| Postoperative |
PONV Airway protection reflexes Respiratory depression ICU for neuro checks |
| Article quality | |
| Editor rating | |
| User likes | 0 |
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 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.[1]
Preoperative management
Patient evaluation
| 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
- Monitor for venous air embolism (EtCO2 and/or precordial doppler)
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
- ↑ Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (6 ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.CS1 maint: others (link)
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