Six months Analysis of Posterior Fossa Surgery in Neurosurgery Unit-I, Punjab Institute of Neurosciences (PINS)
Keywords:Posterior fossa tumours, CP angle SOL
Objective: This is a prospective study. Posterior fossa tumors are a common entity presented in our tertiary care neurosurgical setup. Although the treatment of posterior fossa tumor has underwent a lot of changes over the period of last two decades but unfortunately in the developing countries the Neurosurgical facilities are still not up to the mark.
Materials and Methods: We analyzed the posterior fossa surgery done for the last six months (Feb. 2017 – Aug. 2017) in Neurosurgery Unit I of Punjab Institute of Neurosciences.
Results: A total of 15 cases were operated from Feb 2017 to Aug 2017. Immediate outcome was seen at the time of discharge. Nine out of 15 patients were female (60.00%), 6 patients were male (40%). Maximum 6 cases (40.00%) were seen in 3rd decade of life. Main presenting complain was headache 3 cases (20.00%) followed by vomiting 7 cases (46.66%), vertigo in 5 cases (33.33%), hearing and visual loss in 4 cases (26.66%) and balance disturbance was observed in 3 cases (20.00%). Regarding location 6 cases (40.00%) were tumor midline posterior fossa SOL, 5 cases (33.3%) were CP angle lesions, 3 cases (20.00%) were in cerebellar hemisphere and 1 case (06.60%) was noted in the 4th ventricle. Nine of procedure (60.00%) remained continued for 4 – 8 hours and remaining 6 took up to 4 hours (40.00%). Gross total excision was achieved in 5 cases (33.33%), Maximum debulking (more than 80 percent tumour removal) was achieved in 10 cases (66.66%). Associated procedure V-P Shunt was done in 8 cases (53.33%) and EVD in 4 cases (26.6%).
Complications: CSF leakage and re-exploration for dural repair was needed in 1 case (06.60%).
Outcome: Ten patients were discharged on different status (66.66%) while mortality was noted in 5 cases (33.33%).
2. Macewen W. Meningitis, abscess of the brain, infective sinus thrombosis. In: Pyogenic Infective Diseases of the Brain and Spinal Cord. Glasgow: J. Maclehose & Sons, 1893: 354.
3. Starr MA. Brain Surgery. New York: William Wood, 1893: 29.
4. Goodrich JT. Landmarks in the history of neurosurgery. In: Rengachary SS, Ellenbogen R, eds. Principles of Neurosurgery, 2nd ed. New York: Elsevier Mosby, 20055.
5. CB Lissa and Nanda A. Surgery of the Posterior Cranial Fossa: Historical Aspects.
6. I. Dallan, P. Castelnuovo, C. Vicini, and M. Tschabit-scher. The natural evolution of endoscopic approaches in skull base surgery: robotic-assisted surgery? Acta Otorhinolaryngol Ital. 2011 Dec; 31 (6): 390–394.
7. Adeleye AO, Fasunla JA, Young PH. Skull base sur-gery in a large, resource-poor, developing country with few neurosurgeons: prospects, challenges, and need. World Neurosurg. 2012 Jul; 78 (1-2): 35-43.
8. Battistella PA, Ruffilli R, Viero F, Bendagli B, Condini A. Brain tumors: classification and clinical aspects. Pediatr Med Chir. 1990 Jan-Feb; 12 (1): 33-9.
9. Srinivasarao. S.G, Jyothi B. Analysis of most prevalent clinical features associated with posterior fossa tumors International Journal of Contemporary Medicine Sur-gery and Radiology, 2018; 3 (1): 115-120.
10. Marx S, Reinfelder M, Matthes M, et al. Frequency and treatment of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients. Acta Neurochir (Wien). 2018 May; 160 (5): 1063-1071. J Neurosurg. 2005 Sep; 103 (3 Suppl): 247-52.
11. Morelli D, Pirotte B, Lubansu A et.al. Persistent hydro-cephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endo-scopic third ventriculostomy justified? J Neurosurg. 2005 Sep; 103 (3 Suppl): 247-52.
12. Sainte-Rose C, Cinalli G, Roux FE, Maixner R, et al. Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy.J Neurosurg. 2001 Nov; 95 (5): 791-7.
13. Al-Shatoury HAH, Brian HK.Posterior Fossa Tumors Treatment & Management Pak J Med Sci. 2016 Nov-Dec; 32 (6): 1439–1443.
14. Jagannathan S, K Hari. Anaesthetic considerations for
posterior fossa surgery. Continuing Education in Anae-sthesia Critical Care & Pain, Volume 14, Issue 5, 1 October 2014: Pages 202–206, Published: 19 December 2013.
15. Flexman AM, Merriman B, Griesdale DE et al. Infra-tentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection.J Neurosurg Anesthesiol. 2014 Jul; 26 (3): 198-204.
16. Qureshi AI, Suarez JI, Parekh PD, Bhardwaj A. Pre-diction and timing of tracheostomy in patients with infratentorial lesions requiring mechanical ventilatory support. Crit Care Med. 2000 May; 28 (5): 1383-7.
17. Altaf I, Vohra AH, and Shahzad Shams S. Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery.Pak J Med Sci. 2016 Nov-Dec; 32 (6): 1439–1443.
18. Shaikh HA, Bokhari I, Rehman L et al. Surgical Out-come of Posterior Fossa Brain Tumors. Journal of Sur-gery Pakistan (International) 19 (1) January – March 2014.