0:01

Let's go back to Youmans neurosurgical

0:03

textbook and look at the indications for

0:07

surgery for posterior fossa hematomas.

0:12

Because the posterior fossa is a confined

0:14

space defined by the tentorium and the foramen

0:18

magnum, smaller lesions in the posterior fossa

0:22

exert a greater degree of pressure on the brain.

0:26

And the structures that they may be

0:29

causing pressure on include the medulla,

0:31

which is obviously the center for

0:33

cardiopulmonary function in the brainstem.

0:38

So, in this confined space, the indications for

0:42

surgery are those patients who have mass effect shown

0:45

on a CT scan with associated neurologic dysfunction.

0:49

And by mass effect, we mean obliteration of

0:52

the fourth ventricle, which can lead to acute

0:55

hydrocephalus or at the subarachnoid space of

1:59

the foramen magnum and compression of the basal

1:03

cisterns or obstruction of the ventricular system

1:08

at the level of the cerebral aqueduct, which

1:10

also can cause an obstructive hydrocephalus.

1:13

For these, they may do a decompressive

1:16

craniectomy of the posterior fossa, or they

1:19

may go after the actual hematoma itself.

1:23

These are two different patients.

1:25

One has a parenchymal hematoma, the other

1:28

an epidural hematoma in the posterior fossa.

1:32

And what one sees is the compression of the

1:35

fourth ventricle from right to left, the

1:37

effacement of the basal cisterns around the

1:41

pons, and this is a neurosurgical emergency.

1:44

This patient can die very quickly from the herniation

1:48

and compression of the medulla, as well as acute

1:52

hydrocephalus with an increase in intracranial pressure.

1:55

Similarly, here we have a patient

1:58

whose epidural collection is leading to

2:00

effacement of the perimesencephalic cistern.

2:03

This is another case where, in all likelihood, the

2:07

neurosurgeons will do a decompressive craniectomy

2:09

posteriorly to allow expansion of the posterior

2:14

fossa structures posteriorly, relieving the

2:18

compression of the midbrain and the basal cisterns.

Posterior Fossa Lesions from Trauma

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