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Surgery of the posterior fossa and/or craniospinal region has a high rate of postoperative morbidity and mortality, which has rarely been described in the scientific literature. This review aims to describe the available evidence in the literature on the complications associated with this type of surgery and its neuroanesthesiological and/ or neurocritical management, as well as to highlight the predisposing factors that can increase the complications rate. Knowledge of the complications related to neurosurgical disorders of the posterior fossa could aid in their prevention or help in the selection of appropriate treatment that would minimize their consequences. A systematic literature search was made in Spanish and English for articles published between 1966 and 2012 in various databases. Articles considered important in the identified literature were reviewed. The most frequently described postoperative complications were vomiting and postoperative pain, followed by edema of the tongue and/or airway, involvement of the cranial nerves, and the development of cerebrospinal fluid fistulas. The remaining complications were reported as being uncommon. Posterior fossa and posterior cervical surgery produces higher morbidity and mortality than surgery of the supratentorial space. In addition to the complications involved in all craniotomies, infratentorial surgery has specific complications. Team work among all the specialties and staff involved in the care of these patients is essential to reduce the morbidity and mortality associated with these procedures.

The anesthesiological management of patients undergoing neurosurgery of the posterior fossa has a series of characteristics that should be known by anesthesiologists. Intraoperative management is guided by a series of factors that include the physiopathological changes secondary to the patient's position during surgery, the importance of appropriate patient positioning to facilitate the surgical approach, the lower tolerance to changes in the elastance of the infratentorial region, the limited therapeutic options in episodes of intraoperative edema-swelling, and the presence of complications such as a venous air embolism. This first contribution to the guidelines discusses the main evidence available in the literature on the pre- and intraoperative approach to these patients.

Resumen Objetivos Conocer por medio de una encuesta la actuacion de los anestesiologos espanoles en el manejo perioperatorio de los pacientes intervenidos neuroquirurgicamente de enfermedades de fosa posterior del craneo. Material y metodos Se remitio a los servicios de anestesiologia de hospitales con servicio de neurocirugia un cuestionario con un planteamiento cerrado sobre la participacion de los anestesiologos en el tratamiento perioperatorio de los pacientes sometidos a cirugia de fosa posterior. Resultados De los 73 hospitales nacionales publicos que disponen de servicio de neurocirugia, completaron el formulario 42 (57,5%). En 36 centros se realiza la cirugia de fosa posterior con el paciente en sedestacion, aunque se emplea con menor frecuencia que el decubito lateral o el decubito prono. La monitorizacion neurologica especifica es escasa, asi como el empleo del Doppler precordial y/o transcraneal para la deteccion de embolia vascular aerea. La tecnica anestesica mas empleada en estos procedimientos es la intravenosa. En menos del 10% de los centros se emplea oxido nitroso, y en un 15% se evitan los bloqueadores neuromusculares cuando se usa monitorizacion neurofisiologica intraoperatoria. Los problemas cardiovasculares durante la cirugia se refieren como muy frecuentes en el 29% de los centros, mientras que en el postoperatorio las complicaciones referidas como mas habituales son los deficit de pares craneales, el edema de via aerea (23%) y los vomitos postoperatorios (47%). Conclusiones Los resultados obtenidos de la encuesta muestran que en las cirugias de fosa posterior la sedestacion se utiliza menos que el decubito prono y que apenas se usa monitorizacion neurofisiologica intraoperatoria.

El objetivo del tratamiento quirurgico para la esco-liosis, cifosis y otro tipo de deformidades del raquis esla fusion de las vertebras para que la columna verte-bral no pueda curvarse. Se colocan implantes metali-cos (barras, tornillos, alambres, placas, etc.), paramantener el raquis mientras las vertebras se fusionan.La artrodesis vertebral se potencia con injerto (autoge-nico y/o alogenico) de hueso. El abordaje quirurgicopuede ser posterior, anterior o combinacion de ambos.La cirugia toracoscopica se puede utilizar en el abor-daje anterior del raquis dorsal.La cirugia correctora del raquis en pediatria y adultoses un procedimiento prolongado (en general mas de 4horas), tiene las complicaciones potenciales de la ciru-gia mayor (hemorragia grave, hipotermia, infeccion,embolismo graso o aereo, hipotension arterial, etc.)

To find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa.A closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery.The questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve déficit, airway oedema (23%), and post-operative vomiting (47%).The results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used.

Head injury continues to be the main cause of mortality and morbidity among young people in Europe. The use of technology in managing severe head injury has increased considerably and certain applications may be confusing to physicians who have little experience in neurology but who are charged with providing neurocritical care. Monitoring of brain-injured patients usually focuses on managing intracranial pressure and recording perfusion pressure. New techniques have recently been incorporated into routine monitoring of oxygenation and metabolism in the brain. Continuous monitoring of the partial oxygen pressure of brain tissue (PtO2) has become more common in neurocritical care units, making bedside evaluation of the effects of injuries and therapeutic measures possible. This review discusses technical, safety, and reliability aspects of PtO2 monitoring and its potential advantages in comparison with other techniques for evaluating brain tissue oxygenation.