Posterior Fossa and Craniovertebral Junction Decompression for Brainstem Edema after Neurosurgical Operations

Introduction: Brainstem infarction due to its edema is one of the most frequent causes of mortality and morbidity after vestibular schwannoma surgical removal. In this situation, decompression of the posterior fossa and craniovertebral junction should be urgently performed to prevent fatal consequences.

Materials and Methods: Six patients underwent decompression of posterior fossa and craniovertebral junction with duraplasty at Burdenko Neurosurgery Institute from 2011 to 2015 after posterior fossa surgery. Two patients underwent decompression in a semi-sitting position, 4 patients were operated in a prone position. All of them presented with clinical and radiological symptoms of brainstem edema. In two patients, epidural hematoma was removed. Decompression was performed within 1 to 48 hours after previous operation.

Results: Two patients were discharged in 17 to 61 days (60–80 points on the Karnofsky scale). Treatment of one patient is ongoing. One patient died 5 days after operation due to cardiovascular inefficiency. One patient died 1.5 months after the surgery due to infectious complications.

Conclusion: Decompression of craniovertebral junction with the duraplasty is one of the ways to prevent brain stem swelling and herniation into foramen magnum and thus might be considered as a salvage procedure in this fatal complication.