Neurosurgical otolaryngology I: Neurotology/posterior fossa surgery

Neurotologic surgery uses the temporal bone as a gateway to the posterior cranial fossa and skull base. Neurotologists collaborate with neurosurgeons to treat a variety of neoplastic, inflammatory, and traumatic disorders of this anatomically complex area, of which acoustic neuroma is the most common. Posterior fossa surgery presents significant perioperative challenges to both the surgeon and anesthesiologist. In addition to containing the medulla, pons and cerebellum, this compartment houses cranial nerve nuclei and centers crucial to respiratory and cardiovascular function. The pathology as well as surgical manipulation can lead to potential hemodynamic instability, compression of vital areas, and damage to important neural pathways. These factors combined with the limited size of the posterior fossa compartment can make this surgery tenuous.