MASS LESION |

MASS LESION

Tue, 01/01/2008 - 13:53 — oxygen

PATIENTS WITH A MASS LESION Listen to Audio POSTERIOR FOSSA LESION

Intracranial mass lesions include: -congenital -neoplastic (benign, malignant) -infectious (abscess, cyst) -vascular (hematoma, AVM) Common primary tumors include: -glial cells astrocytoma, oligodendroglioma, glioblastoma -ependymal cells ependymoma -support tissues meningioma, schwanoma, choroidal papilloma Intracranial mass lesions genrally present according to: -growth rate: -location: -ICP Growth rate rapid growth rate: acute presentation (ex. headache, nausea, vomiting, papilledema, inc ICP) slow growth rate: slow progressive presentation ex. weakness leading to focal neurological deficit Location supratentorial: associated with: seizures, hemiplegia, aphasia, infratentorial: associated with: cerebellar dysfunctino (ex.ataxia, nystagmus, dysarthria) brain stem: associated with: cranial nerve palsies, ΔMS, respiratory abnormalities ICP Increased ICP associated with: headache, nausea, vomiting, papilledema, focal neurological deficit, ΔMS POSTERIOR FOSSA LESION OBSTRUCTIVE HYDROCEPHALUS -obstruction of the 4th ventricle or cerebral aqueduct by infratentorial masses which may obstruct CSF outflow -resultant increase in ICP -reduction of ICP is often performed by ventriculostomy prior to induction of general anesthesia BRAINSTEM INJURY -vital circulatory and respiratory centers within the brainstem are vulnerable to injury during operations in the posterior fossa -injuries to the brain stem may occur due to: Direct surgical Trauma retraction ischemia Respiratory center injury often is associated with circulatory changes which involve: -blood pressure -heart rate -rhythm *neurosurgeon should be informed of circulatory changes suggestive of respiratory center injury Monitoring -evoked potential helps assess neural integrity during the surgical protection ex. BAEP: allows for monitoring CN VIII during resection of acoustic neuromas -EMG: allows for the monitoring of CN VII Postioning of patients with posterior fossa surgery may be: -modified lateral position -prone position -sitting position *head should always be elevated above the level of the heart Sitting position involved with increase chance of : -pneumocephalus -venous air embolus (VAE)

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