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Related Experiment Videos

Reverse brain herniation during posterior fossa surgery.

Hemanshu Prabhakar1, G Umesh, R S Chouhan

  • 1Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

Journal of Neurosurgical Anesthesiology
|June 27, 2003
PubMed
Summary

Posterior fossa tumors can cause obstructive hydrocephalus. Rapid cerebrospinal fluid drainage during surgery can lead to reverse brain herniation, a rare but serious complication successfully managed with saline injection.

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Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Critical Care Medicine

Background:

  • Posterior fossa tumors frequently cause obstructive hydrocephalus, necessitating cerebrospinal fluid (CSF) diversion.
  • Surgical intervention for these tumors carries a risk of intracranial pressure (ICP) fluctuations.
  • Rapid CSF drainage can precipitate paradoxical brain herniation, known as reverse coning.

Observation:

  • A 5-year-old male with a posterior fossa tumor and hydrocephalus underwent craniectomy in the prone position.
  • An intraventricular shunt catheter was placed post-craniotomy to decompress the brain.
  • The patient experienced sudden, severe bradycardia and asystole, indicative of reverse coning.

Findings:

  • Reverse coning was diagnosed following rapid CSF drainage.

Related Experiment Videos

  • Prompt intraventricular injection of 10-15 mL normal saline reversed the bradycardia and asystole.
  • The patient's cardiac rhythm spontaneously returned to sinus rhythm.

    • Implications:

    • This case highlights the critical risk of reverse coning during CSF diversion in posterior fossa surgery.
    • Intraventricular saline injection is a potentially life-saving, rapid intervention for reverse coning.
    • Neurosurgeons must be vigilant for and prepared to manage this rare but dangerous complication.