Invasive neuromonitoring of intracranial pressure (ICP) is an important element of
neurosurgical critical care that is used primarily as an indicator of adequate cerebral
perfusion in patients, when clinical observation is not an option. Due to the constraint in
size and the critical structures within the posterior fossa, continuous detection of
postoperative pressures has been deemed desirable in patients with surgery in this region,
particularly in those subjected to prolonged procedures and critical care.
The posterior fossa is an anatomically constricted compartment with narrow spaces and
intracranial hypertension quickly leads to brainstem damage and neurological dysfunction. ICP
in the supratentorial space not necessarily correlates with ICP in the infratentorial space.
Some authors claim that it would be beneficial to measure ICP in infratentorial space after
posterior fossa surgery in some cases.
In patients whose neurological examination results may be inconclusive or limited, it is
valuable to have a reliable alternative method of evaluation. It is generally accepted that
continuous ICP monitoring is very important to determine the timing of surgery and to prevent
secondary brain damage caused by increased ICP.
There have been few clinical studies in which simultaneous pressures were recorded above and
below the tentorium in patients with intracranial pathology. Yet, the relevance of
infratentorial neuromonitoring remains largely unclear. So far, the placement of ICP probes
in the posterior fossa seems to carry very low morbidity. Furthermore, to rely on autonomic
changes, neurological deterioration, or measurements of only the supratentorial compartment
as a sign of relevant complications in the posterior fossa highly narrows the temporal margin
of safety for the institution of treatment. Comprehensive evaluation of possible risks of
posterior fossa lesions and their treatments is crucial. Of note, immediate detection of
treatment-related complications is often challenging, still being able to avoid permanent
neurological sequelae. The application of the advanced neuromonitoring in the posterior fossa
may be supportive in achieving this difficult goal and may provide objective assessments of
procedure-related complications.
Therefore, the data generated by our prospective trial can be expected to be beneficial in
individualized treatment plans. It is a relatively novel approach to intracranial multimodal
neuromonitoring. The application of infratentorial probes offers potential for better
understanding of lesion maturation and progression, clinical deterioration, and monitoring
the effect of treatments.
The investigators hypothesize that additional multimodal infratentorial neuromonitoring will
be of high clinical value detecting any relevant complication and giving detailed insight in
pathophysiological interactions in posterior fossa lesions.