• Amir Hadanny, Uri Rozovski, Erez Nossek, Yuval Shapira, Ido Strauss, Andrew A Kanner, Razi Sitt, Zvi Ram, and Tal Shahar.
• Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
• World Neurosurg. 2016 May 1; 89: 193-8.

ObjectiveSurgical resection of posterior fossa metastases (PFM) includes either suboccipital craniotomy or suboccipital craniectomy. The optimal surgical technique is yet to be defined. We examined the association between the chosen surgical approach and the occurrence of postoperative complications.MethodsWe retrospectively evaluated medical records and imaging characteristics of patients who underwent resection of newly diagnosed PFM between 2003 and 2014 in our medical center to identify covariates that significantly affected postoperative complications.ResultsOf 917 patients with brain metastases, 88 patients underwent surgery for PFM and were included in the study. Craniectomy was performed in 54 cases (61%). Urgent postoperative posterior fossa decompression or cerebrospinal fluid diversion was performed in 4 patients (4.5%). Postoperative complications included postoperative central nervous system infection (n = 10 [12%]), cerebrospinal fluid leak (n = 3 [4%]), wound dehiscence (n = 6 [7%]), and long-term pseudomeningocele (n = 12 [14%]). The perioperative mortality rate was 2.3% (n = 2). Multivariate analysis that included patient baseline characteristics, imaging study parameters, and surgical approaches demonstrated that suboccipital craniectomy was associated with more postoperative complications (P = 0.03, odds ratio = 4.48, 95% confidence interval = 1.14-17.6). There was no correlation between patient baseline characteristics or surgical technique with the need for urgent postoperative posterior fossa decompression or cerebrospinal fluid diversion.ConclusionsSuboccipital craniotomy may be associated with a lower incidence of postoperative morbidity compared with suboccipital craniectomy and should be considered as the preferred approach for the resection of PFM.Copyright © 2016 Elsevier Inc. All rights reserved.

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