• M Ross Bullock, Randall Chesnut, Jamshid Ghajar, David Gordon, Roger Hartl, David W Newell, Franco Servadei, Beverly C Walters, Jack Wilberger, and Surgical Management of Traumatic Brain Injury Author Group.
• Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
• Neurosurgery. 2006 Mar 1; 58 (3 Suppl): S47-55; discussion Si-iv.

IndicationsPatients with mass effect on computed tomographic (CT) scan or with neurological dysfunction or deterioration referable to the lesion should undergo operative intervention. Mass effect on CT scan is defined as distortion, dislocation, or obliteration of the fourth ventricle; compression or loss of visualization of the basal cisterns, or the presence of obstructive hydrocephalus. Patients with lesions and no significant mass effect on CT scan and without signs of neurological dysfunction may be managed by close observation and serial imaging.TimingIn patients with indications for surgical intervention, evacuation should be performed as soon as possible because these patients can deteriorate rapidly, thus, worsening their prognosis.MethodsSuboccipital craniectomy is the predominant method reported for evacuation of posterior fossa mass lesions, and is therefore recommended.

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