Reviews
Anaesthetic Management of Cerebellopontine Angle Tumours: A Narrative Review of Neuroanatomy, Perioperative Strategies and Contemporary Advances
UE12-UE19
Correspondence
Dr. Repalli Leela Rajeswari,
Junior Resident, Department of Anaesthesia, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha-442001, Maharashtra, India.
E-mail: leelarepalli@gmail.com
Cerebellopontine Angle (CPA) tumours represent complicated lesions in the posterior fossa, which have significant anaesthetic complications as they are closely adjacent to cranial nerves, brainstem nuclei, and Cerebrospinal Fluid (CSF) pathways. Vestibular schwannomas are the most common, followed by meningiomas and epidermoid cysts. Progressive tumour growth usually leads to cranial nerve dysfunction, compression of the brainstem, and hydrocephalus; thus, careful perioperative planning is crucial for achieving the best results. This narrative review is a comprehensive assessment of CPA neuroanatomy that is relevant to anaesthesia and its implications for perioperative management. It outlines preoperative neurological and airway assessment, including a focus on lower cranial nerve involvement and risk of aspiration. Intraoperative strategies are critically discussed, with Total Intravenous Anaesthesia (TIVA) being the method of choice to maintain the integrity of intraoperative neuromonitoring such as Brainstem Auditory Evoked Potentials (BAEP) and cranial nerve Electromyography (EMG). Other factors such as patient positioning, haemodynamic stability, brain relaxation techniques and the prevention of neuromuscular blockage are additional considerations to facilitate reliable monitoring conditions. The approaches to postoperative care emphasise airway protection, delayed extubation, neurological monitoring, and the prevention of complications such as aspiration, cranial nerve deficits, and increased intracranial pressure. The novelty of this review lies in its integrated anaesthesia-centric synthesis of CPA tumour management, combining detailed neuroanatomical correlations with contemporary perioperative strategies. It also highlights the potential of emergent innovations like multimodal neuromonitoring, Enhanced Recovery After Surgery (ERAS) protocol and evolving potential of Artificial Intelligence (AI) in intraoperative decision support and postoperative critical care. In conclusion, a structured, anatomy-guided, patient-specific anaesthetic approach incorporating advanced monitoring and emerging technologies is essential to improve safety and neurological outcomes in CPA tumour surgery.