Cranio-Cervical Junction Abnormalities, Chiari Malformations, and Skull Base Surgery — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style cranio-cervical junction abnormalities, chiari malformations, and skull base surgery viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 28-year-old woman with Chiari I malformation and extensive cervicothoracic syringomyelia presents with progressive weakness of both hands, absent gag reflex, bilateral vocal cord paresis, and central sleep apnoea. She is booked for foramen magnum decompression and duraplasty. Detail your preoperative airway and respiratory assessment, your intubation strategy, and your postoperative extubation criteria.
• SCENARIO 2: A 45-year-old man with severe basilar invagination and fixed atlantoaxial dislocation presents with severe quadriparesis (power 2/5 in all limbs). Any cervical movement triggers severe electric shock sensations down his spine (Lhermitte's sign) and respiratory distress. He is scheduled for transoral odontoidectomy followed by posterior stabilization. Outline your anaesthetic plan from awake intubation through intraoperative transoral airway sharing to stage 2 prone repositioning.
• SCENARIO 3: During a 10-hour resection of a giant petroclival chordoma involving the jugular foramen and clivus, the surgeon accidentally lacerates the jugular bulb and petrosal sinus. Massive, dark venous haemorrhage occurs alongside an acute drop in end-tidal CO2 from 36 mmHg to 18 mmHg. Outline your immediate diagnosis and dual management of hemorrhagic shock and venous air embolism.
• SCENARIO 4: A 52-year-old male with a massive anterior skull base olfactory groove meningioma undergoes craniofacial resection. Postoperatively in the recovery unit, clear watery fluid is dripping rapidly from his nose, and he develops acute facial swelling, orbital proptosis, and decreasing consciousness. Explain your diagnosis, immediate management, and prevention of tension pneumocephalus.