Thirty-two patients with posterior fossa tumours or arteriovenous malformations were subjected to elective craniotomy in the prone position. The intracranial pressure (ICP) was measured by a subdural approach in the open area of the exposed dura. Estimation of dural tension before dural incision and the degree of brain swelling/herniation after opening the dura were correlated with the subdural pressure measured with intact dura. The results indicate that at ICP < 10 mmHg, brain swelling/herniation rarely occurred, while at ICP > or = 10 mmHg some degree of brain swelling/herniation was always present. The neurosurgeon's tactile estimation of dural tension correlated poorly with any tendency to brain swelling/herniation. It is concluded that measurement of subdural pressure is a better predictor of the risk of brain swelling/herniation than the tactile estimation of dural tension during posterior fossa surgery.
Adolescent Adult