Chapter 12 – Supratentorial Lesions

The major contribution to the intracranial region is the supratentorial compartment. Consequently, the lesions of this compartment predominate in terms of clinical presentation to a neurological center. Despite the complexity of extra-axial and intra-axial lesions, the greater expanse of the supratentorial area provides for a wide range of compensation before the onset of features of raised intracranial pressure and neurological deterioration. The clinical manifestations in patients with supratentorial lesions will depend on the site, size, and speed of growth of the lesion. The optimal perioperative outcome in these group of patients will rest on the team work between the anesthesiologists, surgeons, radiologists, and pathologists. Perioperative management has to be based on the cerebral pathology and its clinical consequences. The degree of exhaustion of the intracranial compensatory mechanisms and the clinical pattern will dictate the urgency of evacuation of a mass lesion. It is important for the anesthesiologists to have a sound knowledge of the cerebral pathophysiology and altered cerebral dynamics to tailor the anesthetic management.