Introduction: Tongue edema following posterior cranial fossa surgery is occasionally encountered and may result in unexpected poor outcomes. However, to date, no incidence has been reported. The goal of this work is to evaluate the rate of tongue edema following posterior cranial fossa surgery, evaluate clinical outcomes and management strategies.

Methods: This represent a single-center retrospective study of patients who underwent posterior fossa craniotomies between January 2000 and January 2017. Patients who underwent posterior fossa craniotomies were identified using CPT codes and dependent and independent variables were collected via chart review.

Results: Out of 1,567 consecutive posterior fossa craniotomies that were queried, postoperative tongue edema was diagnosed in 32 patients (2.04%). Mean age was 35. 16 were female and 16 were male. Craniotomies that resulted in postoperative tongue edema were performed for tumor resection in 17 cases, for Chiari malformation in 12 cases, stroke in 2 cases and aneurysm clipping in 1 patient. Most surgeries with encountered edema were performed in the prone position (87.5%) under general anesthesia. Average duration of surgery was 459 minutes for these cases. Average patient BMI was 27.37. Average follow-up duration was 49 months. The majority of cases were noted on postop D0 and D1. There were no directly related mortalities. Mean days of hospitalization post procedure in cases complicated by postoperative tongue edema was 14 days. 11 patients had to remain intubated postop and 4 patients were reintubated post extubation for development of tongue edema. 11 patients ultimately required tracheostomy placement; of these patients, 4 had decannulation of their tracheostomy during follow-up and 6 are still tracheostomy-dependent.

Conclusions: Tongue edema occurs in about 2% of posterior fossa craniotomies and can result in significant postoperative morbidity including prolonged hospitalizations, prolonged intubation times, re-intubation and tracheostomy placement.

Patient Care: This work will enhance recognition of post-operative tongue edema, its incidence, management strategies, and can help to establish ways to minimize it in patients undergoing posterior fossa craniotomies.

Learning Objectives: 1) Describe the incidence of tongue edema following posterior fossa craniotomies 2) Describe the outcomes of patients who suffer from post-operative tongue edema. 3) Discuss management strategies of post-operative tongue edema.

References: 1. Iwuchukwu I, Ardelt A, Cueva W, Reshi R, Goldenberg F, Frank J. Macroglossia associated with brainstem injury. Neurocritical care. Feb 2014;20(1):106-110. 2. Nimjee SM, Wright DR, Agrawal A, McDonagh DL, Husain AM, Britz GW. Tongue swelling and necrosis after brain tumor surgery. Asian journal of neurosurgery. Oct 2012;7(4):214-216. 3. El Hassani Y, Narata AP, Pereira VM, Schaller C. A reminder for a very rare entity: massive tongue swelling after posterior fossa surgery. Journal of neurological surgery. Part A, Central European neurosurgery. May 2012;73(3):171-174. 4. Pivalizza EG, Katz J, Singh S, Liu W, McGraw-Wall BL. Massive macroglossia after posterior fossa surgery in the prone position. Journal of neurosurgical anesthesiology. Jan 1998;10(1):34-36. 5. Kotil K, Yavasca P, Bilge T. Postoperative massive macroglossia in Klippel-Feil syndrome after posterior occipitocervical fixation surgery in the sitting position. Journal of spinal disorders & techniques. May 2006;19(3):226-229. 6. Figueredo-Gaspari E, Fredes-Kubrak R, Canosa-Ruiz L. [Macroglossia after surgery of the posterior fossa]. Revista espanola de anestesiologia y reanimacion. Apr 1997;44(4):157-158. 7. Tsung YC, Wu CT, Hsu CH, Yeh CC, Lin SL, Wong CS. Macroglossia after posterior fossa surgery in the prone position--a case report. Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. Mar 2006;44(1):43-46. 8. Vermeersch G, Menovsky T, De Ridder D, De Bodt M, Saldien V, Van de Heyning P. Life-threatening macroglossia after posterior fossa surgery: a surgical positioning problem? B-ent. 2014;10(4):309-313. 9. Toyama S, Hoya K, Matsuoka K, Numai T, Shimoyama M. Massive macroglossia developing fast and immediately after endotracheal extubation. Acta anaesthesiologica Scandinavica. Feb 2012;56(2):256-259. 10. Sinha A, Agarwal A, Gaur A, Pandey CK. Oropharyngeal swelling and macroglossia after cervical spine surgery in the prone position. Journal of neurosurgical anesthesiology. Jul 2001;13(3):237-239. 11. Tattersall MP. Massive swelling of the face and tongue. A complication of posterior cranial fossa surgery in the sitting position. Anaesthesia. Oct 1984;39(10):1015-1017.