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Hearing rehabilitation treatment is dictated by the nature and etiology of hearing loss. Patients with absent/destroyed cochlear nerves or complete labyrinthine aplasia (Michel’s aplasia) render peripheral cochlear stimulation ineffective and such patients benefit from an auditory brainstem implant (ABI). A coordinated multidisciplinary team approach is necessary for the safe conduct of this challenging surgery using electrophysiologic measures to confirm the accurate placement of the ABI array. The role of the anaesthesiologist ranges from preoperative assessment of syndromal associations, difficult airway assessment, building rapport with the child, and counseling the family. Adequate premedication, smooth induction, and facilitation of neurophysiological monitoring are essential. The anaesthetist also plays a crucial role in decreasing intracranial pressure and improving surgical access while avoiding excessive cerebellar retraction. Close monitoring of vitals, care of the lumbar drain, provision of adequate analgesia, and antiemesis are the main concerns postoperatively.

Head fixation devices are frequently used to immobilize the position of the head in neurosurgery. We report a rare complication of a four-pin Sugita device causing epidural hematoma (EDH) in a young adult male undergoing transcranial excision of a craniopharyngioma manifesting intraoperatively as an intractable tense brain. Decreased bone mineral density secondary to the metabolic consequences of craniopharyngioma could have increased the susceptibility to breach of the bony cortex. The index case highlights the essential role of a preoperative computed tomography (CT) scan review for the thickness of the cranial vault and the identification of weaker zones in high-risk groups.

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