184
Perioperative Care and Surgical
Techniques for Metastasis
to the Posterior Fossa
Prior to the work of Harvey Cushing, tumor resec-
tion of posterior fossa lesions was seldom
attempted because of the high morbidity and mor-
tality associated with the procedure. Through
meticulous documentation and perioperative care,
coupled with new cautery instrumentation, Cushing
added the practice of posterior fossa surgery into the
neurosurgical armamentarium [ 44 ]. Much of
today’s surgical decision making is influenced by
understanding the precise three- dimensional
location of a tumor and the posterior fossa.Fig. 13.5 Images of a
patient with metastatic
colon cancer with
controlled systemic
disease and no
neurological complaints
or symptoms.
Preoperative (a) axial
and (b) coronal
T1-weighted,
gadolinium-enhanced
MRIs demonstrate one
small cerebellar lesion
and one high parietal
lesion. (c, d)
Radiosurgical treatment
of both lesions was
performed. (e, f) MRI
3 years later demonstrate
no new lesions and only
small enhancing scar
tissue with no evidence
of tumor growth over
this time period
B.D. Weaver and R.L. Jensen