© Springer International Publishing AG 2018 195
W.T. Couldwell (ed.), Skull Base Surgery of the Posterior Fossa,
https://doi.org/10.1007/978-3-319-67038-6_14
Microsurgical Management
of Posterior Fossa Vascular Lesions
M. Yashar S. Kalani and Robert F. Spetzler
Abbreviations
AICA Anterior inferior cerebellar artery
ARUBA A Randomized Trial of Unruptured
Brain AVMs
AVM Arteriovenous malformation
BA Basilar artery
CT Computed tomography
CTA Computed tomography angiography
DSA Digital subtraction angiography
ICG Indocyanine green angiography
ISUIA International Study of Unruptured
Intracranial Aneurysms
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
PCA Posterior cerebral artery
PCoA Posterior communicating artery
PICA Posterior inferior cerebellar artery
SAH Subarachnoid hemorrhage
SCA Superior cerebral artery
SCIT Supracerebellar infratentorial
VA Vertebral artery
Introduction
Microsurgical management of lesions in the
posterior fossa is complicated by the labyrinth
of critical neurovascular structures that reside
in a confined corridor encased by a dense for-
tress of bone. The complexity of the anatomy
and the unforgiving nature of the neurovascu-
lar bundle in the posterior fossa have resulted
in reluctance on the part of many practitioners
to surgically treat lesions in this region. The
past two decades have seen a gradual decline
in reliance on surgical treatment of lesions in
the posterior fossa and a greater dependence
on other treatment modalities, such as endo-
vascular treatment for vascular lesions and
radiosurgery for tumors and vascular malfor-
mations. Nonetheless, surgical competence
and excellence remains essential for treating
select posterior fossa lesions, including those
vascular lesions that cannot be treated opti-
mally using other modalities [ 1 ]. In this chap-
ter, we review the microsurgical treatment of
posterior circulation vascular lesions, focus-
ing on the treatment of aneurysms, arteriove-
nous malformations (AVMs), and cavernous
M.Y.S. Kalani, MD, PhD • R.F. Spetzler, MD (*) malformations.
Department of Neurosurgery, Barrow Neurological
Institute, St. Joseph’s Hospital and Medical Center,
350 W. Thomas Rd., Phoenix, AZ 85013, USA
e-mail: [email protected]