Green, John R.; Vaughan, Richard J.
September 1972
Angiology;Sep1972, Vol. 23 Issue 8, p474
Academic Journal
Case reports of blood vessel tumors and hematomas in the posterior fossa of four adolescents are presented and pertinent literature is reviewed. One patient with hemangioblastoma presented in an unusual manner with subarachnoid hemorrhage. Another young girl was found to have an arteriovenous malformation in the posterior fossa with the endothelial proliferation which is usually associated microscopically with a capillary hemangioblastoma. Arteriovenous malformations appeared on the posterior circulation with greater frequency than in usually reported in the brain. Total intracranial angiography is the preferred definitive investigation because it simultaneously delineates a vascular lesion or lesions and localizes a mass. Angiographic diagnosis of posterior fossa lesions is now as precise as it is above the tentorium. The principles of surgical technique are emphasized, particularly the objective of total excision of the hemangioblastoma and the arteriovenous malformation. The latter procedure is more precise with the use of the operating microscope, bipolar coagulation forceps for bleeders, and a fine suction tip. A subpial incision is made just proximal to the arterial feeders which are clipped, coagulated, and divided, following which the mass shrivels and is then excised after clipping, coagulating, and dividing the draining veins. Ligation of a feeding vessel is not an effective treatment nor is embolization a safe one in the treatment of posterior fossa arteriovenous malformations. Because of lethal hazards of benign blood vessel tumors and hematomas of the posterior fossa if untreated and the satisfactory results following surgical excision, early definitive neurosurgery is advised in these lesions. The successful excision of an extensive arteriovenous malformation involving the pons, medulla, cranial nerves and cerebellum in the posterior fossa is described, perhaps, for the first time.


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