Principles of posterior fossa surgery: surgical management

269 Pages·2012·17.98 MB·English

by  Anil Nanda

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Principles of
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Posterior Fossa Surgery
A comprehensive review
of surgical approaches and
techniques for the posterior fossa
The ability to operate successfully in the posterior fossa requires a thorough understanding P Anil Nanda
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of its neuroanatomy and physiology, accurate localization of lesions, and optimal surgical
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technique. Principles of Posterior Fossa Surgery provides an in-depth review of this
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complex surgical region with detailed coverage of anatomy, pathology, imaging, disease- i
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based management, and surgical approaches. Written by a team of highly respected
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e
specialists, it will be a valued reference and refresher for clinicians who perform posterior
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fossa surgery and for trainees.
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Features: P
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• Begins with a useful framework in neuroimaging, neuropathology, and microsurgical
s
anatomy of the posterior cranial fossa t
e
• Covers a wide range of approaches and pathologies in the region, including congenital r
i
Chiari malformations, infections, trauma, aneurysms, and tumors o
• Highlights the anatomy of common surgical approaches, with numerous radiographic r

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and endoscopic images that aid in visualizing concepts
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• Provides full coverage of surgical techniques, starting with basic concepts and progressing s
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to operations on more challenging entities like petroclival meningiomas, jugular bulb
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tumors, acoustic neuromas, complex basilar aneurysms, and posterior circulation
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aneurysms u
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• Includes comprehensive sections on surgical management of pediatric posterior fossa
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tumors and shunt surgery for lesions e
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• Shares the insights of prominent neurosurgeons from top centers around the world,
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who discuss their preferred strategies for tackling this challenging area of the brain
Focusing solely on the posterior fossa, this book fills an important gap for neurosurgeons,
skull base specialists, and residents and fellows who are training in this anatomically
challenging region. It will enrich their understanding and knowledge of the field, expand
their surgical armamentarium, and help achieve the most successful clinical outcomes.
Anil Nanda, MD, FACS, is Professor and Chairman, Department of Neurosurgery, Louisiana
State University Health Sciences Center, Shreveport, Louisiana.
An award-winning international medical and scientific publisher, Thieme has demonstrated
its commitment to the highest standard of quality in the state-of-the-art content and
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ISBN 978-1-58890-663-2
www.thieme.com
Principles of Posterior Fossa Surgery

Principles of Posterior Fossa Surgery
Anil Nanda, MD
Professor and Chairman
Department of Neurosurgery
Louisiana State University Health Sciences Center
Shreveport, Louisiana
Thieme
New York • Stuttgart
Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
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Printed in China
5 4 3 2 1
ISBN 978-1-58890-663-2
Dedication
Matru devo bhava
Pitru devo bhava
Aachaarya devo bhava
Revere your Mother as God
Revere your Father as God
Revere your Teacher as God
Taittiriya Upanishad, 3000 B.C.
To my parents, Dr. and Mrs. Krishan and Uma Nanda
My wife, Laura, Ubi Amor Ibi Fides
My children, Alexander, Christopher, and Mary Catherine
v

Contents
Foreword by Peter J. Jannetta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
I General Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1 Surgery of the Posterior Cranial Fossa: Historical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Lissa C. Baird and Anil Nanda
Chapter 2 Microsurgical Anatomy of the Posterior Cranial Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Amitabha Chanda, Anirban Banerjee, and Anil Nanda
Chapter 3 Neuroimaging of the Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Thomas J. Vogl and Marc Harth
Chapter 4 Neurosurgical Pathology of the Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Marjorie Fowler
Chapter 5 Neurologic Entities of the Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Roger E. Kelley and Alireza Minagar
II Disease-Based Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Chapter 6 Congenital Chiari Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Vijayakumar Javalkar and Anil Nanda
Chapter 7 Trauma to the Temporal Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Prasad Vannemreddy and Anil Nanda
Chapter 8 Posterior Fossa Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Vijaysaradhi Mudumba, Challa Sundaram, and Prasad Vannemreddy
Chapter 9 Temporal Bone Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
James Andrew Sipp and Douglas E. Mattox
Chapter 10 Hemangiomas and Dural Fistulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Louis J. Kim, Michael R. Levitt, Iman Feiz-Erfan, and Robert F. Spetzler
vii
III Surgical Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Chapter 11 Basic Concepts in Posterior Fossa Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Lissa C. Baird, Vijayakumar Javalkar, and Anil Nanda
Chapter 12 Surgical Management of Petroclival Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Carl B. Heilman, Vasilios A. Zerris, and Carlos A. David
Chapter 13 Jugular Bulb Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Michael L. Madison and Jon H. Robertson
Chapter 14 The Retromastoid Approach: Techniques and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Madjid Samii, Sam Safavi-Abbasi, and Amir Samii
Chapter 15 Acoustic Neuromas: Translabyrinthine Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Nicholas Saunders and Paul A. Fagan
Chapter 16 Middle Fossa Craniotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Jose N. Fayad and Derald E. Brackmann
Chapter 17 Microvascular Decompressions for Hemifacial Spasm and Trigeminal Neuralgia . . . . . . . . 161
Tetsuo Kanno and Iyer Viswanathan
Chapter 18 Management of Posterior Cranial Fossa Pathology: Gamma Knife Radiosurgery . . . . . . . . 170
Vijayakumar Javalkar, Federico Ampil, and Anil Nanda
Chapter 19 Aneurysms of the Basilar Trunk: Far Lateral and Petrosal Approaches . . . . . . . . . . . . . . . . . . 181
Anil Nanda, Haim Ezer, and Prasad Vannemreddy
Chapter 20 Approaches and Management of Basilar Tip Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Brian L. Hoh and Christopher S. Ogilvy
s
nt Chapter 21 Endovascular Treatment of Posterior Circulation Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . 197
e
t Ramachandra P. Tummala, Junichi Yamamoto, Eric Sauvageau,
n
Co and L. Nelson Hopkins
Chapter 22 Posterior Interhemispheric Approach to Pineal Region and Brainstem . . . . . . . . . . . . . . . . . 209
Prasad Vannemreddy, Haim Ezer, and Anil Nanda
Chapter 23 Posterior Fossa Arteriovenous Malformations and Cavernous Angiomas . . . . . . . . . . . . . . . 218
Ramachandra P. Tummala, Mustafa K. Başkaya, and Roberto C. Heros
IV Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter 24 Shunt Surgery for Posterior Fossa Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Prasad Vannemreddy, Anirban Banerjee, and Brian Willis
Chapter 25 Surgical Management of Pediatric Posterior Fossa Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Fredrick A. Boop, Robert A. Sanford, and Michael D. Taylor
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
viii
Foreword
When I first met Anil Nanda, I was impressed by his poise gion, that is, historical perspectives, anatomy, imaging, pa-
and natural brilliance. I immediately accepted him as a post- thology, and neurological entities.
graduate fellow in microneurosurgery. Since he began the Next is a disease-based series of discussions, spanning con-
fellowship, I have never once been disappointed. I am re- genital, neoplastic to vascular, and infection problems. This
minded of the anticipation we all have before a trip, educa- is followed by details of operative techniques for a diverse
tional meeting, or social event. With Dr. Nanda, it is safe to group of problems that all neurologists and neurosurgeons
anticipate, for he always produces in a way that exceeds all see and treat, and must treat well. Finally, the last section
possible expectations. contains a brief two-chapter discussion of miscellany impor-
And, so it is with Principles of Posterior Fossa Surgery. tant to the surgery of the posterior fossa.
Nanda, with a select group of colleagues, each an established A book in science or medicine is a good book when it is
and knowledgeable leader in a specific area, exposes the well written, well organized, and informative. It is a great
“gloomy corner” of neurosurgery. They bring to it the Klieg book when it is organized by a master, is written by profi-
light of forthright inspection, brilliant evaluation, lucid ex- cient and articulate leaders in a field, is fully informative, and
position, and faultless description of the nuances of opera- meets a need. This volume is a great contribution which
tive treatment. every neurosurgeon, neurologist, and otolaryngologist should
Principles of Posterior Fossa Surgery is organized into four read and have on the bookshelf.
logically divided sections. General Considerations contains
the background one needs just to think clearly about the re- Peter J. Jannetta, MD
ix