Blood Vessel Tumors and Hematomas of the Posterior Fossa in Adolescence

Arteriovenous malformations of the posterior fossa: Clinical presentation, diagnostic evaluation and surgical treatment

“…The initial procedure for successful extirpation of a cerebellar AVM occurred in 1932 [13] and several authors reported small series of surgically treated patients subsequently [1,2,9,16,20]. It has only been with the introduction of microvascular surgical technique that these lesions have been more routinely submitted to surgical removal with acceptable morbidity and mortality [5,7,8,11,17,21].…”

“…Despite these drawbacks, by relying heavily on the extensive pathological review by McCormick and colleagues, a general appreciation of the common distribution of these lesions can be obtained [12]. An overall total of some 120 verified posterior fossa AVM's have been reported by these several authors [1,2,4,5,7,11,18] each of which could be classified as involving either stem, cerebellum or both (included here are the combination lesions and those which Drake and others have termed CP angle malformations). In general some two-thirds of AVM's located beneath the tentorium were found to lie solely within the cerebellum, another 20% found to involve the medulla or pons exclusively, with the remaining 15-20% being combined lesions usually located at least in part in the cerebellopontine angle.…”

“…The recent developments in neuroradiographic diagnostic techniques coupled with coincident advances in anesthetic and surgical capabilities has broadened the feasibility of surgical excision to include more intricate and involved lesions of the midline structures, cerebellopontine angle and some brain stem malformations [3,4,5,7,8,10,21]. As yet, the specific peculiarities of the proximal vertebro-basilar system and its AVM's have prevented recent interventional radiographic techniques from exerting a therapeutic influence similar to that seen in treatment protocols with large supratentorial malformations.…”

Arteriovenous Malformations of the Brainstem in Childhood

“…In 1965, Mount [16] related an attempt to excise a brain stem arteriovenous malformation, but succeeded in clipping the right ante rior inferior cerebellar artery and obliterating the lesion. Subsequent reports by Green and Vaughan [6], Chou et al [1] and Drake [3] outlined the individual case experience with these brainstem vascular lesions, whose treatment was undertaken with the belief that the malformations lay superficially on the brainstem and, like the lesions within the spinal cord, could be dissected free in an extrapial plane. 2 patients of Drake [3], both of Chou et al [1] and that of Green and Vaughan [6] were children or adolescents.…”

“…Subsequent reports by Green and Vaughan [6], Chou et al [1] and Drake [3] outlined the individual case experience with these brainstem vascular lesions, whose treatment was undertaken with the belief that the malformations lay superficially on the brainstem and, like the lesions within the spinal cord, could be dissected free in an extrapial plane. 2 patients of Drake [3], both of Chou et al [1] and that of Green and Vaughan [6] were children or adolescents. This report will examine 9 children with confirmed, classic arteriove nous malformations lying within the brainstem, and diagnosed by ncuroradiologic and/or histologic examination, at the Hospital for Sick Chil dren, Toronto.…”