Surgery of Posterior Fossa AVM

Prior to the routine use of vertebral angiography, posterior fossa AVMs were usually found unexpectedly during the evacuation of posterior fossa hematomas [1]. In 1932 (May 5th), Olivecrona had reported their first successful radical removal of a left cerebellar AVM in a 37-year-old male who was misdiagnosed of having a posterior fossa tumor. After an 8-h-long marathon surgery under local anesthesia and with a blood transfusion of 2000 ml, the AVM was removed. The postoperative course was uneventful and the patient left the hospital 3 months later [2]. As vertebral angiography became more widely used, the preoperative diagnosis of posterior fossa AVMs became possible. Even so, at that time, neurosurgeons thought that it was possible to operate on small-to-moderate-sized AVMs in silent areas of the brain but were reluctant to touch AVMs in nonsilent areas [2], including the more demanding posterior fossa. Neurosurgeons were, however, disappointed that only very few AVMs could be removed entirely without great risk, which led to the development of other, ineffectual techniques, such as vertebral artery or feeder ligation [1].