FOREWORD

The Posterior Cranial Fossa: Microsurgical Anatomyand Surgical Approaches

This work has grown out of my personal desire to im-prove the care of my patients. It represents a lifelongattempt to gain an understanding of the anatomy and

intricacies of the brain that would improve the safety, gentle-ness, and accuracy of surgery for my patients. During college,I planned to pursue a career in social work but, during acourse on psychology and the brain, I became captivated bythe possibility of serving humanity through a career in neu-rosurgery. During medical school, I began working in a neu-roscience laboratory in my spare time and, at the end of myresidency, I completed a fellowship in neuroanatomy. It wasduring this fellowship that I realized the potential for greaterknowledge about microneurosurgical anatomy to improvethe care of my patients. This volume, a distillation of ourstudies of the posterior fossa, represents nearly 40 years ofwork and study in which more than 50 residents and fellowshave participated, resulting in several hundred publications.It has been gratifying to view the role of our fellows andtrainees in spreading this knowledge to other countries andaround the world and to see the benefits of neurosurgeonsapplying this knowledge to improve surgery for their patients(Table 1). Especially gratifying has been the association with Drs.Katsutoshi Kitamura, Masashi Fukui, and Toshio Matsushima inFukuoka, Japan, and Drs. Evandro de Oliveira, Helder Tedeschi,and Hung Wen in Sao Paulo, Brazil. It is to the fellows andassociates in the microsurgery laboratory that this volume isdedicated. Special thanks go to our medical illustrators, DavidPeace and Robin Barry, who have worked with us for 2decades; to Ron Smith, who has directed the microsurgerylaboratory for many years; and to Laura Dickinson and FranJohnson, who have labored over these and earlier manuscripts.

In the beginning, nearly 40 years ago, even with microsur-gical techniques, our dissections were crude by current stan-dards, with photographs needing to be retouched to bring outthe facets of anatomy important in achieving a satisfactoryoutcome at surgery. Over the years, as we have learned toexpose fine neural structures, the display of microsurgicalanatomy has become more vividly accurate and beautifulthan we had imagined at the onset, and it has enhanced theaccuracy and beauty of our surgery. We hope that it will dothe same for our readers. We plan to produce a second issueon the cerebrum and supratentorial areas in 2002 for the 25thanniversary of Neurosurgery, which I had some role in birth-ing, as President of the Congress of Neurological Surgeons 22years ago.

In the early development of neurosurgery, approaches tothe posterior fossa were directed largely via the occipitalsquama and less frequently via the subtemporal transtentorialroute. With the development of microsurgery and cranial base

TABLE 1. Residents and Fellows Who Have Worked in Dr.Rhoton’s Microsurgery Laboratory

Name Location

Hajime Arai Tokyo, JapanAllen S. Boyd, Jr. Memphis, TennesseeRobert Buza Salem, OregonChristopher C. Carver Salinas, CaliforniaEvandro de Oliveira Sao Paulo, BrazilW. Frank Emmons Olympia, WashingtonJ. Paul Ferguson Rome, GeorgiaAndrew D. Fine Gainesville, FloridaBrandon Fradd Gainesville, FloridaKiyotaka Fujii Fukuoka, JapanHirohiko Gibo Nagano, JapanJohn L. Grant Portsmouth, VirginiaKristinn Gudmundsson Reykjavik, IcelandDavid G. Hardy Cambridge, EnglandFrank S. Harris Temple, TexasTsutomo Hitotsumatsu Fukuoka, JapanTakuya Inoue Fukuoka, JapanTooru Inoue Fukuoka, JapanChang Jin Kim Seoul, South KoreaToshiro Katsuta Fukuoka, JapanShigeaki Kobayashi Matsumoto, JapanWilliam Lineaweaver Stanford, CaliforniaJ. Richard Lister Peoria, IllinoisQing Liang Liu Beijing, ChinaJack E. Maniscalco Tampa, FloridaRichard G. Martin Huntsville, AlabamaHaruo Matsuno Fukuoka, JapanToshio Matsushima Fukuoka, JapanJ. Robert Mozingo (Deceased)Hiroshi Muratani Fukuoka, JapanAntonio C. M. Mussi Sao Paulo, BrazilShinji Nagata Fukuoka, JapanYoshihiro Natori Fukuoka, JapanKazunari Oka Fukuoka, JapanMichio Ono Tokyo, JapanT. Glenn Pait Little Rock, ArkansasWayne S. Paullus Amarillo, TexasDavid Perlmutter Sarasota, FloridaWade H. Renn Valdosta, GeorgiaSaran S. Rosner Hawthorne, New YorkNaokatsu Saeki Chiba, JapanShuji Sakata Fukuoka, JapanEduardo Seoane Buenos Aires, ArgentinaXiang-en Shi Beijing, ChinaRyusui Tanaka Tokyo, JapanHelder Tedeschi Sao Paulo, BrazilErdener Timurkaynak Ankara, TurkeyHung T. Wen Sao Paulo, BrazilC. J. Whang Seoul, South KoreaIsao Yamamoto Yokohama, JapanArnold A. Zeal Jacksonville, Florida

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surgery, it became possible to work in long, narrow expo-sures, thus setting the stage for opening virtually all of thecranial base through carefully placed windows exposingsmall and selective parts of the posterior fossa. These devel-opments led to approaches to the posterior fossa via thetemporal bone as well as set the stage for approaches directedvia the anterior and middle cranial base. In this volume, wehave attempted not only to display the brain and cranial basein the best views for understanding the anatomy, but also toshow the anatomy as exposed in opening multiple surgicalroutes to the posterior fossa. For those wanting even greaterdetail than displayed in this volume, our prior works, pub-lished largely in Neurosurgery and the Journal of Neurosurgery,can be consulted.

This work has been sustained by numerous private contri-butions to our department and the University of Florida. Mostprominent among these has been the R.D. Keene family, whomade the first $1 million gift to the University of Florida, a giftthat has supported our work for many years. Their gift wasfollowed by additional endowments, totaling $16 million,which support many aspects of education and research in

neurosurgery at the University of Florida. These gifts haveendowed the following chairs and professorships: the R.D.Keene Family Chair, the C.M. and K.E. Overstreet Chair, theMark Overstreet Chair, the Albert E. and Birdie W. EinsteinChair, the James and Newton Eblen Chair, the Dunspaugh-Dalton Chair, the Edward Shed Wells Chair, the Robert Z. andNancy J. Greene Chair, the L.D. Hupp Chair, the WilliamMerz Professorship, and the Albert L. Rhoton, Jr. Chairman’sProfessorship. The most recent of these is the $4 million giftestablishing the Albert L. Rhoton, Jr. Neurosurgery Professor-ship, held by William A. Friedman, who has followed me asChairman of Neurosurgery. The efforts of the numerous cli-nicians and scientists recruited, as a result of the EndowedChairs, contributed greatly to the founding of the Universityof Florida Brain Institute, where our studies of microsurgicalanatomy are being completed. With this volume, we join ourdonors in their aspiration to improve the lives of those un-dergoing brain surgery throughout the world.

Albert L. Rhoton, Jr.Gainesville, Florida

Cranial cavity drawing by Leonardo da Vinci captures the growing sense of a science of proporations for Renaissanceartists. In addition to serving as anatomical specimens, his drawings remain consummate examples of draftsmanship.

Courtesy, Dr. Edwin Todd, Pasadena, California. (Also see pages S193 and S286.)

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