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The Posterior Cranial Fossa: Microsurgical Anatomy
and Surgical Approaches

his work has grown out of my personal desire to im- TABLE 1. Residents and Fellows Who Have Worked in Dr.
prove the care of my patients. It represents a lifelong Rhoton’s Microsurgery Laboratory
attempt to gain an understanding of the anatomy and
Name Location
intricacies of the brain that would improve the safety, gentle-
ness, and accuracy of surgery for my patients. During college, Hajime Arai Tokyo, Japan
I planned to pursue a career in social work but, during a Allen S. Boyd, Jr. Memphis, Tennessee
course on psychology and the brain, I became captivated by Robert Buza Salem, Oregon
the possibility of serving humanity through a career in neu- Christopher C. Carver Salinas, California
Evandro de Oliveira São Paulo, Brazil
rosurgery. During medical school, I began working in a neu- W. Frank Emmons Olympia, Washington
roscience laboratory in my spare time and, at the end of my J. Paul Ferguson Rome, Georgia
residency, I completed a fellowship in neuroanatomy. It was Andrew D. Fine Gainesville, Florida
during this fellowship that I realized the potential for greater Brandon Fradd Gainesville, Florida
knowledge about microneurosurgical anatomy to improve Kiyotaka Fujii Fukuoka, Japan
the care of my patients. This volume, a distillation of our Hirohiko Gibo Nagano, Japan
John L. Grant Portsmouth, Virginia
studies of the posterior fossa, represents nearly 40 years of
Kristinn Gudmundsson Reykjavik, Iceland
work and study in which more than 50 residents and fellows David G. Hardy Cambridge, England
have participated, resulting in several hundred publications. Frank S. Harris Temple, Texas
It has been gratifying to view the role of our fellows and Tsutomo Hitotsumatsu Fukuoka, Japan
trainees in spreading this knowledge to other countries and Takuya Inoue Fukuoka, Japan
around the world and to see the benefits of neurosurgeons Tooru Inoue Fukuoka, Japan
applying this knowledge to improve surgery for their patients Chang Jin Kim Seoul, South Korea
Toshiro Katsuta Fukuoka, Japan
(Table 1). Especially gratifying has been the association with Drs.
Shigeaki Kobayashi Matsumoto, Japan
Katsutoshi Kitamura, Masashi Fukui, and Toshio Matsushima in William Lineaweaver Stanford, California
Fukuoka, Japan, and Drs. Evandro de Oliveira, Helder Tedeschi, J. Richard Lister Peoria, Illinois
and Hung Wen in São Paulo, Brazil. It is to the fellows and Qing Liang Liu Beijing, China
associates in the microsurgery laboratory that this volume is Jack E. Maniscalco Tampa, Florida
dedicated. Special thanks go to our medical illustrators, David Richard G. Martin Huntsville, Alabama
Haruo Matsuno Fukuoka, Japan
Peace and Robin Barry, who have worked with us for 2
Toshio Matsushima Fukuoka, Japan
decades; to Ron Smith, who has directed the microsurgery J. Robert Mozingo (Deceased)
laboratory for many years; and to Laura Dickinson and Fran Hiroshi Muratani Fukuoka, Japan
Johnson, who have labored over these and earlier manuscripts. Antonio C. M. Mussi São Paulo, Brazil
In the beginning, nearly 40 years ago, even with microsur- Shinji Nagata Fukuoka, Japan
gical techniques, our dissections were crude by current stan- Yoshihiro Natori Fukuoka, Japan
dards, with photographs needing to be retouched to bring out Kazunari Oka Fukuoka, Japan
Michio Ono Tokyo, Japan
the facets of anatomy important in achieving a satisfactory
T. Glenn Pait Little Rock, Arkansas
outcome at surgery. Over the years, as we have learned to Wayne S. Paullus Amarillo, Texas
expose fine neural structures, the display of microsurgical David Perlmutter Sarasota, Florida
anatomy has become more vividly accurate and beautiful Wade H. Renn Valdosta, Georgia
than we had imagined at the onset, and it has enhanced the Saran S. Rosner Hawthorne, New York
accuracy and beauty of our surgery. We hope that it will do Naokatsu Saeki Chiba, Japan
the same for our readers. We plan to produce a second issue Shuji Sakata Fukuoka, Japan
Eduardo Seoane Buenos Aires, Argentina
on the cerebrum and supratentorial areas in 2002 for the 25th Xiang-en Shi Beijing, China
anniversary of Neurosurgery, which I had some role in birth- Ryusui Tanaka Tokyo, Japan
ing, as President of the Congress of Neurological Surgeons 22 Helder Tedeschi São Paulo, Brazil
years ago. Erdener Timurkaynak Ankara, Turkey
In the early development of neurosurgery, approaches to Hung T. Wen São Paulo, Brazil
the posterior fossa were directed largely via the occipital C. J. Whang Seoul, South Korea
Isao Yamamoto Yokohama, Japan
squama and less frequently via the subtemporal transtentorial
Arnold A. Zeal Jacksonville, Florida
route. With the development of microsurgery and cranial base

Neurosurgery, Vol. 47, No. 3, September 2000 Supplement S5
S6 Rhoton

surgery, it became possible to work in long, narrow expo- neurosurgery at the University of Florida. These gifts have
sures, thus setting the stage for opening virtually all of the endowed the following chairs and professorships: the R.D.
cranial base through carefully placed windows exposing Keene Family Chair, the C.M. and K.E. Overstreet Chair, the
small and selective parts of the posterior fossa. These devel- Mark Overstreet Chair, the Albert E. and Birdie W. Einstein
opments led to approaches to the posterior fossa via the Chair, the James and Newton Eblen Chair, the Dunspaugh-
temporal bone as well as set the stage for approaches directed Dalton Chair, the Edward Shed Wells Chair, the Robert Z. and
via the anterior and middle cranial base. In this volume, we Nancy J. Greene Chair, the L.D. Hupp Chair, the William
have attempted not only to display the brain and cranial base Merz Professorship, and the Albert L. Rhoton, Jr. Chairman’s
in the best views for understanding the anatomy, but also to Professorship. The most recent of these is the $4 million gift
show the anatomy as exposed in opening multiple surgical establishing the Albert L. Rhoton, Jr. Neurosurgery Professor-
routes to the posterior fossa. For those wanting even greater ship, held by William A. Friedman, who has followed me as
detail than displayed in this volume, our prior works, pub- Chairman of Neurosurgery. The efforts of the numerous cli-
lished largely in Neurosurgery and the Journal of Neurosurgery, nicians and scientists recruited, as a result of the Endowed
can be consulted. Chairs, contributed greatly to the founding of the University
This work has been sustained by numerous private contri- of Florida Brain Institute, where our studies of microsurgical
butions to our department and the University of Florida. Most anatomy are being completed. With this volume, we join our
prominent among these has been the R.D. Keene family, who
donors in their aspiration to improve the lives of those un-
made the first $1 million gift to the University of Florida, a gift
dergoing brain surgery throughout the world.
that has supported our work for many years. Their gift was
followed by additional endowments, totaling $16 million, Albert L. Rhoton, Jr.
which support many aspects of education and research in Gainesville, Florida

Cranial cavity drawing by Leonardo da Vinci captures the growing sense of a science of proporations for Renaissance
artists. 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.)

Neurosurgery, Vol. 47, No. 3, September 2000 Supplement