History of Posterior Fossa Tumor Surgery

Abstract

Development of surgical techniques for the treatment of posterior fossa disorders is, in the terms of historical events, very recent. In the sense of “modern” surgical techniques, we are only looking at a period that developed in the late quarter of the nineteenth century. In looking back at the historical literature, surgeons since the time of antiquity avoided any kind of surgical intervention within the posterior fossa. Early surgeons quickly realized that this region of the brain is extremely sensitive to any type of manipulation. Loss of respiration, sudden death, and distortion of the brain stem, all could lead to a rapid demise of the patient. As we shall see, surgery of the posterior fossa really only came in being with the origins of the twentieth century. A review of surgical textbooks in the latter half of the nineteenth century reveals only a minimal discussion of surgery in the posterior fossa. In the last 25 years, there has been a virtual explosion of techniques and equipment related to what is now called frameless surgical technology. To provide a historical perspective on this subject, the author will review the development of posterior fossa surgery with only a brief look at antiquity and then quickly move to the Renaissance and the pioneering work of the anatomists of the sixteenth century. This chapter will review how the anatomy of the posterior fossa was first understood. The evolution of surgical technique and the individuals who provided us with these new ideas will be discussed.