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  • Modified Park Bench Position For Superior Vermian Arteriovenous Malformations: A Case Series

    Final Number:

    Rouzbeh Motiei-Langroudi, MD, Christoph J. Griessenauer, MD, Abdulrahman Y. Alturki, MD, Paul H. Chapman, MD, Christopher S. Ogilvy MD, Ajith J. Thomas, MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Arteriovenous malformations (AVMs) of the superior cerebellar vermis and dural AV fistulas (AVFs) are uncommon. Various surgical approaches and positions have been used to gain access.

    Methods: To present our experience with 13 superior vermian AVMs and tentorial dural AVFs, each resected through a supracerebellar infratentorial approach in park bench position with modification of the neck and head position (vertex tilt-up instead of down), which is presented for the first time in the current surgical practice and literature.

    Results: All 13 patients were treated surgically, in 3 preceded by endovascular embolization. Postoperative digital subtraction angiography (DSA) confirmed complete AVM resection in all. One patient experienced superficial wound infection treated by oral antibiotics, and another presented with a cerebrospinal fluid (CSF) collection due to occult hydrocephalus requiring insertion of a ventriculo-peritoneal shunt. The median modified Rankin Scales (MRS) at last follow-up was 1. There were no surgical complications at the time of last follow-up.

    Conclusions: Our series shows that for superior vermian AVMs, the supracerebellar infratentorial approach in a vertex tilt-up park bench position is a feasible, safe, and effective surgical approach. Our surgical approach, applied and presented for the first time for the treatment of this condition, may help other surgeons in the management of the disease.

    Patient Care: It will improve surgical results and decrease complications

    Learning Objectives: 1) a modification to a well-known surgical position to gain better results


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