The infratentorial-supracerebellar approaches allow safe circumferential exposure of the posterior and middle incisural space. Choosing among different variants allows the surgeon to reach selected areas, with the midline variant being best for exposure of the posterior incisural space, and the paramedian and extreme-lateral variants being best for reaching the posterior and the anterior part of the middle incisural space, respectively. The more lateral the approach, the more anterior and multiangled the exposure gained. Complete, constant exposure and retraction of the dural sinuses improves the exposure. Accurate knowledge of the regional anatomy is mandatory.

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This retrospective study confirms that the surgical treatment results of SDAVF are satisfactory even if evaluated after many years. Given these results, and in accordance with the majority of the literature, we concur that surgery should be the first choice treatment for these spinal vascular lesions in order to avoid a dangerous delay and consequently further neurological deterioration. In our group of patients the only prognostic factor statistically related to clinical outcome was the pre-treatment neurological status, particularly the grade of paraparesis and the class of disability.

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