46 Supracerebellar Infratentorial Approach: Microsurgical Perspective

A. Karim Ahmed, Samuel Kalb, Jean G. de Oliveira, and Robert F. Spetzler

Abstract

The supracerebellar infratentorial approach is an invaluable technique for microsurgical exposure of lesions located medially in the posterior pineal or incisural region and lesions located laterally in the posterolateral mesencephalon and ambient cistern. This surgical technique allows extra-axial exposure to deep intracranial structures with a surgical trajectory beneath the deep venous system while avoiding the surgical morbidity from parenchymal dissection and minimizing ischemia from vascular compromise. Preoperative evaluation using a variety of imaging modalities is key to the success of this surgical technique. Part of the reason for the success of this procedure is the two-point method, which allows the surgeon to reach the lesion while avoiding incisions into vital brainstem parenchyma and reducing additional retraction. With adequate patient positioning, which can be performed in several different ways, the approach to deep lesions can be conducted from multiple angles, the techniques for which are discussed in this chapter.

Key words

brainstem - brain tumors - cavernous malformations - developmental venous anomaly - infratentorial - microsurgery - supracerebellar

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