Extreme Lateral Supracerebellar Infratentorial Approach for Resection of Incisural Meningioma: Two-Dimensional Operative Video

Abstract

Surgical resection of lesions occupying the incisural space is challenging and requires deep knowledge of the complex neurovascular and skull base anatomy. This video illustrates a case of incisural meningioma that was surgically resected using the extreme lateral supracerebellar infratentorial (SCIT) approach. A 49-year-old woman presented with a history of left-sided numbness, gait instability, and left trochlear nerve palsy. Neuroimaging demonstrated a left incisural meningioma with brainstem compression. Surgical management was indicated using the extreme lateral SCIT. Postoperatively, the patient showed good recovery with residual left trochlear nerve palsy that improved on follow-up. The extreme lateral SCIT approach provided direct access to the incisual space with minimal cerebellar retraction and favorable outcomes.

Keywords

tentorial meningioma - incisural meningioma - supracerebellar infratentorial approach

Incisural Meninginoma (That Has Been Usually Grouped With Tentorial Meningiomas) Represents 3-6% Of All Intracranial Meningiomas.[1] These Tumors Can Extend Anteromedially In The Anterior Incisura Space, Anterolaterally In The Region Of The Cavernous Sinus And Medial Middle Fossa, Laterally Over The Anterior Aspect Of The Pyramid, Inferomedially Over The Clivus, And Inferolaterally In The Cerebellopontine Angle.[2] Deep Knowledge Of Their Location And Extention And Careful Preoperative Planning Is Prerequisite To Achieve Excellent Surgical Outcomes. Various Surgical Approaches Have Been Described Depending On The Location Of The Lesion In Relation To The Tentorium. The Extreme Lateral Supracerebellar Infratentorial Approach Provides Access To The Incisural Space With Minimal Cerebellar Retraction.[3] This Video Illustrates A Case Of Incisural Meningioma That Was Surgically Resected Using The Extreme Lateral Supracerebellar Infratentorial (SCIT) Approach (Video 1, Available In The Online Version).

Video 1 Operative video: extreme lateral SCIT for incisural meningioma.

Conflict of interest

None declared.

Transcript (mm:ss)

00:03: Clinical presentation.

00:24: Imaging.

00:40: Management options.

00:56: Selected approach.

01:16: Alternative approach.

01:27: Positioning and skin incision.

01:54: Surgical video.

03:30: Clinical and radiological outcomes.

03:51: Disease background.

• References

• 1 de Oliveira JG, Lekovic GP, Safavi-Abbasi S. et al. Supracerebellar infratentorial approach to cavernous malformations of the brainstem: surgical variants and clinical experience with 45 patients. Neurosurgery 2010; 66 (02) 389-399
• 2 Samii M, Ammirati M. Incisural meningiomas. In: Surgery of Skull Base Meningiomas: with a Chapter on Pathology by GF Walter. Berlin: Springer; 1992: 97-103
• 3 Talacchi A, Biroli A, Medaglia S, Locatelli F, Meglio M. Surgical management of anterolateral and posteromedial incisural tentorial meningioma. Oper Neurosurg (Hagerstown) 2018; 15 (02) 120-130

Publication History

Article published online:
02 April 2025