Paramedian supracerebellar approach to the upper brain stem and peduncular lesions.

Abstract

The infratentorial paramedian supracerebellar approach is useful for lesions involving the upper brain stem or the cerebellar pedunculi. We provide a precise description of this approach and its indications. Four patients were operated on using this approach. The lesions included a squamous cell carcinoma, a glioblastoma multiforme, a hematoma, and a cavernoma. The lesions involved the quadrigeminal plate, the superior cerebellar peduncle, the middle cerebellar peduncle, and the quadrangular lobule of the cerebellum. Postoperatively, there was no apparent aggravation of neurological symptoms. The main advantage of the approach was that the operation can be performed with a wide horizontal view without sacrificing the deep veins. It is concluded that lesions in the superior and inferior colliculus, superior and middle cerebellar peduncles, and quadrangular lobules of the cerebellum can be safely operated on with this approach.