The supratonsillar approach to the inferior cerebellar peduncle: Anatomy, surgical technique, and clinical application to cavernous malformations

Michael T. Lawton, Alfredo Quiñones-Hinojosa, Peter Jun

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

OBJECTIVE: To introduce the supratonsillar approach, an approach that traverses the tonsillobiventral fissure in a trajectory over the cerebellar tonsil to the inferior cerebellar peduncle, and to demonstrate the utility of this approach for resecting peduncular cavernous malformations. METHODS: Anatomy of the cerebellar tonsil and surrounding fissures, arteries, and veins are reviewed using cadaveric brain specimens. The surgical approach uses the three-quarter prone position, a suboccipital craniotomy, and wide splitting of the tonsillobiventral fissure. RESULTS: Of our experience with 171 patients with cavernous malformations, six patients had lesions in the inferior cerebellar peduncle that were resected using the supratonsillar approach. All cavernous malformations were removed completely and no patients experienced surgical complications or new deficits. CONCLUSION: The supratonsillar approach differs from the transvermian and telovelar approaches to the fourth ventricle, with a more superolateral trajectory that leads instead to the inferior cerebellar peduncle. By splitting the tonsillobiventral fissure and mobilizing the tonsil inferomedially, the point of access to the lesion is deepened and transgression of normal cerebellar tissue is minimized. This elegant approach is ideally suited to the removal of cavernous malformations.

Original languageEnglish (US)
Pages (from-to)ONS-244-ONS-251
JournalNeurosurgery
Volume59
Issue number4 SUPPL. 2
DOIs
StatePublished - Oct 1 2006

Keywords

  • Biventral lobule
  • Cerebellar tonsil
  • Inferior cerebellar peduncle
  • Secondary fissure
  • Supratonsillar approach
  • Tonsillobiventral fissure

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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