Infradentate Approach to the Fourth Ventricle

The use of minimally invasive transcranial ports for the resection of deep-seated lesions has been shown to be safe and effective for supratentorial lesions. The routine use of this surgical modality for posterior fossa masses has not been well established in the literature. In particular, fourth ventricular tumors are not the typical target for neuro-port surgery because of potential injury to the dentate nucleus.

To describe the use of a tubular retractor system to reach the fourth ventricle while sparing the cerebellar vermis and the dentate nucleus. Three cases illustrations are presented.

Surgical access to the fourth ventricle was developed sparing the cerebellar vermis and the dentate nucleus. The authors reviewed 3 cases to illustrate the feasibility of minimal access transcerebellar port surgery for the resection of these lesions using an infradentate access.

None of the patients developed new neurological deficits and the pathology was successfully resected in all cases. There were no major complications related to surgery and no mortalities.

The infradentate approach obviates the need for traditional approaches to the fourth ventricle, thus making this challenging target in the posterior fossa more accessible to neurosurgeons. The authors observed successful removal of lesions involving the fourth ventricle while avoiding any associated morbidity or mortality.