Supracerebellar Infratentorial Approach, Indications, and Technical Pitfalls

Posterior tentorial incisura not infrequently requires to be exposed for tumors of pineal gland, pulvinar, midbrain and cerebellum, aneurysms, arteriovenous malformations. Residing almost at the center of the brain, this area is almost equal distance to any point on the calvarium behind coronal sutures enabling alternative routes to encounter. Compared to supratentorial routes either subtemporal or suboccipital approach, infratentorial supracerebellar route has several advantages as providing shortest, most direct approach to the lesions of this area without encountering any important arteries and veins. Since its initial description at the early twentieth century, a wide range of complications arising from cerebellar infarction, air embolism, and neural tissue damage have been encountered. Working in a deep, narrow corridor without enough illumination and visibility under very limited anesthesiology support hindered popularization of this approach. In the contemporary era of neurosurgery, advanced diagnostic tools and surgical microscopes with state-of-the-art microsurgery techniques coupled with modern anesthesiology have eliminated almost all drawbacks of infratentorial supracerebellar approach.