Microsurgical approaches to the cerebellar interpeduncular region: qualitative and quantitative analysis

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  • 1 Department of Neurology and Neurosurgery,
  • | 2 Laboratory of Microneurosurgery Anatomy, and
  • | 3 Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Brazil;
  • | 4 Departments of Neurosurgery and
  • | 5 Neuroscience, University of Virginia Health System, Charlottesville, Virginia;
  • | 6 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
  • | 7 Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, Brazil
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OBJECTIVE

The cerebellar interpeduncular region (CIPR) is a gate for dorsolateral pontine and cerebellar lesions accessed through the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), or the subtemporal transtentorial approach (STa). The authors sought to compare the exposures of the CIPR region that each of these approaches provided.

METHODS

Three approaches were performed bilaterally in eight silicone-injected cadaveric heads. The working area, area of exposure, depth of the surgical corridor, length of the interpeduncular sulcus (IPS) exposed, and bridging veins were statistically studied and compared based on each approach.

RESULTS

The OTa provided the largest working area (1421 mm2; p < 0.0001) and the longest surgical corridor (6.75 cm; p = 0.0006). Compared with the SCITa, the STa provided a larger exposure area (249.3 mm2; p = 0.0148) and exposed more of the length of the IPS (1.15 cm; p = 0.0484). The most bridging veins were encountered with the SCITa; however, no significant differences were found between this approach and the other approaches (p > 0.05).

CONCLUSIONS

To reach the CIPR, the STa provided a more extensive exposure area and more linear exposure than did the SCITa. The OTa offered a larger working area than the SCIT and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.

ABBREVIATIONS

CIPR = cerebellar interpeduncular region; CN = cranial nerve; IPS = interpeduncular sulcus; LMS = lateral mesencephalic sulcus; MCP = middle cerebellar peduncle; OTa = occipital transtentorial approach; SCA = superior cerebellar artery; SCITa = supracerebellar infratentorial approach; SCP = superior cerebellar peduncle; SPS = superior petrosal sinus; STa = subtemporal transtentorial approach.

Supplementary Materials

    • Supplemental Tables 1 and 2 (PDF 209 KB)

Illustration from Serrato-Avila (pp 1410–1423). Copyright Johns Hopkins University, Art as Applied to Medicine. Published with permission.

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