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

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.