Endoscopic High Occipital Interhemispheric Transtentorial Approach for Lesions in the Anterosuperior Cerebellum, Upper Fourth Ventricle, and Upper Dorsal Brain Stem

The occipital transtentorial route is considered the most suitable for surgical treatment of lesions arising from the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem. Therefore, this study examined the feasibility and effectiveness of the endoscopic high occipital interhemispheric transtentorial approach (EHOTA) for lesions in these areas, in achieving results comparable to the endoscopic occipital interhemispheric transtentorial approach (EOTA). EOTA has recently been reported to be an effective procedure for pineal region tumors, having several advantages that include minimal invasiveness with a small entrance limiting the retraction of the occipital lobe, the elimination of blind spots, and the facilitation of fine manipulation due to the bright, magnified panoramic view.By using 30 clinical datasets of venous-phase head computed tomography angiogram, measurements on images were performed and differences between EOTA and EHOTA were identified. In addition, the feasibility of EHOTA was verified with 5 cadaver heads.Although the operative field via EHOTA was considered significantly deeper and less maneuverable than with the procedure via EOTA, beneficial angles for manipulation in the superior cerebellum and the fourth ventricle were obtained in EHOTA, on account of their becoming more obtuse. Using EHOTA, it was possible to reach those regions and effectively manipulate all 10 sides of the 5 cadaveric heads, as well as a case with anterosuperior cerebellar cavernous angioma.EHOTA, which has the same advantages as EOTA, could prove to be an efficacious procedure for lesions in the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem.