Supracerebellar Infratentorial Approach and Its Vascular Complications

Introduction Supracerebellar infratentorial approach is an effective extracerebellar approach to pathologies of upper part of cerebellum, pineal region, mesencephalon, pulvinar thalami, or even mediobasal parts of temporal lobes. Venous complications belong to the most important ones.

Material and Methods We studied retrospectively a series of 13 patients where this approach was used. There were two glioblastomas, two atypical meningiomas G II, two arachnoid cysts and by one pilocytic astrocytoma, hemangioblastoma, pinealoblastoma, seminoma, ependymoma G II, metastasis, and cavernoma. The operations were performed in the sitting position. No air embolization occurred. The deep venous system stayed intact in all patients. In all operations, however, one or two bridging veins from cerebellum to tentorium were cut. No retraction on the cerebellum was used.

Results Total and subtotal resection was achieved in eight and five patients, respectively. All surgical results were good except for one mild hemiparesis (meningioma) and one death (thalamic cavernoma) due to venous infarction and malignant edema of cerebellum.

Conclusion Supracerebellar infratentorial approach is a very efficient approach for many pathological processes and in majority of cases lead to very good results. The most severe complications occur as a result to the damage of the deep venous system. Even cutting of the bridging veins might cause a disastrous damage to the cerebellum in ∼1% of the patients. The patients should be informed about this risk before the operation.