The Interpeduncular Fossa Approach for Resection of Centromedian Midbrain Lesions

The authors describe the interpeduncular fossa safe-entry zone as a novel route for resection of centromedian midbrain lesions. This safe-entry zone is approached using a contralateral orbitozygomatic trans-interpeduncular fossa approaches.

The interpeduncular fossa may be incised to resect anteriorly located lesions that are medial to the third cranial nerve and can serve as an alternative to the perioculomotor safe entry zone for resection of ventral mesencephalic lesions intrinsic to the brainstem. Using a contralateral modified orbitozygomatic approach the space between the mammillary bodies and the top of the basilar artery is accessed to arrive at the ventral mesencephalon and medial to the third cranial nerve. The technical nuances of this approach and results in three patients are described.