TY - JOUR AU - Kalani, M. Yashar S.; Couldwell, William T. TI - Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain SN - 2193-6331 SN - 2193-634X PY - 2018 JO - J Neurol Surg B Skull Base JF - Journal of Neurological Surgery Part B: Skull Base LA - EN VL - 79 IS - S 05 SP - S415 EP - S417 ET - 2018/09/25 DA - 2018/11/16 KW - extreme lateral supracerebellar infratentorial KW - mesencephalon KW - brainstem KW - surgery KW - cavernous malformation AB - This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg. PB - Georg Thieme Verlag KG DO - 10.1055/s-0038-1669981 UR - http://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0038-1669981 ER -