• Lorenzo Giammattei, Daniele Starnoni, Vladimir Benes, Sebastien Froelich, Giulia Cossu, Francois Borsotti, Martin Májovsky, Albert A Sufianov, Arianna Fava, Paolo di Russo, Samer K Elbabaa, Pablo González-López, Mahmoud Messerer, and Roy T Daniel.
• Department of Neurosurgery, Lariboisière Hospital, Paris, France.
• World Neurosurg. 2021 Mar 1; 147: 89-104.

ObjectiveThe extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches.MethodsThe surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented.ResultsThe ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches.ConclusionsThe ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.

35 keywords...

hide…