• Akin Akakin, Maria Peris-Celda, Turker Kilic, Askin Seker, Antonio Gutierrez-Martin, and Albert Rhoton.
• *University of Florida, College of Medicine, Department of Neurosurgery, Neuroanatomy Laboratory, Gainesville, Florida; ‡La Fe University Hospital, Department of Neurosurgery, Valencia, Spain; §Bahcesehir University, College of Medicine, Department of Neurosurgery, Istanbul, Turkey.
• Neurosurgery. 2014 Apr 1;74(4):401-24; discussion 424-5.

BackgroundNeurosurgical management of cerebellar lesions remains challenging. Thus, it is important to have sound knowledge of the microsurgical anatomy of the cerebellum and dentate nucleus (DN) and to define different types of exposure in a variety of surgical interventions.ObjectiveTo examine the anatomy of the DN from a neurosurgical viewpoint using fiber tracking techniques.MethodsTen formalin-fixed human hemispheres were dissected with the Ludwig and Klingler fiber dissection technique under × 6 to × 40 magnification. Anatomic images were created with 3-dimensional diffusion tensor imaging. The relationships of the DN to tentorium and suboccipital and lateral surfaces of the cerebellum and its spatial positioning relative to different surgical approaches in the cerebellum and fourth ventricle were examined. The fiber tracts terminating at and surrounding the DN were defined.ResultsThe DN is at greater risk of being injured in the transvermian and supratonsillar approaches to the cerebellum and fourth ventricle, with lesser risk in the telovelar and subtonsillar approaches. Superior approaches are safer compared with other approaches.ConclusionThe DN represents an important anatomic structure in surgical interventions involving the posterior fossa, particularly in the elderly because of the common occurrence of atrophy-related problems in this age group. Functionally and anatomically, the DN is closely related to the superior and middle cerebellar peduncles. The inferior cerebellar peduncle poses positional risks because it follows an anterior and superior course relative to the DN. The telovelar approach is a safer procedure for interventions involving the pathological lesions of the fourth ventricle floor.

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