• Juan Leonardo Serrato-Avila, Juan Alberto Paz Archila, CostaMarcos Devanir Silva daMDSD1Department of Neurology and Neurosurgery.2Laboratory of Microneurosurgery Anatomy, and., Paulo Ricardo Rocha, Sergio Ricardo Marques, Luis Otavio Carvalho de Moraes, Sergio Cavalheiro, Kaan Yağmurlu, Michael T Lawton, and Feres Chaddad-Neto.
• 1Department of Neurology and Neurosurgery.
• J. Neurosurg. 2022 May 1; 136 (5): 141014231410-1423.

ObjectiveThe cerebellar interpeduncular region (CIPR) is a gate for dorsolateral pontine and cerebellar lesions accessed through the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), or the subtemporal transtentorial approach (STa). The authors sought to compare the exposures of the CIPR region that each of these approaches provided.MethodsThree approaches were performed bilaterally in eight silicone-injected cadaveric heads. The working area, area of exposure, depth of the surgical corridor, length of the interpeduncular sulcus (IPS) exposed, and bridging veins were statistically studied and compared based on each approach.ResultsThe OTa provided the largest working area (1421 mm2; p < 0.0001) and the longest surgical corridor (6.75 cm; p = 0.0006). Compared with the SCITa, the STa provided a larger exposure area (249.3 mm2; p = 0.0148) and exposed more of the length of the IPS (1.15 cm; p = 0.0484). The most bridging veins were encountered with the SCITa; however, no significant differences were found between this approach and the other approaches (p > 0.05).ConclusionsTo reach the CIPR, the STa provided a more extensive exposure area and more linear exposure than did the SCITa. The OTa offered a larger working area than the SCIT and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.

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