• Juan Leonardo Serrato-Avila, Juan Alberto Paz Archila, Alejandro Monroy-Sosa, Sebastian Aníbal Alejandro, CostaMarcos Devanir Silva daMDSD1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil., Sergio Cavalheiro, Kaan Yagmurlu, Michael T Lawton, and Feres Chaddad-Neto.
• 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
• J. Neurosurg. 2024 Apr 1; 140 (4): 116011681160-1168.

ObjectiveThe lateral aspect of the cerebellomesencephalic fissure frequently harbors vascular pathology and is a common surgical corridor used to access the pons tegmentum, as well as the cerebellum and its superior and middle peduncles. The quadrangular lobule of the cerebellum (QLC) represents an obstacle to reach these structures. The authors sought to analyze and compare exposure of the cerebellar interpeduncular region (CIPR) before and after QLC resection and provide a case series to evaluate its clinical applicability.MethodsForty-two sides of human brainstems were prepared with Klingler's method and dissected. The exposure area before and after resection of the QLC was measured and statistically studied. A case series of 59 patients who underwent QLC resection for the treatment of CIPR lesions was presented and clinical outcomes were evaluated at 1-year follow-up.ResultsThe anteroposterior surgical corridor of the CIPR increased by 10.3 mm after resection of the QLC. The mean exposure areas were 42 mm2 before resection of the QLC and 159.6 mm2 after resection. In this series, ataxia, extrapyramidal syndrome, and akinetic mutism were found after surgery. However, all these cases resolved within 1 year of follow-up. Modified Rankin Scale score improved by 1 grade, on average.ConclusionsQLC resection significantly increased the exposure area, mainly in the anteroposterior axis. This surgical strategy appears to be safe and may help the neurosurgeon when operating on the lateral aspect of the cerebellomesencephalic fissure.

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