• Shiro Horisawa, Hiroshi Nakano, Takakzu Kawamata, and Takaomi Taira.
• Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
• World Neurosurg. 2017 Nov 1; 107: 1-5.

BackgroundStereotactic transcerebellar biopsies of brainstem tumors have often been reported. The Leksell frame or Cosman-Roberts-Wells frame is often used in transcerebellar approaches. However, to access lesions via the cerebellum, these frames should be secured as inferiorly on the cranium as possible, which can require exaggerated neck flexion and limit the flexible trajectory to the target. To overcome these disadvantages, we have devised a new way to use the Leksell frame for transcerebellar approaches.MethodsThe frame was fixed to the upper part of the head and arc support by attaching the frame upside down, which gives surgeons a wide operative field and permits flexible trajectory planning.ResultsUnder local anesthesia, the surgery was performed in a sitting position. Air was observed in the target site on postoperative computed tomography and magnetic resonance imaging, which confirmed that a specimen had been successfully sampled from the site as planned.ConclusionsOur devised transcerebellar approach provided a generous operative field and a flexible trajectory, which enabled minimally invasive biopsy of a posterior fossa lesions to be performed in a short amount of time with the patient under local anesthesia.Copyright © 2017 Elsevier Inc. All rights reserved.

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