title: Trans-cerebellomedullary fissure approach with special reference to lateral route.
abstract: The trans-cerebellomedullary fissure (CMF) approach provides good exposure of the fourth ventricle without splitting the inferior vermis. The popularly utilized trans-CMF approach is performed in the midline suboccipital approach. However, the trans-CMF approach actually has two routes: medial and lateral. The lateral route is the trans-CMF approach through a lateral foramen magnum approach such as the transcondylar approach, opening the CMF from the lower unilateral side. We studied the surgical anatomy of the CMF and fourth ventricle. Based on the anatomic findings, we adopted the lateral route of the trans-CMF approach for four patients, each with a tumor near the jugular tubercle extending into the fourth ventricle through the CMF. Our study demonstrated that the lateral route of the trans-CMF approach enables sufficient exposure of not only unilateral cerebellopontine cistern but also of the lateral part of the fourth ventricle. A tumor is safely removed by this approach with easy feeder or tumor bed controls, especially if it is anchored at the lateral part of the CMF as is the jugular tubercle meningioma.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan. MasatouAzu@aol.com
authors.forename: Masatou
authors.initials: M
authors.lastname: Kawashima
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsushima
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakahara
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Takase
authors.forename: Jun
authors.initials: J
authors.lastname: Masuoka
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohata
mesh_terms: D000328:Adult; D020295:Brain Stem Neoplasms / Q000473:pathology / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000473:pathology / Q000601:surgery; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D002531:Cerebellum / Q000033:anatomy & histology / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D003390:Cranial Nerve Neoplasms / Q000473:pathology / Q000601:surgery; D004806:Ependymoma / Q000473:pathology / Q000601:surgery; D005260:Female; D020546:Fourth Ventricle / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000033:anatomy & histology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*