Caleb Rutledge1, Daniel A Tonetti1, Kunal P Raygor1, Adib A Abla2. 1. University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. 2. University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. adib.abla@ucsf.edu.
Abstract
BACKGROUND: The horizontal fissure approach is a workhorse for brainstem lesions in the central and dorsolateral pons and middle cerebellar peduncle (MCP). The cerebellopontine fissure is a V-shaped fissure with a superior and inferior limb between the cerebellum, pons, and MCP. The horizontal or petrosal fissure is at the apex of the cerebellopontine fissure and extends laterally to divide the petrosal surface of the cerebellum into superior and inferior parts. Splitting this fissure exposes the posterolateral aspect of the MCP without excessive retraction or transgression of the cerebellum. METHOD: We demonstrate and describe the horizontal fissure operative approach to the middle cerebellar peduncle for resection of a pontine cavernoma with illustrative figures and operative video. CONCLUSION: Splitting the horizontal (petrosal) fissure of the cerebellum brings the middle cerebellar peduncle into view behind the root entry zone of the trigeminal nerve, providing an expanded, safe corridor to the central and dorsolateral pons.
BACKGROUND: The horizontal fissure approach is a workhorse for brainstem lesions in the central and dorsolateral pons and middle cerebellar peduncle (MCP). The cerebellopontine fissure is a V-shaped fissure with a superior and inferior limb between the cerebellum, pons, and MCP. The horizontal or petrosal fissure is at the apex of the cerebellopontine fissure and extends laterally to divide the petrosal surface of the cerebellum into superior and inferior parts. Splitting this fissure exposes the posterolateral aspect of the MCP without excessive retraction or transgression of the cerebellum. METHOD: We demonstrate and describe the horizontal fissure operative approach to the middle cerebellar peduncle for resection of a pontine cavernoma with illustrative figures and operative video. CONCLUSION: Splitting the horizontal (petrosal) fissure of the cerebellum brings the middle cerebellar peduncle into view behind the root entry zone of the trigeminal nerve, providing an expanded, safe corridor to the central and dorsolateral pons.
Authors: Margaret A Horne; Kelly D Flemming; I-Chang Su; Christian Stapf; Jin Pyeong Jeon; Da Li; Susanne S Maxwell; Philip White; Teresa J Christianson; Ronit Agid; Won-Sang Cho; Chang Wan Oh; Zhen Wu; Jun-Ting Zhang; Jeong Eun Kim; Karel Ter Brugge; Robert Willinsky; Robert D Brown; Gordon D Murray; Rustam Al-Shahi Salman Journal: Lancet Neurol Date: 2015-12-02 Impact factor: 44.182