Skip to main content

Median Suboccipital Approach

  • Chapter
Posterior Fossa Tumors in Children

Abstract

The median suboccipital approach is the most commonly used approach to the posterior fossa in pediatric neurosurgery. In contrast to the retrosigmoid and far lateral approaches, it provides access to midline tumors in the cerebellum, particularly those arising from the fourth ventricle and the cerebellar vermis. Hemispheric cerebellar tumors may also be removed through this route, with a slight modification of the approach towards the side of the lesion. The most common pediatric posterior fossa tumors specifically pilocytic astrocytomas, medulloblastomas, or ependymomas can be removed with this approach. It provides access to the pineal region and permits the removal of those brain stem tumors with an exophytic component in the fourth ventricle.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 269.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 349.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 349.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Starr A (1893) Brain surgery. William Wood & Company, New York

    Google Scholar 

  2. Starr MA (1903) Organic nervous disease. Lea Brothers & Co, New York

    Google Scholar 

  3. Diller T (1909) The writings of Benjamin Franklin pertaining to medicine and the medical profession. Aesculapian 1(2):65–84

    PubMed Central  CAS  PubMed  Google Scholar 

  4. Yasargil (1996) Surgical approaches. In: Yasargil (ed) Microneurosurgery of CNS tumours. Thieme, Stuttgart, New York

    Google Scholar 

  5. Rhoton AL Jr (2000) Cerebellum and fourth ventricle. Neurosurgery 47(3 Suppl):S7–S27

    Article  PubMed  Google Scholar 

  6. Rhoton AL Jr (2000) The foramen magnum. Neurosurgery 47(3 Suppl):S155–S193

    Article  PubMed  Google Scholar 

  7. Rhoton AL Jr (2000) The posterior fossa veins. Neurosurgery 47(3 Suppl):S69–S92

    Article  PubMed  Google Scholar 

  8. Mussi AC, Rhoton AL Jr (2000) Telovelar approach to the fourth ventricle: microsurgical anatomy. J Neurosurg 92(5):812–823

    Article  CAS  PubMed  Google Scholar 

  9. Rhoton AL Jr (2000) The cerebellar arteries. Neurosurgery 47(3 Suppl):S29–S68

    Article  PubMed  Google Scholar 

  10. Hermann EJ, Rittierodt M, Krauss JK (2008) Combined transventricular and supracerebellar infratentorial approach preserving the vermis in giant pediatric posterior fossa midline tumors. Neurosurgery 63(1 Suppl 1):ONS30–ONS35; discussion ONS35–ONS37

    PubMed  Google Scholar 

  11. Epstein FJ, Goh KC (2000) Ependymomas of the posterior fossa. In: Kaye AH, Black P (eds) Operative neurosurgery. Churchill Livingstone, London, pp 429–436

    Google Scholar 

  12. Kotil K et al (2008) Cerebellar mutism following posterior fossa tumor resection in children. Turk Neurosurg 18(1):89–94

    PubMed  Google Scholar 

  13. Dailey AT, McKhann GM 2nd, Berger MS (1995) The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children. J Neurosurg 83(3):467–475

    Article  CAS  PubMed  Google Scholar 

  14. Kellogg JX, Piatt JH Jr (1997) Resection of fourth ventricle tumors without splitting the vermis: the cerebellomedullary fissure approach. Pediatr Neurosurg 27(1):28–33

    Article  CAS  PubMed  Google Scholar 

  15. El-Bahy K (2005) Telovelar approach to the fourth ventricle: operative findings and results in 16 cases. Acta Neurochir 147(2):137–142; discussion 142

    Article  CAS  PubMed  Google Scholar 

  16. Deshmukh VR et al (2006) Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle. Neurosurgery 58(4 Suppl 2):ONS-202–ONS-206; discussion ONS-206–ONS-207

    Article  Google Scholar 

  17. Tanriover N et al (2004) Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg 101(3):484–498

    Article  PubMed  Google Scholar 

  18. Shimoji K et al (2009) Surgical considerations in fourth ventricular ependymoma with the transcerebellomedullary fissure approach in focus. Child Nerv Syst 25(10):1221–1228

    Article  Google Scholar 

  19. Rajesh BJ et al (2007) Telovelar approach: technical issues for large fourth ventricle tumors. Child Nerv Syst 23(5):555–558

    Article  CAS  Google Scholar 

  20. Greenberg ML, Hargrave D, Bond J (2004) Information needs for children and families. In: Walker DA (ed) Brain and spinal tumors of childhood. Arnold, London

    Google Scholar 

  21. Di Rocco C (1999) Cerebellar astrocytomas. In: Choux M (ed) Pediatric neurosurgery. Churchill Livingstone, London

    Google Scholar 

  22. Alexander JW et al (1983) The influence of hair-removal methods on wound infections. Arch Surg 118(3):347–352

    Article  CAS  PubMed  Google Scholar 

  23. Kurpad SN, Cohen AR (1999) Posterior fossa craniotomy: an alternative to craniectomy. Pediatr Neurosurg 31(1):54–57

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wirginia June Maixner M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Jenny, B., Maixner, W.J. (2015). Median Suboccipital Approach. In: Özek, M., Cinalli, G., Maixner, W., Sainte-Rose, C. (eds) Posterior Fossa Tumors in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-11274-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-11274-9_8

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-11273-2

  • Online ISBN: 978-3-319-11274-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics