Acta Neurochirurgica

, Volume 159, Issue 9, pp 1613–1617 | Cite as

The midline suboccipital subtonsillar approach to the cerebellomedullary cistern: how I do it

  • Stephan HerlanEmail author
  • Florian Roser
  • Florian H. Ebner
  • Marcos Tatagiba
How I Do it -Neurosurgical Anatomy



Lesions lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and include different pathologies. There is no consensus on an ideal surgical approach.


To gain access to this area, we use the midline suboccipital subtonsillar approach (STA). This midline approach with unilateral retraction of the cerebellar tonsil enables entry into the cerebellomedullary cistern.


The STA offers excellent access with a panoramic view of the cerebellomedullary cistern and its structures and therefore can be useful for a number of different pathologies in the lower petroclival area.


Cerebellomedullary cistern Suboccipital subtonsillar approach Lower cranial nerves 


Supplementary material


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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryEberhard Karls University TübingenTübingenGermany
  2. 2.Institute of Clinical Anatomy and Cell AnalysisEberhard Karls University TübingenTübingenGermany
  3. 3.Neurological InstituteCleveland ClinicAbu DhabiUnited Arab Emirates

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