A young and booming approach: the extreme lateral supracerebellar infratentorial approach

Abstract

Surgical accesses to lesions of the posterolateral pontomesencephalic junction (PMJ) region and the posterolateral tentorial gap remain a challenge in the field of neurosurgery. Since the first report of application of the extreme lateral supracerebellar infratentorial (ELSI) approach in resecting the PMJ lesions in 2000, a few articles concerning the ELSI approach have been published. The present review mainly provided an intimate introduction of the ELSI approach, and evaluated it in facets of patient position, skin incision, craniectomy, draining veins, retraction against the cerebellum, exposure limits, patient healing, as well as advantages and limitations compared with other approaches. The ELSI approach is proposed to be a very young and promising approach to access the lesions of posterolateral PMJ region and the posterolateral tentorial gap. Besides, it has several advantages such as having a shorter surgical pathway, causing less surgical complications, laborsaving, etc. Still, more studies are needed to improve this approach.

摘要

神经外科手术中, 后外侧小脑幕切记间隙以及后外侧脑桥中脑结合部是很难到达的区域, 切除这些部位的病变在神经外科领域一直是个很大的挑战。 自从2000年极外侧幕下小脑上入路被首次报道可用于切除后外侧脑桥中脑结合部位的病变以来, 这一新入路为解决神经外科手术难题提供了新的方案。 本文主要从手术体位、 皮肤切口、 骨瓣形成、 入路相关引流静脉的处理、 小脑牵引、 暴露范围及内容、 病人手术效果等方面对该入路进行了全面的综述。 极外侧幕下小脑上入路是在后外侧小脑幕切迹间隙和后外侧脑桥中脑结合部等部位切除病变的可选入路, 相较于其他入路有手术路径短、 手术并发症少、 省力等诸多优点, 值得在临床工作中推广。