Extreme lateral supracerebellar infratentorial approach: how I do it

  • L. GiammatteiEmail author
  • F. Borsotti
  • R. T. Daniel
How I Do it - Tumor - Meningioma
Part of the following topical collections:
  1. Tumor – Meningioma



The extreme lateral supracerebellar infratentorial (ELSI) approach was initially proposed to treat lesions of the posterolateral surface of the pons principally cavernomas. The versatility of the approach allowed its use for other pathologies like gliomas, aneurysms, epidermoids, and meningiomas.


We describe here the ELSI approach along with its advantages and limits in comparison with other surgical approaches for the treatment of meningiomas of the petroclival region.


ELSI is a versatile approach that allows access to the anterolateral brainstem surface including extensions to the midbrain diencephalic junction when needed. ELSI compares favorably to other surgical alternatives with respect to the approach-related morbidity, while allowing adequate access to treat the pathology.


Supracerebellar infratentorial approach Petroclival meningiomas Tentorial meningiomas tentorial incisura 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Patient consent

The patient/next of kin/guardian has consented to the submission of this “How I Do It” to the journal.

Supplementary material

Video S1

A short video showing the resection of a petroclival meningioma through an extreme lateral supracerebellar infratentorial approach is added. (MP4 417,221 kb)


  1. 1.
    Ammirati M, Bernardo A, Musumeci A, Bricolo A (2002) Comparison of different infratentorial-supracerebellar approaches to the posterior and middle incisural space: a cadaveric study. J Neurosurg 97:922–928CrossRefGoogle Scholar
  2. 2.
    Chen X, Feng YG, Tang WZ, Li HT, Li ZJ (2010) A young and booming approach: the extreme lateral supracerebellar infratentorial approach. Neurosci Bull 26:479–485CrossRefGoogle Scholar
  3. 3.
    de Oliveira JG, Lekovic GP, Safavi-Abbasi S, Reis CV, Hanel RA, Porter RW, Preul MC, Spetzler RF (2010) Supracerebellar infratentorial approach to cavernous malformations of the brainstem: surgical variants and clinical experience with 45 patients. Neurosurgery 66:389–399CrossRefGoogle Scholar
  4. 4.
    Goel A, Muzumdar D (2004) Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases. Surg Neurol 62:332–338CrossRefGoogle Scholar
  5. 5.
    Rhoton AL Jr (2000) Tentorial incisura. Neurosurgery 47:131–153CrossRefGoogle Scholar
  6. 6.
    Shukla D, Behari S, Jaiswal AK, Banerji D, Tyagi I, Jain VK (2009) Tentorial meningiomas: operative nuances and perioperative management dilemmas. Acta Neurochir 151:1037–1035CrossRefGoogle Scholar
  7. 7.
    Spektor S, Fraifeld S, Margolin E, Saseedharan S, Eimerl D, Umansky F (2015) Comparison of outcomes following complex posterior fossa surgery performed in the sitting versus lateral position. J Clin Neurosci 22:705–712CrossRefGoogle Scholar
  8. 8.
    Talacchi A, Biroli A, Medaglia S, Locatelli F, Meglio M (2018) Surgical management of anterolateral and posteromedial incisural tentorial meningioma. Oper Neurosurg (Hagerstown) 15:120–130CrossRefGoogle Scholar
  9. 9.
    Vishteh AG, David CA, Marciano FF, Coscarella E, Spetzler RF (2000) Extreme lateral supracerebellar infratentorial approach to the posterolateral mesencephalon: technique and clinical experience. Neurosurgery 46:384–388CrossRefGoogle Scholar
  10. 10.
    Vougioukas VI, Omran H, Gläsker S, Van Velthoven V (2005) Far lateral supracerebellar infratentorial approach for the treatment of upper brainstem gliomas: clinical experience with pediatric patients. Childs Nerv Syst 21:1037–1041CrossRefGoogle Scholar
  11. 11.
    Wayhs SY, Lepski GA, Frighetto L, Isolan GR (2017) Petroclival meningiomas: remaining controversies in light of minimally invasive approaches. Clin Neurol Neurosurg 152:68–75CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital of LausanneLausanneSwitzerland

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