Anatomy and Surgical Aspects of Supracerebellar Infratentorial Approach

The pineal region and cerebellopontine angle, petrous apex, and petroclival regions are deep-seated areas surrounded by highly eloquent structures. Surgery of these regions ‘lesions is considered a challenging task, due to the close relationship of lesions in this location with neural and vascular structures. The medial supracerebellar infratentorial (SCIT) approach provides a direct corridor to different pineal region lesions inferior to the great vein of Galen, particularly pineal gland tumors, metastases, germ cell tumors, meningiomas, gliomas, ependymomas, hemangioblastomas, and neuroectodermal tumors. The lateral approach allows a direct approach to upper cerebellopontine angle, petrous apex, and petroclival area, with meningiomas being the most frequent target. In both corridors, the tentorial section allows for widening the approach and allowing for resection of tumors in the posterior thalamus, medial temporal area, and suboccipital region. The technique of SCIT is described in detail, introducing its variability of targets, its pros and cons, associated anatomical understanding, and possible SCIT alternatives.