Resection of the quadrangular lobule of the cerebellum to increase exposure of the cerebellomesencephalic fissure: an anatomical study with clinical correlation

Authors

Juan Leonardo Serrato-Avila, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
Juan Alberto Paz Archila, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
Alejandro Monroy-Sosa, Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México.
Sebastian Aníbal Alejandro, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
Marcos Devanir Costa, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
Sergio Cavalheiro, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.
Kaan Yagmurlu, Departments of5Neurosurgery and.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and.
Feres Chaddad-Neto, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil.

Document Type

Article

Abstract

OBJECTIVE: The lateral aspect of the cerebellomesencephalic fissure frequently harbors vascular pathology and is a common surgical corridor used to access the pons tegmentum, as well as the cerebellum and its superior and middle peduncles. The quadrangular lobule of the cerebellum (QLC) represents an obstacle to reach these structures. The authors sought to analyze and compare exposure of the cerebellar interpeduncular region (CIPR) before and after QLC resection and provide a case series to evaluate its clinical applicability. METHODS: Forty-two sides of human brainstems were prepared with Klingler's method and dissected. The exposure area before and after resection of the QLC was measured and statistically studied. A case series of 59 patients who underwent QLC resection for the treatment of CIPR lesions was presented and clinical outcomes were evaluated at 1-year follow-up. RESULTS: The anteroposterior surgical corridor of the CIPR increased by 10.3 mm after resection of the QLC. The mean exposure areas were 42 mm2 before resection of the QLC and 159.6 mm2 after resection. In this series, ataxia, extrapyramidal syndrome, and akinetic mutism were found after surgery. However, all these cases resolved within 1 year of follow-up. Modified Rankin Scale score improved by 1 grade, on average. CONCLUSIONS: QLC resection significantly increased the exposure area, mainly in the anteroposterior axis. This surgical strategy appears to be safe and may help the neurosurgeon when operating on the lateral aspect of the cerebellomesencephalic fissure.

Medical Subject Headings

Humans; Cerebellum (surgery); Neurosurgical Procedures (methods); Brain Stem (surgery); Microsurgery (methods); Craniotomy (methods)

Publication Date

4-1-2024

Publication Title

Journal of neurosurgery

E-ISSN

1933-0693

Volume

140

Issue

4

First Page

1160

Last Page

1168

PubMed ID

38564813

Digital Object Identifier (DOI)

10.3171/2023.7.JNS222838

Recommended Citation

Serrato-Avila, Juan Leonardo; Paz Archila, Juan Alberto; Monroy-Sosa, Alejandro; Alejandro, Sebastian Aníbal; Costa, Marcos Devanir; Cavalheiro, Sergio; Yagmurlu, Kaan; Lawton, Michael T.; and Chaddad-Neto, Feres, "Resection of the quadrangular lobule of the cerebellum to increase exposure of the cerebellomesencephalic fissure: an anatomical study with clinical correlation" (2024). Neurosurgery. 2022.
https://scholar.barrowneuro.org/neurosurgery/2022