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Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1277--1278

The Cover Page - Endoscopic-view of Supra-Cerebellar Infratentorial Approach

Sandeep Kandregula, Bharat Guthikonda 
 Department of Neurosurgery, LSU Health Sciences, Shreveport, LA 71103, LA

Correspondence Address:
Dr. Sandeep Kandregula
[email protected]

How to cite this article:
Kandregula S, Guthikonda B. The Cover Page - Endoscopic-view of Supra-Cerebellar Infratentorial Approach.Neurol India 2020;68:1277-1278

How to cite this URL:
Kandregula S, Guthikonda B. The Cover Page - Endoscopic-view of Supra-Cerebellar Infratentorial Approach. Neurol India [serial online] 2020 [cited 2021 Jan 16 ];68:1277-1278
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Full Text

Supra-cerebellar Infratentorial (SCIT) approach (also known as Krause's approach) dates back to 1926 when Krause published a report of three patients with pineal region tumors. Later in 1971, Stein successfully operated on six patients with this approach with minimal morbidity. The introduction of the endoscope in Neurosurgery led to tremendous innovations and modifications to the operative procedures. While the SCIT approach evolved into the midline, paramedian, extreme lateral, and contralateral SCIT approaches, endoscopic assistance led to the visualization of the unseen corners, and integrating two simultaneous visuals information led to gross total resection and reduced recurrences. Along with SCIT, the occipital tentorial approach also gives access to the posterior third ventricular region/cisternal pulvinar surface. A few studies compared the qualitatively between the operative exposures. Ipsilateral paramedian SCIT gives a shorter corridor distance, and contralateral paramedian SCIT gives a better surgical view.[2] Using 00 and 450 endoscopes provides a better view of the pineal gland, internal cerebral vein, and median posterior choroidal arteries.[1] 300 and 700 endoscopes help visualize the tumors/lesions hidden behind the critical and delicate neurovascular structures.[3] The pathology and the surgeon's expertise in using the endoscope assistance led to smaller craniotomies and faster post-operative recovery. One of the potential drawbacks of using endoscope assistance is the damage to the tissues while introducing the instruments and endoscope itself into the operative space. Careful insertion, along with increased expertise, can overcome this particular disadvantage.

In this illustration, we showed endoscopic assisted midline SCIT for excision of the epidermoid. Illustrations depicted the anatomy of the posterior third ventricular and pineal region after the excision of the epidermoid.

Software: Procreate.

Device: Ipad Pro.



1Akiyama O, Matsushima K, Gungor A, Matsuo S, Goodrich DJ, Tubbs RS, et al. Microsurgical and endoscopic approaches to the pulvinar. J Neurosurg 2017:127;630-45. doi: 10.3171/2016.8.JNS16676.
2Cohen-Cohen S, Cohen-Gadol AA, Gomez-Amador JL, Alves-Belo JT, Shah KJ, Fernandez-Miranda JC. Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar: Ipsilateral Versus Contralateral Corridors. Oper Neurosurg (Hagerstown) 2019:16;351-359. doi: 10.1093/ons/opy173.
3Schroeder HW, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg 2004:101;227-32. doi: 10.3171/jns. 2004.101.2.0227.