Cerebellar Tumors

Indications

The suboccipital craniotomy is used for most lesions in the posterior fossa. Its indications are:

• Brain tumors such as meningiomas, ependymomas, gliomas, medulloblastomas, acoustic neuromas and metastatic lesions.

• Vascular lesions such as aneurysms, cavernous malformations, arteriovenous malformations and intraparenchymal hemorrhages.

• Developmental anomalies such as Chiari malformations.

• Posterior fossa infections.

Contraindications

• Cervical spine pathology that would oppose flexion and reduction of the neck.

• The sitting positioning is contraindicated in patients with patent foramen ovale (this position requires a preoperative echocardiogram to rule out patent foramen ovale).

• If lesions extend above the tentorium, special consideration should be given to a combined approach, e.g. a supracerebellar and a supratentorial approach, to have good visualization of the lesion to be resected.

• If the lesion extends from the posterior fossa to the middle fossa, a combined or staged lateral approach may be considered.

Surgical Procedure