Surgical Advantages of the Trans-cerebellomedullary Fissure Approach

Abstract

  The cerebellomedullary fissure (CMF) is the deepest and widest fissure among the cerebellobrainstem fissures. The CMF is a cleavage plane between the cerebellar hemisphere and medulla oblongata and is usually closed by arachnoidal adhesion. The trans-CMF approach provides a wide and safe operative field without a neural tissue incision. The trans-CMF approach is also useful for posterior inferior cerebellar artery (PICA) lesions, in addifion to fourth ventricle or brain stem lesions. In the case of a vermian tumor, the feeding arteries of the tumor arising from PICA can be easily identified after opening the CMF. When the tonsillo-medullary segment course has a high position relative to the CMF or the proximal portion of the telovelo-tonsillar segment of the PICA was used as the recipient artery, the trans-CMF fissure approach provides a sufficient and safe operative field for bypass surgery.