Median Suboccipital Approach

Abstract

The median suboccipital approach is the most commonly used approach to the posterior fossa in pediatric neurosurgery. In contrast to the retrosigmoid and far lateral approaches, it provides access to midline tumors in the cerebellum, particularly those arising from the fourth ventricle and the cerebellar vermis. Hemispheric cerebellar tumors may also be removed through this route, with a slight modification of the approach towards the side of the lesion. The most common pediatric posterior fossa tumors specifically pilocytic astrocytomas, medulloblastomas, or ependymomas can be removed with this approach. It provides access to the pineal region and permits the removal of those brain stem tumors with an exophytic component in the fourth ventricle.