The supracerebellar infratentorial approach (SCITA) is a standard approach used in a neurosurgical practice. It carries some risk of associated complications including cerebellar venous infarction with possible serious sequelae. The objective of this study is to address the incidence of cerebellar venous infarction in SCITA. A search through the currently available literature was performed in September 2019 from the year 2000 until September 2019 dealing with 'supracerebellar infratentorial approach'. Out of the 578 patients found in thirteen case series, two venous infarctions were present; the remaining four patients were published as case reports. By analysing the case series, we calculated the risk of such a complication to be 0.345% (95% CI [0.061%, 1.248%]). Case reports were not included. The real risk is estimated to be higher. The risk of cerebellar venous infarction is an unpredictable, infrequent but real complication with potentially dreadful sequelae. Each neurosurgeon using this approach should be aware of this event when employing this approach. The avoidance of cerebellar venous infarction can be lowered by leaving as many bridging veins intact as possible.

Department of Neurosurgery University Hospital Brno Brno Czech Republic

Masaryk University Brno Czech Republic

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Aboul-Enein H, El-Aziz Sabry AA, Hafez Farhoud A (2015) Supracerebellar infratentorial approach with paramedian expansion for posterior third ventricular and pineal region lesions. Clin Neurol Neurosurg 139:100–109. https://doi.org/10.1016/j.clineuro.2015.08.009 PubMed DOI

Ausman J, Malik GM, Dujovny M et al (1988) Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 29(4):298–306 DOI

Bonney PA, Boettcher LB, Cheema AA et al (2015) Operative results of keyhole supracerebellar-infratentorial approach to the pineal region. J Clin Neurosci 22(7):1105–1110. https://doi.org/10.1016/j.jocn.2014.12.029 PubMed DOI

Cavalcanti DD, Morais BA, Figueredo EG et al (2019) Supracerebellar infranetorial variant approaches to the intercolicular safe entry zone. World Neurosurg 122:e1285–e1290 DOI

Hajnsek S, Paladino J, Gadze ZP, Nanković S, Mrak G, Lupret V (2013) Clinical and neurophysiological changes in patients with pineal region expansions. Coll Antropol 37(1):35–40 PubMed

Hernesniemi J, Romani R, Albayrak BS et al (2008) Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 70(6):576–583. https://doi.org/10.1016/j.surneu.2008.07.019 PubMed DOI

Jakola AS, Bartek J, Mathiesen T (2013) Venous complications in supracerebellar infratentorial approach. Acta Neurochir 155:477–478 DOI

Kaku Y, Takei H, Miyai M et al (2016) Surgical approach to ponto-mesencephalic cavernoma. Acta Neurochir Suppl 123:189–195. https://doi.org/10.1007/978-3-319-29887-0_27 PubMed DOI

Kodera T, Bozinov O, Sürücü O, Ulrich NH, Burkhardt JK, Bertalanffy H (2011) Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach. J Clin Neurosci 18(11):1481–1485. https://doi.org/10.1016/j.jocn.2011.02.035 PubMed DOI

Kumar A, Bhattacharjee SBP et al (2012) Brain death after Concorde positioning for supracerebellar-infratentorial approach: unanswered questions and lessons learned. Surg Neurol Int 3:37 DOI

Krogager ME, Jakola AS, Poulsgaard L et al (2019, 2019) Safe handling of veins in the pineal region-a mixed method study. Neurosurg Rev. https://doi.org/10.1007/s10143-019-01189-y

Májovský M, Netuka D, Beneš V (2018) Is surgery for pineal cysts safe and effective? Short review. Neurosurg Rev 41(1):119–124. https://doi.org/10.1007/s10143-017-0876-2 PubMed DOI

Mascitelli J, Burkhardt JK, Gandhi S, Lawton MT (2018) Contralateral supracerebellar-infratentorial approach for resection of thalamic cavernous malformations. Oper Neurosurg (Hagerstown) 15(4):404–411. https://doi.org/10.1093/ons/opy004 DOI

Mottolese C, Szathmari A, Ricci-Franchi AC et al (2015) Supracerebellar infratentorial approach for pineal region tumors: our surgical and technical considerations. Neurochirurgie 61(2–3):176–183. https://doi.org/10.1016/j.neuchi.2014.02.004 PubMed DOI

Nair P, Sahu RN, Kumar R, Behari S, Nair AP, Srivastava AK (2012) Large epidermoids of the quadrigeminal cistern: an experience of 15 consecutive cases and review of literature. Acta Neurochir 154(8):1391–1398. https://doi.org/10.1007/s00701-012-1415-0 PubMed DOI

Oliveira J, Cerejo A, Silva PS (2013) The infratentorial supracerebellar approach in surgery of lesions of the pineal region. Surg Neurol Int 30(4):154. https://doi.org/10.4103/2152-7806.122504 eCollection 2013 DOI

Oliveira JG, Lekovic GP, Safavi-Abbasi S et al (2010) Supracerebellar infratentorial approach to cavernous malformations of the brainstem: surgical variants and clinical experience with 45 patients. Neurosurgery 66(2):389–399 DOI

Page LK (1977) The infratentorial-supracerebellar exposure of tumors in the pineal area. Neurosurgery 1(1):36–40 DOI

Piatt JH, Kellogg JX (2000) A hazard of combining the infratentorial supracerebellar and the cerebellomedullary fissure approaches: cerebellar venous insufficiency. Pediatr Neurosurg 33(5):243–248 DOI

Ueyama T, Al-Mefty O, Tamaki N (1988) Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations. Neurosurgery 43:1137–1145 DOI

Wackenheim A, Braun JP (1978) The veins of the posterior fossa: normal and pathologic findings. Springer-Verlag, Berlin DOI