{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:39:38Z","timestamp":1762504778640,"version":"build-2065373602"},"reference-count":5,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n The purpose of this video is to describe the microsurgical corridor of the trans-tonsillar approach for resection of a tumor located in the right lateral aspect of the medulla.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n We presented a 56-year-old patient with headache and diplopia. On the preoperative magnetic resonance imaging (MRI), we found a localized tumor with surrounding edema in the anterior portion of the right cerebellomedullary fissure, and on the positron emission tomography-computed tomography, a hypermetabolic lesion in the right lung. We decided to excise the intracranial lesion given the risk of a postradiotherapy edema. We performed a suboccipital approach extended to the right side. At the intradural stage, the lesion was not reachable through a sub-tonsillar access because it was located in front of the right tonsil. For this reason, the surgical team decided to modify the initial plan, opting for a trans-tonsillar corridor instead. Pathological anatomy reveals metastasis of a lung adenocarcinoma. The patient evolved favorably, without neurologic deficit, and the postoperative MRI showed adequate resection and disappearance of the edema. The patient gave his written consent for the use of photographs, images, and surgical video in this work.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n In the neurosurgical literature, there are descriptions of the suboccipital subtonsillar approach, including cadaveric studies, technical notes, and reports of its application in various pathologies. However, the use of the trans-tonsillar pathway is not described in the neurosurgical bibliography. This fact attracts attention, since resection or coagulation of only cerebellar tonsils does not generate a clinically significant neurological deficit. This suggests that the trans-tonsillar pathway, if necessary, is a valid option. The current work constitutes the first report of the usage of a suboccipital trans-tonsillar approach.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_567_2025","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:23:56Z","timestamp":1762503836000},"page":"468","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trans-tonsillar approach for resection of a tumor located in the lateral aspect of the medulla: Operative video"],"prefix":"10.25259","volume":"16","author":[{"given":"Alvaro","family":"Campero","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Padilla de Tucuman, San Miguel de Tucuman, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan F.","family":"Villalonga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Padilla de Tucuman, San Miguel de Tucuman, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgar G.","family":"Ordonez-Rubiano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de San Jos\u00e9, Fundaci\u00f3n Universitaria de Ciencias de la Salud, Fundaci\u00f3n Santa Fe de Bogot\u00e1, Bogota, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Castillo-Rangel","sequence":"additional","affiliation":[{"name":"Neurosurgery Department of the 1ro de Octubre Hospital ISSTE, M\u00e9xico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matias","family":"Baldoncini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, San Fernando Hospital, San Fernando, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"10.25259\/SNI_567_2025\/ref-1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.wneu.2018.06.019","article-title":"Modified \u201cextended\u201d suboccipital subtonsillar clipping of a ruptured proximal pica aneurysm: Technical note with relevant anatomical demonstration","volume":"117","author":"Di Somma","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_567_2025\/ref-2","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1007\/s00701-017-3270-5","article-title":"The midline suboccipital subtonsillar approach to the cerebellomedullary cistern: How I do it","volume":"159","author":"Herlan","year":"2017","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_567_2025\/ref-3","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1227\/01.NEU.0000053146.83780.74","article-title":"Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study","volume":"52","author":"Jean","year":"2003","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_567_2025\/ref-4","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3389\/fsurg.2015.00072","article-title":"Surgical application of the suboccipital subtonsillar approach to reach the Inferior half of medulla oblongata tumors in adult patients","volume":"2","author":"Rabad\u00e1n","year":"2016","journal-title":"Front Surg"},{"key":"10.25259\/SNI_567_2025\/ref-5","first-page":"318","article-title":"Glossopharyngeal neuralgia treated with an endoscopic assisted midline suboccipital subtonsillar approach: Technical note","volume":"74","author":"Roser","year":"2013","journal-title":"J Neurol Surg Part A Cent Eur Neurosurg"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/trans-tonsillar-approach-for-resection-of-a-tumor-located-in-the-lateral-aspect-of-the-medulla-operative-video\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/trans-tonsillar-approach-for-resection-of-a-tumor-located-in-the-lateral-aspect-of-the-medulla-operative-video\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:23:57Z","timestamp":1762503837000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/trans-tonsillar-approach-for-resection-of-a-tumor-located-in-the-lateral-aspect-of-the-medulla-operative-video\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":5,"alternative-id":["10.25259\/SNI_567_2025"],"URL":"https:\/\/doi.org\/10.25259\/sni_567_2025","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11,7]]},"article-number":"468"}}