{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T05:59:12Z","timestamp":1763445552351,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Lausanne"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>(1) Background: Superior cerebellar peduncle (SCP) lesions are sparsely reported in the literature. The surgical approaches to the cerebello-mesencephalic region remain challenging. In this article, we present the extreme lateral supracerebellar infratentorial (ELSI) approach to treat a large hemorrhagic pilocytic astrocytoma of the SCP. (2) Methods: An 11-year-old boy, known for neurofibromatosis Type I, presented to the emergency department of our institution with symptoms and signs of intracranial hypertension. The cerebral magnetic resonance imaging (MRI) revealed a large hemorrhagic lesion centered on the SCP provoking obstructive hydrocephalus. Following an emergency endoscopic third ventriculocisternostomy (ETV), he underwent a tumor resection via an endoscope-assisted ELSI approach. (3) Results: ELSI approach allows for a wide exposure with direct access to lesions of the SCP. The post-operative course was uneventful, and the patient was discharged home on post-operative day 5. Post-operative MRI revealed a near total resection with a small residual tumor within the mesencephalon. (4) Conclusion: ELSI approach offers an excellent exposure with the surgical angles necessary for median and paramedian lesions. The park-bench position with appropriate head flexion and rotation offers a gravity-assisted relaxation of the tentorial and petrosal cerebellar surfaces. The endoscope can be an adjunct to illuminate the blind areas of the surgical corridor for an improved tumor resection without significant cerebellar retraction.<\/jats:p>","DOI":"10.3390\/children9050640","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T16:49:57Z","timestamp":1651250997000},"page":"640","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Endoscope-Assisted Extreme Lateral Supracerebellar Infratentorial Approach for Resection of Superior Cerebellar Peduncle Pilocytic Astrocytoma: Technical Note"],"prefix":"10.3390","volume":"9","author":[{"given":"Kyriakos","family":"Papadimitriou","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Cossu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9128-0364","authenticated-orcid":false,"given":"Ekkehard","family":"Hewer","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0169-3884","authenticated-orcid":false,"given":"Manuel","family":"Diezi","sequence":"additional","affiliation":[{"name":"Hemato-Oncology Unit, Department of Pediatric, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy Thomas","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Messerer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.3171\/2015.9.PEDS15449","article-title":"Low rates of recurrence and slow progression of pediatric pilocytic astrocytoma after gross-total resection: Justification for reducing surveillance imaging","volume":"17","author":"Dodgshun","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"unstructured":"Knight, J., and De Jesus, O. (2022, March 27). Pilocytic Astrocytoma, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560614\/.","key":"ref_2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.14791\/btrt.2019.7.e36","article-title":"Survival and Prognosis of Patients with Pilocytic Astrocytoma: A Single-Center Study","volume":"7","author":"Park","year":"2019","journal-title":"Brain Tumor Res. Treat."},{"key":"ref_4","first-page":"365","article-title":"Brain tumors with hemorrhage","volume":"98","author":"Lieu","year":"1999","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3171\/JNS\/2008\/108\/2\/0223","article-title":"Rate of spontaneous hemorrhage in histologically proven cases of pilocytic astrocytoma","volume":"108","author":"White","year":"2008","journal-title":"J. Neurosurg."},{"key":"ref_6","first-page":"59","article-title":"Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case","volume":"19","author":"Voigt","year":"1976","journal-title":"Neurochirurgia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/00006123-200002000-00022","article-title":"Extreme lateral supracerebellar infratentorial approach to the posterolateral mesencephalon: Technique and clinical experience","volume":"46","author":"Vishteh","year":"2000","journal-title":"Neurosurgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.wneu.2020.12.042","article-title":"Extreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature","volume":"147","author":"Giammattei","year":"2021","journal-title":"World Neurosurg."},{"doi-asserted-by":"crossref","unstructured":"Papadimitriou, K., Belouaer, A., Starnoni, D., and Daniel, R.T. (2021). Extreme lateral supracerebellar infratentorial approach for tentorial arteriovenous fistula associated with a giant venous ectasia: How I do it. Acta Neurochir.","key":"ref_9","DOI":"10.1007\/s00701-021-04945-6"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E334","DOI":"10.1093\/ons\/opaa472","article-title":"Technical Note: Extreme Lateral Supracerebellar Approach for Resection of Superior Cerebellar Peduncle Arteriovenous Malformations","volume":"20","author":"Klironomos","year":"2021","journal-title":"Oper. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3171\/2015.2.JNS142707","article-title":"Anatomy and approaches along the cerebellar-brainstem fissures","volume":"124","author":"Matsushima","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1177\/0883073809342005","article-title":"Pediatric low-grade gliomas","volume":"24","author":"Sievert","year":"2009","journal-title":"J. Child Neurol."},{"doi-asserted-by":"crossref","unstructured":"Bene\u0161, V., Z\u00e1potock\u00fd, M., Lib\u00fd, P., T\u00e1borsk\u00fd, J., Bla\u017ekov\u00e1, J., Bla\u017ekov\u00e1, J., Sumerauer, D., Mi\u0161ove, A., Pern\u00edkov\u00e1, I., and Kyn\u010dl, M. (2022). Survival and functional outcomes in paediatric thalamic and thalamopeduncular low grade gliomas. Acta Neurochir.","key":"ref_13","DOI":"10.1016\/j.bas.2021.100680"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s10143-017-0915-z","article-title":"Hemorrhagic presentation of intracranial pilocytic astrocytomas: Literature review","volume":"42","author":"Prasad","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10143-018-0969-6","article-title":"Pediatric cerebellar pilocytic astrocytoma presenting with spontaneous intratumoral hemorrhage","volume":"43","author":"Donofrio","year":"2020","journal-title":"Neurosurg. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1227\/00006123-198605000-00010","article-title":"Surgical management of cerebellar peduncle lesions in children","volume":"18","author":"Tomita","year":"1986","journal-title":"Neurosurgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s00381-021-05405-3","article-title":"Management and outcome of pediatric brainstem and cerebellar peduncular low-grade gliomas: A retrospective analysis of 62 cases","volume":"38","author":"Rady","year":"2022","journal-title":"Childs Nerv. Syst."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/j.1365-2990.2010.01113.x","article-title":"Tumour vasculature and angiogenic profile of paediatric pilocytic astrocytoma; is it much different from glioblastoma?","volume":"36","author":"Sie","year":"2010","journal-title":"Neuropathol. Appl. Neurobiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10014-008-0243-7","article-title":"Hemorrhagic onset of pilocytic astrocytoma and pilomyxoid astrocytoma","volume":"26","author":"Shibahara","year":"2009","journal-title":"Brain Tumor Pathol."},{"doi-asserted-by":"crossref","unstructured":"Baran, O., Baydin, S., Mirkhasilova, M., Bayramli, N., Bilgin, B., Middlebrooks, E., Ozlen, F., and Tanriover, N. (2022). Microsurgical anatomy and surgical exposure of the cerebellar peduncles. Neurosurg. Rev.","key":"ref_20","DOI":"10.1016\/j.bas.2022.101298"},{"unstructured":"Malcolm, B. (1991). Carpenter, Core Text of Neuroanatomy, Williams & Wilkins. [4th ed.]. Chapter 8.","key":"ref_21"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.4103\/1673-5374.145364","article-title":"Recovery of cerebellar peduncle injury in a patient with a cerebellar tumor: Validation by diffusion tensor tractography","volume":"9","author":"Kim","year":"2014","journal-title":"Neural Regen. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S131","DOI":"10.1097\/00006123-200009001-00015","article-title":"Tentorial incisura","volume":"47","author":"Rhoton","year":"2000","journal-title":"Neurosurgery"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1093\/ons\/opaa373","article-title":"Supracerebellar Infratentorial Infratrochlear Trans-Quadrangular Lobule Approach to Pontine Cavernous Malformations","volume":"20","author":"Rutledge","year":"2021","journal-title":"Oper. Neurosurg."},{"key":"ref_25","first-page":"1330","article-title":"Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts","volume":"43","author":"Hopf","year":"1998","journal-title":"Neurosurgery"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2020.10.FOCUS20620","article-title":"Benefits of endoscope-assisted microsurgery in the management of pediatric brain tumors","volume":"50","author":"Atteya","year":"2021","journal-title":"Neurosurg. Focus"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/5\/640\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:03:47Z","timestamp":1760137427000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/5\/640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,29]]},"references-count":26,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["children9050640"],"URL":"https:\/\/doi.org\/10.3390\/children9050640","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2022,4,29]]}}}