The infratentorial supracerebellar approach provides a safe access route to lesions in the pineal region[^1] and can be used, for example, for the surgical removal of Pineal cysts[^3] [^4].
Positioning
An infratentorial supracerebellar approach can be performed, for example, with the patient in the sitting position or in Concorde positioning. The advantage of the sitting position is retraction of the Cerebellum by gravity, which, depending on the lesion, can optimally open the surgical access corridor.
Classification
Depending on the angle of access, the infratentorial supracerebellar approach is classified as median, paramedian, lateral, or far-lateral[^2].
Side of access
In midline lesions, the following factors may influence the choice of side of access[^4]:
Side of the dominant Transverse sinus
Position of the Bridging veins
Height of the transverse sinus for an optimal trajectory