Transcollicular approach to intrinsic tectal lesions

OBJECTIVE: We used a paramedian, infratentorial-supracerebellar, transcolli cular approach to resect 11 intrinsic tectal lesions, including 8 tumors an d 3 hematomas, in 11 patients. The route of access to the lesions was desig ned to minimize the anatomic and functional damage to the surrounding struc tures. METHODS: Access was through one superior colliculus in each of seven patien ts, through one inferior colliculus in each of two patients, and through th e superior and inferior colliculi of one side in each of two patients. RESULTS: Of the eight tumors, three were totally resected, four were nearly totally resected, and one was partially resected. The preoperative ocular symptoms did not change in six of these eight patients and worsened in two, and the neurological deficits, except ocular symptoms, improved in two. Al l three hematomas were completely removed, along with abnormal blood vessel s in the wall of the hematoma cavity; all three of these patients experienc ed neurological improvement. CONCLUSION: We conclude that the paramedian, infratentorial-supracerebellar , transcollicular approach permits safe removal oi intrinsic tectal lesions . Resection of the superior or inferior colliculus or both on one side seem s to be neurologically well tolerated.