====== Fourth ventricle approaches ======

===== General information =====

● position, skin incision, craniectomy: as in Midline [[suboccipital craniectomy]] using the
[[Concorde position]] 

● the posterior arch of [[C1]] does not need to be removed unless the [[tonsil]]s extend inferior to the [[foramen magnum]] 

● options:

○ [[neuromonitoring]]: SSEP/MEP, BAER

○ temporary pacemaker in case of bradycardia due to brainstem manipulation

○ image guided navigation: if used, fiducials placed before pre-op imaging and kept in place until
surgery usually helps with registration

● complications:
○ hydrocephalus: incidence as high as 30%; average is probably lower

○ [[cerebellar mutism]]: develops in up to 30%

○ other complications: dysarthria: 30%, dyphagia:33%


The two most common surgical routes to the [[fourth ventricle]] are:

[[Transvermian approach]] and [[Telovelar approach]]es.

see [[Tonsillouvular fissure approach]].