Midline suboccipital craniotomy and direct stimulation for a dorsally exophytic brainstem tumor

David S. Hersh, MD,1,2 Katherine N. Sanford, BS,1 Kenneth Moore, MD,1 and Frederick A. Boop, MD1–3

1Department of Neurosurgery, University of Tennessee Health Science Center; 2Le Bonheur Children’s Hospital; and 3Semmes Murphey Clinic, Memphis, Tennessee

Dorsally exophytic brainstem tumors arise from within the brainstem itself. As the tumor grows, it pulls eloquent tissue with it, resulting in a shape that is analogous to the sides of a volcano. Rather than a resection that is flush with the brainstem being performed, this functional tissue on the lateral edges of the tumor must be identified and preserved in order to avoid postoperative deficits. The authors describe a midline, suboccipital approach with the use of intraoperative direct stimulation to identify and preserve functional tissue innervating the palate during the resection of a dorsally exophytic medullary tumor.


**Intro music: "Daybreak" by Graeme Rosner