A young and booming approach: the extreme lateral supracerebellar infratentorial approach

Surgical accesses to lesions of the posterolateral pontomesencephalic junction (PMJ) region and the posterolateral tentorial gap remain a challenge in the field of neurosurgery. Since the first report of application of the extreme lateral supracerebellar infratentorial (ELSI) approach in resecting the PMJ lesions in 2000, a few articles concerning the ELSI approach have been published. The present review mainly provided an intimate introduction of the ELSI approach, and evaluated it in facets of patient position, skin incision, craniectomy, draining veins, retraction against the cerebellum, exposure limits, patient healing, as well as advantages and limitations compared with other approaches. The ELSI approach is proposed to be a very young and promising approach to access the lesions of posterolateral PMJ region and the posterolateral tentorial gap. Besides, it has several advantages such as having a shorter surgical pathway, causing less surgical complications, labor-saving, etc. Still, more studies are needed to improve this approach.