The Telovelar Approach: Part 2—Surgical Techniques

The two most common approaches to the fourth ventricle that have been described in the literature are the transvermian approach and the telovelar approach, with the latter used increasingly used during the past decade because of its superior complication profile. The telovelar approach, also called the “telovelotonsillar” approach, utilizes the splitting of the cerebellomedullary fissure (CMF) as a natural corridor to the fourth ventricle. A detailed microsurgical anatomy of the CMF and its related structures was discussed in the previous article in this series: The Telovelar Approach: Part 1—Historical Perspectives and Anatomic Considerations (vol. 45 no. 1). In this article, we will discuss the microsurgical steps needed for this approach, technical pearls, and case illustrations. We will also discuss the additional potential benefits of opening the uvulotonsillar fissures which allows greater superior and lateral exposure.