Stereotactic posterior midline approach under direct microscopic view for biopsy of medulla oblongata tumors: technical considerations

BACKGROUND: Open and stereotactic transfrontal or transcerebellar approaches have been used to biopsy brainstem lesions. METHOD: In this report, a stereotactic posterior and midline approach to the distal medulla oblongata under microscopic view is described. The potential advantages and limitations are discussed, especially bilateral damage of the X nerve nuclei. CONCLUSION: This approach should be considered for biopsy of distal and posterior lesions. We strongly recommend the use of direct microscopic view to identify the medullary vessels, confirm the midline entry point, and avoid potential shift of the medulla. Further experience is needed to confirm safety and success rate of this approach. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-020-04600-6) contains supplementary material, which is available to authorized users.