OBJECTIVE: The occipitotranstentorial approach is well accepted for lesions of the pineal region, superior cerebellar vermis, or mesencephalon. Although evidently suitable, this approach has not, to our knowledge, been reported for lesions of the superior cerebellar hemisphere in adults. Experience with this approach is reported. METHODS: Four patients underwent surgery between August 1995 and March 1997. The findings obtained are evaluated. RESULTS: Al! lesions were situated in the

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... lobules (one extending into the vermis), and all were completely removed. Postoperative deficits, especially visual field deficits, did not occur. CONCLUSION: Lesions of the superior cerebellar hemispheres are easily approached by an occipitotranstentorial route. The major advantages over a supracerebellar approach are that the surgical route is nearly perpendicular to the lesion and to the tentorium instead of parallel,