Changes in the Gene Expression Profiles of the Inferior Colliculus Following Unilateral Cochlear Ablation in Adult Rats.

This study aimed to explore gene expression changes in the inferior colliculus (IC) after single-sided deafness (SSD). Forty 8-week-old female Sprague-Dawley rats were used. Twenty rats underwent right-side cochlear ablation, and IC tissues were harvested after 2 weeks (SSD 2-week group). Twenty rats underwent a sham operation and were sacrificed after 2 weeks (control group). Both sides of the IC were analyzed using a gene expression array. Pathway analyses were performed on genes that were differentially expressed compared with their levels in the control group. The expression levels of genes involved in the candidate pathways were confirmed using reverse transcription polymerase chain reaction (RT-PCR). Among the genes with ≥ 1.5-fold changes in expression levels and P < 0.05, there were 7 and 9 genes with increased and decreased expression, respectively, in the ipsilateral IC and 10 and 12 genes with increased and decreased expression, respectively, in the contralateral IC. The pathway analysis did not identify significantly related pathway. In the bilateral analysis, a total of 14 genes were ≥ 1.3-fold downregulated in both the ipsilateral and contralateral IC in the SSD 2-week group compared with their expression in the control group. Pathway analyses of these 14 genes included 7 genes, namely, amine compound solute carrier (Slc)5a7; Slc18a3; Slc6a5; synaptic vesicle glycoprotein 2C (Sv2c); S100 calcium binding protein A10 (S100a10); a gene with sequence similarity to family 111, member A (Fam111a); and peripherin (Prph), that were related to the acetylcholine neurotransmitter release cycle, SLC transporters, and the neurotransmitter release cycle pathways. RT-PCR showed reduced expression of Slc5a7, Sv2c, and Prph in the contralateral IC and Slc18a3 and Slc6a5 in the ipsilateral IC of the SSD 2-week group compared with that in the control group.

Hemangioblastoma of Cerebral Aqueduct Removed via Sitting, Supracerebellar Intracollicular Approach.

BACKGROUND: Tumors protruding into the cerebral aqueduct are rare, and tumors arising from within the cerebral aqueduct are rarer still. CASE DESCRIPTION: In this report, we discuss the presentation and clinical outcome of a 65-year-old man who presented to us with symptoms of hydrocephalus. Prior imaging had revealed a small enhancing nodule within the cerebral aqueduct. In the 6 months between initial imaging and our seeing the patient, the tumor demonstrated substantial interval growth, so the patient was offered resection. The tumor was accessed using a sitting, supracerebellar, intracollicular approach, which allowed for gross total resection of the mass without complication. Histopathology later revealed the lesion to be a hemangioblastoma. Two years after surgery, the patient was doing well with no neurologic deficits. CONCLUSIONS: We report the first case of an aqueductal hemangioblastoma and describe our use of a sitting, supracerebellar, intracollicular approach to access tumors occupying this cerebrospinal fluid space.

Synchrony, connectivity, and functional similarity in auditory midbrain local circuits.

The central nucleus of the inferior colliculus (ICC) contains a laminar structure that functions as an organizing substrate of ascending inputs and local processing. While topographic distributions of ICC response parameters within and across laminae have been reported, the functional micro-organization of the ICC is less well understood. For pairs of neighboring ICC neurons, we examined the nature of functional connectivity and receptive field preferences to gain a better understanding of the structure and function of local circuits. By recording from pairs of adjacent neurons and presenting pure-tone and dynamic broad-band stimulation, we estimated functional connectivity and local differences in frequency response areas (FRAs), spectrotemporal receptive fields (STRFs), nonlinear input/output functions, and single-spike information. From the cross-covariance functions we identified putative unidirectional as well as bidirectional excitatory/inhibitory interactions. STRFs of neighboring neurons strongly conserve best frequency, and moderately agree in STRF similarity, bandwidth, temporal response type, best modulation frequency, nonlinearity structure, and degree of information processing. Excitatory connectivity was stronger and temporally more precise than for inhibitory connections. Neither connection strength nor degree of synchrony correlated with receptive field parameters. The functional similarity of local pairs of ICC neurons was substantially less than for local pairs in the granular layers of primary auditory cortex (AI). These results imply that while the ICC is an obligatory nexus of ascending information, local neurons are comparatively weakly connected and exhibit considerable receptive field variability, potentially reflecting the heterogeneity of converging inputs to ICC functional zones.

A new method for piercing the tentorium cerebelli for implanting fragile electrodes into the brain stem in the rhesus monkey (Macaca mulatta).

Recent developments in neuron recording techniques include the invention of some fragile electrodes. The fragility of these electrodes impedes their successful use in deep brain recordings because it is difficult to penetrate the electrodes through the dura mater, especially the tentorium cerebelli (TC) enclosing the cerebellum and brain stem. This paper reports a new method to pierce the TC for inserting fragile electrodes into the inferior colliculus of rhesus monkeys. Briefly, a unique tool kit, consisting of needles with sharp tips, a guide tube and an "impactor," was used in a multistep protocol to pierce the TC. The impactor provided a brief force that quickly thrusts the needles through the meninges without causing significant damage to the brain tissue under the TC. Using this novel approach, tetrodes were successfully implanted into the inferior colliculus of a rhesus monkey and neuronal discharge signals were recorded. This method, which is simple, convenient and economical, allows neurophysiologists to study the electrophysiological characteristics of deep brain structures under the TC with advanced, albeit fragile, electrodes.

An anatomical assessment of the supracerebellar midline and paramedian approaches to the inferior colliculus for auditory midbrain implants using a neuronavigation model on cadaveric specimens.

The inferior colliculus (IC) is an alternative site for electrode placement in neural deafness due to its surgical accessibility and its well-known tonotopic stratification. In patients where tumor surgery has already occurred and the cerebellopontine angle contains scar tissue or tumor-remnants, midline and paramedian supracerebellar approaches are alternative routes. They are often avoided due to concerns regarding the venous drainage of the cerebellum, the electrode trajectory and the course of the electrode cable. We studied these surgical routes in five neuronavigated fixed cadaveric specimens. For paramedian and midline approaches, the transverse sinus was exposed 5.8mm on average. A mean of 1.6 cerebellar veins, with an average diameter of 2.0mm, draining to the tentorium were transected to reach the tentorial notch. Only 0.4 arterial branches were met. We conclude that the supracerebellar midline and paramedian approaches provide a good exposure of the IC and offer safe and viable alternative routes to the IC. Additionally, they provide a wider angle of action for optimal electrode placement.

Calcifying pseudoneoplasm of the inferior colliculus: an unusual location for a rare tumor: case report.

OBJECTIVE: Quadrigeminal plate lesions are rare and usually present with a silent clinical course. Tumors, vascular lesions, inflammatory and infectious processes have been described in this region. Calcifying pseudoneoplasms, also reported as fibro-osseous lesions, cerebral calculi, and brain stones, are unusual lesions in the central nervous system. They can be revealed by cranial radiography, computed tomography, and magnetic resonance imaging as calcified masses and should be differentiated from neoplastic, inflammatory, and vascular lesions. To the best of our knowledge, the occurrence of a calcifying pseudoneoplasm located at the quadrigeminal plate has not yet been reported. CLINICAL PRESENTATION: A 67-year-old woman with a 6-month history of several daily attacks of dizziness presented to our service. Magnetic resonance imaging studies revealed a tumor in the right inferior colliculus. This lesion was isointense on T1-weighted imaging, hypointense on T2-weighted imaging, and homogeneously enhanced with contrast. INTERVENTION: The lesion at the quadrigeminal plate was completely removed, and the patient was successfully treated without any new neurological deficit. At the time of follow-up, all preoperative symptoms had resolved. CONCLUSION: We report the first case of a calcifying pseudoneoplasm of the inferior colliculus. Complete surgical removal of this type of tumor is feasible. We propose surgical treatment in this location when this tumor becomes symptomatic.

Auditory midbrain implant: a review.

The auditory midbrain implant (AMI) is a new hearing prosthesis designed for stimulation of the inferior colliculus in deaf patients who cannot sufficiently benefit from cochlear implants. The authors have begun clinical trials in which five patients have been implanted with a single shank AMI array (20 electrodes). The goal of this review is to summarize the development and research that has led to the translation of the AMI from a concept into the first patients. This study presents the rationale and design concept for the AMI as well a summary of the animal safety and feasibility studies that were required for clinical approval. The authors also present the initial surgical, psychophysical, and speech results from the first three implanted patients. Overall, the results have been encouraging in terms of the safety and functionality of the implant. All patients obtain improvements in hearing capabilities on a daily basis. However, performance varies dramatically across patients depending on the implant location within the midbrain with the best performer still not able to achieve open set speech perception without lip-reading cues. Stimulation of the auditory midbrain provides a wide range of level, spectral, and temporal cues, all of which are important for speech understanding, but they do not appear to sufficiently fuse together to enable open set speech perception with the currently used stimulation strategies. Finally, several issues and hypotheses for why current patients obtain limited speech perception along with several feasible solutions for improving AMI implementation are presented.

The first successful case of hearing produced by electrical stimulation of the human midbrain.

HYPOTHESIS: Electrical stimulation of the inferior colliculus in the midbrain can provide a safe and efficacious alternative to auditory brainstem implants (ABIs). BACKGROUND: Patients with neurofibromatosis type 2 (NF2) receive limited speech recognition with ABIs. Some ABI patients without NF2 can achieve excellent speech understanding, suggesting that the limited NF2 performance is due to brainstem damage from the tumor and its removal. METHODS: An array of electrodes (Med-El ABI) was placed on the dorsal surface of the inferior colliculus in the midbrain of a human volunteer as an auditory prosthesis via an infratentorial supracerebellar median surgical approach. Electrophysiological responses, psychophysical responses, and speech recognition were measured. RESULTS: Electrical stimulation produced auditory sensations on all 12 electrodes with no nonauditory sensations. Auditory threshold levels indicated the stability of the electrode array over time. Electrophysiological measures showed activation in the contralateral auditory cortex but none in ipsilateral cortex. All electrodes demonstrated a full range of loudness sensation and electrode-specific pitch sensations. Speech recognition was significant, but limited in the first month after surgery. CONCLUSION: This approach may provide advantages for patients with brainstem damage.

Electrophysiological validation of a human prototype auditory midbrain implant in a guinea pig model.

The auditory midbrain implant (AMI) is a new treatment for hearing restoration in patients with neural deafness or surgically inaccessible cochleae who cannot benefit from cochlear implants (CI). This includes neurofibromatosis type II (NF2) patients who, due to development and/or removal of vestibular schwannomas, usually experience complete damage of their auditory nerves. Although the auditory brainstem implant (ABI) provides sound awareness and aids lip-reading capabilities for these NF2 patients, it generally only achieves hearing performance levels comparable with a single-channel CI. In collaboration with Cochlear Ltd. (Lane Cove, Australia), we developed a human prototype AMI, which is designed for electrical stimulation along the well-defined tonotopic gradient of the inferior colliculus central nucleus (ICC). Considering that better speech perception and hearing performance has been correlated with a greater number of discriminable frequency channels of information available, the ability of the AMI to effectively activate discrete frequency regions within the ICC may enable better hearing performance than achieved by the ABI. Therefore, the goal of this study was to investigate if our AMI array could achieve low-threshold, frequency-specific activation within the ICC, and whether the levels for ICC activation via AMI stimulation were within safe limits for human application. We electrically stimulated different frequency regions within the ICC via the AMI array and recorded the corresponding neural activity in the primary auditory cortex (A1) using a multisite silicon probe in ketamine-anesthetized guinea pigs. Based on our results, AMI stimulation achieves lower thresholds and more localized, frequency-specific activation than CI stimulation. Furthermore, AMI stimulation achieves cortical activation with current levels that are within safe limits for central nervous system stimulation. This study confirms that our AMI design is sufficient for ensuring safe and effective activation of the ICC, and warrants further studies to translate the AMI into clinical application.

The auditory midbrain implant: a new auditory prosthesis for neural deafness-concept and device description.

The auditory midbrain implant (AMI) is a new central auditory prosthesis designed for penetrating stimulation of the human inferior colliculus. The major group of candidates for the AMI consists of neurofibromatosis type 2 (NF2) patients who develop neural deafness because of growth and/or surgical removal of bilateral acoustic neuromas. Because of the absence of a viable auditory nerve, these patients cannot benefit from cochlear implants. An alternative solution has been the auditory brainstem implant (ABI), which stimulates the cochlear nucleus. However, speech perception performance in NF2 ABI patients has been limited. The fact that the ABI is able to produce high levels of speech perception in nontumor patients (with inaccessible cochleae or posttraumatic damage to the cochlear nerve) suggests that limitations in ABI performance in NF2 patients may be associated with cochlear nucleus damage caused by the tumors or the tumor removal process. Thus, stimulation of the auditory midbrain proximal to the damaged cochlear nucleus may be a better alternative for hearing restoration in NF2 patients. We propose the central nucleus of the inferior colliculus (ICC) as the potential site. A penetrating electrode array aligned along the well-defined tonotopic gradient of the ICC should selectively activate different frequency regions, which is an important elementfor supporting good speech understanding. The goal of this article is to present the ICC as an alternative site for an auditory implant for NF2 patients and to describe the design of the first human prototype AMI. Practical considerations for implementation of the AMI will also be discussed.

Remodeling of synaptic structure in sensory cortical areas in vivo.

Although plastic changes are known to occur in developing and adult cortex, it remains unclear whether these changes require remodeling of cortical circuitry whereby synapses are formed and eliminated or whether they rely on changes in the strength of existing synapses. To determine the structural stability of dendritic spines and axon terminals in vivo, we chose two approaches. First, we performed time-lapse two-photon imaging of dendritic spine motility of layer 5 pyramidal neurons in juvenile [postnatal day 28 (P28)] mice in visual, auditory, and somatosensory cortices. We found that there were differences in basal rates of dendritic spine motility of the same neuron type in different cortices, with visual cortex exhibiting the least structural dynamics. Rewiring visual input into the auditory cortex at birth, however, failed to alter dendritic spine motility, suggesting that structural plasticity rates might be intrinsic to the cortical region. Second, we investigated the persistence of both the presynaptic (axon terminals) and postsynaptic (dendritic spine) structures in young adult mice (P40-P61), using chronic in vivo two-photon imaging in different sensory areas. Both terminals and spines were relatively stable, with >80% persisting over a 3 week period in all sensory regions. Axon terminals were more stable than dendritic spines. These data suggest that changes in network function during adult learning and memory might occur through changes in the strength and efficacy of existing synapses as well as some remodeling of connectivity through the loss and gain of synapses.

Unilateral cochlear ablation produces greater loss of inhibition in the contralateral inferior colliculus.

Bilateral cochlear ablation leads to a profound weakening of synaptic inhibition within the inferior colliculus (IC) of gerbils [Vale & Sanes (2000) J. Neurosci., 20, 1912-1921]. To examine whether unilateral deafening leads to similar functional alterations, we studied the effect of unilateral cochlear ablation on inhibitory synaptic properties both ipsilateral and contralateral to the deafened ear. Lateral lemniscal and commissure of the IC-evoked inhibitory postsynaptic currents (IPSCs) were recorded in an IC brain slice preparation using whole-cell and gramicidin perforated-patch electrodes in the presence of kynurenic acid. Unilateral cochlear ablation led to a 23 mV depolarizing shift in the IPSC equilibrium potential for IC neurons contralateral to the deafened ear, but only a 10 mV depolarization in the ipsilateral IC. Lateral lemniscal-evoked inhibitory synaptic conductance declined significantly in the ipsilateral and contralateral IC, whereas commissural-evoked inhibitory synaptic conductance declined only contralateral to the ablated cochlea. An analysis of paired-pulse facilitation showed that inhibitory transmitter release was more affected ipsilateral to the ablated cochlea. Thus, unilateral cochlear ablation modifies inhibitory synapses in the inferior colliculus, but these changes appear to be dominated by postsynaptic alterations in the contralateral IC, and by presynaptic changes in the ipsilateral IC.

Dural arteriovenous fistula after craniotomy for pilocytic astrocytoma in a patient with protein S deficiency.

BACKGROUND: We report an unusual case, which may provide insight into the etiology and pathogenesis of dural arteriovenous malformation. CASE DESCRIPTION: A 24-year-old woman presented with hemorrhage into a pilocytic astrocytoma of the collicular plate. Angiography was normal and the tumor was surgically resected. She developed sigmoid sinus thrombosis and a transverse/sigmoid sinus dural arteriovenous fistula 11 months after this and was found to have protein S deficiency. The fistula was not treated. Angiography 4 years later was unchanged. CONCLUSION: This report illustrates an acquired etiology of a dural arteriovenous fistula. To our knowledge this is the first reported case of postoperative sigmoid sinus thrombosis along with arteriovenous fistula in a patient with previously undetected protein S deficiency.

Enhanced plasticity of retinothalamic projections in an ephrin-A2/A5 double mutant.

Ascending sensory information reaches primary sensory cortical areas via thalamic relay neurons that are organized into modality-specific compartments or nuclei. Although the sensory relay nuclei of the thalamus show consistent modality-specific segregation of afferents, we now show in a wild-type mouse strain that the visual pathway can be surgically "rewired" so as to induce permanent retinal innervation of auditory thalamic cell groups. Applying the same rewiring paradigm to a transgenic mouse lacking the EphA receptor family ligands ephrin-A2 and ephrin-A5 results in more extensive rewiring than in the wild-type strain. We also show for the first time that ephrin-A2 and ephrin-A5 define a distinct border between visual and auditory thalamus. In the absence of this ephrin-A2/A5 border and after rewiring surgery, retinal afferents are better able to invade and innervate the deafferented auditory thalamus. These data suggest that signals that induce retinal axons to innervate the denervated auditory thalamus may compete with barriers, such as the ephrins, that serve to contain them within the normal target. The present findings thus show that the targeting of retinothalamic projections can be surgically manipulated in the mouse and that such plasticity can be controlled by proteins known to regulate topographic mapping.

Long-term changes in middle latency response and evidence of retrograde degeneration in the medial geniculate body after auditory cortical ablation in cats.

Short- and long-term changes in the middle latency response (MLR) after bilateral ablation of the auditory cortices were studied in awake cats. The amplitude of the negative peak with a latency of about 15 ms (NA) decreased to 60% of the original value 1 week after ablation (short-term change). In the long term, i.e. 11-30 months, NA either decreased further (decreased group) or remained unchanged (non-decreased group). A histological study with light microscopy revealed degeneration of neurons in the ventral nucleus of the medial geniculate body (MGv) in the decreased group, whereas the neurons in this region were preserved in the non-decreased group. This study suggests that long-term changes in NA reflect retrograde degeneration in the MGv after auditory cortical ablation.

Near-field responses from the round window, inferior colliculus, and auditory cortex of the unanesthetized chinchilla: manipulations of noiseburst level and rate.

Few studies have compared the response properties of near-field potentials from multiple levels of the auditory nervous system of unanesthetized animals. The purpose of this study was to investigate the effects of brief-duration noisebursts on neural responses recorded from electrodes chronically implanted at the round window, inferior colliculus and auditory cortex of chinchillas. Responses were obtained from seven unanesthetized chinchillas to a noiseburst-level and noiseburst-rate series. For the noiseburst-rate series, a 70 dB pSPL noiseburst was varied in rate from 10 to 100 Hz using conventional averaging procedures, and from 100 to 500 Hz using pseudorandom pulse trains called maximum length sequences (MLSs). Response thresholds were similar for the compound action potential (CAP), inferior colliculus potential (ICP) and auditory cortex potential (ACP). With decreasing noiseburst level, there were decreases in the amplitudes and increases in the latencies of the CAP, ICP and ACP. The shapes of the mean normalized amplitude input/output (I/O) functions were similar for the ICP and ACP, while the normalized I/O functions for the first positive peak (P1) and first negative peak (N1) of the CAP differed from each other and from the ICP and ACP. The slopes of the latency/intensity functions were shallowest for the CAP, intermediate for the ICP, and steepest for the ACP. With increasing rate, the latency shift was least for the CAP, intermediate for the ICP and greatest for the ACP. The amplitude of P1 of the CAP varied little with rate. All other potentials showed a pronounced decrease in amplitude at high stimulation rates. Excluding CAP P1, proportional amplitude decrease with rate was greatest for the ACP, intermediate for N1 of the CAP and least for the ICP. Responses were present in most animals at all recording sites, even for the highest rate (500 Hz) used in this study. For all potentials, the MLS procedure allowed the collection of a response at rates well above those where sequential responses would have overlapped using conventional averaging procedures.

Spatial sound detection and the role of the inferior colliculus in the Long-Evans rat.

The ability of Long-Evans hooded rats (n = 10) to detect sounds presented from sources in the horizontal plane at 0 degrees elevation and the effects of bilateral lesions of the inferior colliculus on these abilities were examined. Rats were trained on a directional detection task which required animals to suppress licking responses in a conditioned avoidance paradigm when 100-ms noise bursts were presented at random from speakers at 45 degrees intervals beginning at azimuth (0 degrees). A task performance rate was determined by reducing the correct lick suppression rate for signal trials by the proportion of incorrect suppression responses on non-signal trials. Higher performance rates were observed for stimuli presented from 0-90 degrees than for stimuli presented in the caudal hemifield prior to surgical procedures. Bilateral lesions restricted to the inferior colliculus reduced detection performance (p < 0.05) and shifted the best performance rates from sounds presented at 0-45 degrees to stimuli emitted from a 90 degrees source (p < 0.05). These results demonstrate that pigmented rats show differential detection levels for noise bursts presented from different locations throughout the horizontal interaural plane, and suggest that the inferior colliculus is involved in this aspect of directional hearing.

Sex differences in auditory sensitivity of chinchillas before and after exposure to impulse noise.

OBJECTIVE: To determine if chinchillas exhibit sex differences in 1) basic auditory sensitivity and 2) susceptibility to cochlear damage and hearing loss from high-level impulse noise. DESIGN: The auditory sensitivity of 73 chinchillas was assessed by measuring evoked potentials from electrodes implanted in the inferior colliculus (IC-EVPs) and cubic (2f1-f2) distortion product otoacoustic emissions (CDPs). A subgroup of 16 chinchillas were retested after exposure to simulated M16 rifle fire (150 dB pSPL impulse noise). Thresholds and postexposure temporary and permanent threshold shifts were compared as a function of sex and frequency using analysis of variance procedures. Cochleograms, showing the percent of hair cells missing as a function of location on the basilar membrane, were constructed to show inner hair cell (IHC) and outer hair cell (OHC) losses for each group. RESULTS: Female chinchillas had slightly lower high-frequency thresholds, and slightly higher low-frequency thresholds than male chinchillas, but similar IC-EVP and CDP amplitude functions. Significant sex differences were observed after exposure to high-level impulse noise. Overall, female chinchillas developed approximately 10 dB more high-frequency hearing loss, but approximately 5 dB less low-frequency hearing loss than males. Hair cell losses, particularly IHC losses, were substantially less for females as compared with males. CONCLUSIONS: The results point to close similarities between chinchillas and humans with regard to sex/gender differences in basic auditory sensitivity before noise exposure, suggesting that the chinchilla may be a good model for exploring the anatomical and physiological bases of these differences. In addition, the results show significant sex differences in the physiological and anatomical response of the chinchilla cochlea to high-level noise. Similar differences in humans could have important implications with regard to military assignments and hearing conservation programs.

The long-term effect of bilateral inferior colliculus ablation on auditory brainstem response in awake cats.

In this study auditory brainstem responses (ABRs) were recorded repeatedly in three awake cats before and after bilateral aspiration of the inferior colliculi (ICs). All surgical procedures were performed under anaesthesia with Nembutal. Postoperative recordings were obtained 1 week, 3 months, 8 months and 13 months after bilateral aspiration of the ICs in order to study the long-term changes in ABRs. The P5 amplitude was markedly reduced only at 1 week after aspiration. P1 and P2 amplitudes were affected slightly at 3 months and 1 year, but those of P3 and P4 decreased significantly. After perfusion of these cats, histological examination of the brainstem revealed complete ablation of both ICs, neuronal loss in the nucleus of the lateral lemniscus and the superior olivary complex and preservation of the cochlear nucleus. Our results suggest that retrograde degeneration of neuronal cells of the brainstem, which project to the IC from the nucleus of the lateral lemniscus and superior olivary complex except the cochlear nucleus, affect the peak amplitudes of the ABR over the long-term.

Transcollicular approach to intrinsic tectal lesions.

OBJECTIVE: We used a paramedian, infratentorial-supracerebellar, transcollicular approach to resect 11 intrinsic tectal lesions, including 8 tumors and 3 hematomas, in 11 patients. The route of access to the lesions was designed to minimize the anatomic and functional damage to the surrounding structures. METHODS: Access was through one superior colliculus in each of seven patients, through one inferior colliculus in each of two patients, and through the superior and inferior colliculi of one side in each of two patients. RESULTS: Of the eight tumors, three were totally resected, four were nearly totally resected, and one was partially resected. The preoperative ocular symptoms did not change in six of these eight patients and worsened in two, and the neurological deficits, except ocular symptoms, improved in two. All three hematomas were completely removed, along with abnormal blood vessels in the wall of the hematoma cavity; all three of these patients experienced neurological improvement. CONCLUSION: We conclude that the paramedian, infratentorial-supracerebellar, transcollicular approach permits safe removal of intrinsic tectal lesions. Resection of the superior or inferior colliculus or both on one side seems to be neurologically well tolerated.