The anatomical relationship between tonsillo-biventral fissure and dentate nucleus in surgical approaches for hypertensive cerebellar hemorrhage

OBJECTIVE: To investigate the anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus in detail. Additionally, to apply this knowledge to guide the surgical management of hypertensive cerebellar hemorrhage. MATERIALS AND METHODS: A total of nine cases of hypertensive cerebellar hemorrhage treated between January 2025 and October 2025 were reviewed, in which the anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus was fully utilized to guide surgery. The specific operative steps and underlying rationale of this innovative surgical concept were analyzed and described in detail. RESULTS: There is a close anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus. Since hypertensive cerebellar hemorrhage mainly originates from the dentate nucleus, these anatomical characteristics should be integrated with patient-specific imaging findings to guide surgical planning. The hematoma can be directly exposed through the natural corridor of the tonsillo-biventral fissure, or this fissure can serve as a constant anatomical landmark to guide cortical fenestration, thereby providing the surgeon with a more straightforward operative strategy. CONCLUSION: Fully utilizing the anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus to guide the surgical treatment of hypertensive cerebellar hemorrhage is a safe, efficient, simple, and minimally invasive technique worth promoting and disseminating.