The Tonsillouvular Fissure Approach: Access to Dorsal and Lateral Aspects of the Fourth Ventricle

•Microsurgical anatomy and surgical technique for TUFA are described in detail.•TUFA provides a direct route to and excellent surgical view of lesions around FV.•Smaller lesions on the dorsal and lateral aspects of FV are best candidates for TUFA.•Minimal traversing of neural tissue is required compared with transvermian approach.•For lesions with minimal or no representation in FV, TUFA is superior to telovelar approach.