Two-stage endoscopic assisted approach for large pineal region and falcotentorial meningioma: first stage paramedian supracerebellar infratentorial approach, second stage interhemispheric occipital transtentorial approach: surgical cases and anatomical study

Transtentorial Approach ◽

Wide Exposure

We describe the surgical anatomy and technical aspects of the interoccipital transtentorial approach to lesions of the dorsal midbrain and pineal region using the lateral-semiprone position. This approach offers a wide exposure of the posterior midbrain and pineal region tumors, avoiding the risks of the semi-sitting position used for the supracerebellar infratentorial approach. A step-by-step description of the approach is presented, with detailed anatomical pictures and case illustrations.

Comparison of the Infratentorial and Transtentorial Approaches to the Pineal Region

Neurosurgery ◽

10.1227/00006123-197807000-00001 ◽

1978 ◽

Vol 3 (1) ◽

pp. 1-8 ◽

Cited By ~ 79

Author(s):

William S. Reid ◽

Kemp W. Clark

Keyword(s):

Pineal Region ◽

The Other ◽

The Past ◽

Mass Lesions ◽

Abstract During the past 10 years, two different operative approaches to the pineal region have been recommended by different authors. Numerous reports have appeared in the literature, indicating the safe use of one or the other of these two techniques for the excision of masses in the pineal region. This paper reports experience with both techniques in the treatment of 15 patients with mass lesions in this area. Four patients underwent a supracerebellar infratentorial approach and 11 patients underwent an occipital transtentorial approach to the pineal region. These two approaches are compared in terms of anatomical exposure, technical difficulties, and real or potential complications. The authors prefer the occipital transtentorial approach in dealing with lesions in the pineal region.

Surgical management of pineal region lesions

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0037 ◽

2019 ◽

pp. 439-446

Author(s):

Christoph M. Woernle ◽

René L. Bernays ◽

Nicolas de Tribolet

Keyword(s):

Third Ventricle ◽

Pineal Region ◽

Cerebral Veins ◽

Internal Cerebral Veins ◽

Basal Vein Of Rosenthal ◽

Third Ventricle Tumours ◽

Quadrigeminal Plate ◽

The Brain

Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.

Surgery of Pineal Region Tumors : Keypoints of Occipital Transtentorial Approach

Japanese Journal of Neurosurgery ◽

10.7887/jcns.8.151 ◽

1999 ◽

Vol 8 (3) ◽

pp. 151-155

Author(s):

Ryuichi TANAKA

Keyword(s):

Pineal Region ◽

Pineal Region Tumors ◽

Right occipital transtentorial approach for a pineal malignant germ cell tumor

Neurosurgical Focus: Video ◽

10.3171/2021.4.focvid2151 ◽

2021 ◽

Vol 5 (1) ◽

pp. V3

Author(s):

Brian J. A. Gill ◽

Dominique M. Higgins ◽

Matei A. Banu ◽

Michael G. Argenziano ◽

Neil A. Feldstein ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Pineal Region ◽

First Line ◽

Intracranial Germ Cell Tumors ◽

Somatic Transformation ◽

Malignant Germ Cell Tumor ◽

Malignant Lesions ◽

Germ cell tumors account for up to 53% of the malignant lesions found in the pineal region and are typically managed with a combination of radiation therapy and chemotherapy. Malignant somatic transformation of intracranial germ cell tumors is exceedingly rare and has only been reported on two other occasions. Here the authors present the case of a pineal yolk sac tumor that failed optimum first-line treatment and underwent malignant somatic transformation to an enteric mucinous adenocarcinoma requiring surgical intervention. This video demonstrates the technical nuances of the occipital transtentorial approach and the safe microsurgical dissection of lesions within the pineal region. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2151.

Microsurgical approaches to the cerebellar interpeduncular region: qualitative and quantitative analysis

Journal of Neurosurgery ◽

10.3171/2021.6.jns204457 ◽

2021 ◽

pp. 1-14

Author(s):

Juan Leonardo Serrato-Avila ◽

Juan Alberto Paz Archila ◽

Marcos Devanir Silva da Costa ◽

Paulo Ricardo Rocha ◽

Sergio Ricardo Marques ◽

...

Keyword(s):

Quantitative Analysis ◽

The Other ◽

Qualitative And Quantitative Analysis ◽

Qualitative And Quantitative ◽

Bridging Veins ◽

Cerebellar Lesions ◽

Surgical Corridor ◽

OBJECTIVE The cerebellar interpeduncular region (CIPR) is a gate for dorsolateral pontine and cerebellar lesions accessed through the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), or the subtemporal transtentorial approach (STa). The authors sought to compare the exposures of the CIPR region that each of these approaches provided. METHODS Three approaches were performed bilaterally in eight silicone-injected cadaveric heads. The working area, area of exposure, depth of the surgical corridor, length of the interpeduncular sulcus (IPS) exposed, and bridging veins were statistically studied and compared based on each approach. RESULTS The OTa provided the largest working area (1421 mm2; p < 0.0001) and the longest surgical corridor (6.75 cm; p = 0.0006). Compared with the SCITa, the STa provided a larger exposure area (249.3 mm2; p = 0.0148) and exposed more of the length of the IPS (1.15 cm; p = 0.0484). The most bridging veins were encountered with the SCITa; however, no significant differences were found between this approach and the other approaches (p > 0.05). CONCLUSIONS To reach the CIPR, the STa provided a more extensive exposure area and more linear exposure than did the SCITa. The OTa offered a larger working area than the SCIT and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.