scholarly journals Interhemispheric occipital transtentorial approach to the pineal region and dorsal midbrain

2018 ◽  
Vol 20 (1) ◽  
pp. 22-26
Author(s):  
Andrei Fernandes Joaquim ◽  
Marcos Juliano Dos Santos ◽  
Élton Gomes Da Silva ◽  
Hélder Tedeschi
Keyword(s):  
Surgical Anatomy ◽  
Pineal Region ◽  
Sitting Position ◽  
Technical Aspects ◽  
Pineal Region Tumors ◽  
Supracerebellar Infratentorial Approach ◽  
Occipital Transtentorial Approach ◽  
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.

Exclusive Endoscopic Occipital Transtentorial Approach for Pineal Region Tumors

2019 ◽  
Vol 131 ◽  
pp. 167-173 ◽  
Author(s):  
Motoki Tanikawa ◽  
Hiroshi Yamada ◽  
Tomohiro Sakata ◽  
Yasuhiko Hayashi ◽  
Yasuo Sasagawa ◽  
...  
Keyword(s):  
Pineal Region ◽  
Pineal Region Tumors ◽  
Occipital Transtentorial Approach ◽  
Transtentorial Approach

scholarly journals Pineal region chordoid meningioma

2018 ◽  
Vol 24 (2) ◽  
pp. 148-152
Author(s):  
Felipe Salviero ◽  
Cláuder Ramalho ◽  
João Noberto Stavale ◽  
Sérgio Cavalheiro ◽  
Manoel Antônio De Paiva Neto
Keyword(s):  
Histological Analysis ◽  
Clinical Presentation ◽  
Pineal Region ◽  
Chordoid Meningioma ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Ophthalmologic Examination ◽  
Occipital Transtentorial Approach ◽  
Vertical Gaze ◽  
Transtentorial Approach

Background: Meningiomas correspond to only 8% of pineal region tumors. Chordoid meningioma (CM) comprises only 0.5 to 1.0% of all intracranial meningiomas and is even rarer in the pineal region. In the literature, we found only six cases of pineal region CMs reported. Clinical presentation: We describe a case of one patient with headache, confusion, slurred speech and gait disturbance. The ophthalmologic examination revealed vertical gaze paresis and near-light dissociation of papillary reflex. MRI disclosed a large pineal region tumor with heterogeneous contrast enhancement. The tumor was totally removed by an occipital transtentorial approach (OTA) in a “three-quarter prone” position. Histological analysis disclosed a CM. Conclusion: Chordoid meningioma is a very rare variant of meningioma and the pineal region is a poorly described site. This study contributes to the understanding of this heterogeneous entity, to consider the CM as a differential diagnosis of pineal region tumors and to provide proper management of affected patients.

Comparison of the Infratentorial and Transtentorial Approaches to the Pineal Region

Neurosurgery ◽  
1978 ◽  
Vol 3 (1) ◽  
pp. 1-8 ◽  
Author(s):  
William S. Reid ◽  
Kemp W. Clark
Keyword(s):  
Pineal Region ◽  
The Other ◽  
The Past ◽  
Supracerebellar Infratentorial Approach ◽  
Occipital Transtentorial Approach ◽  
Mass Lesions ◽  
Transtentorial Approach

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.

scholarly journals Endoscopic-assisted interhemispheric parieto-occipital transtentorial approach for microsurgical resection of a pineal region tumor: operative video and technical nuances

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Occipital Lobe ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Straight Sinus ◽  
Occipital Transtentorial Approach ◽  
Microsurgical Resection ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The angle of the straight sinus and tentorium cerebelli can often influence the choice of surgical approach to the pineal region. The supracerebellar infratentorial approach can be technically challenging and a relative contraindication in cases where the angle of the straight sinus and tentorium is very steep. Similarly, an occipital transtentorial approach, which uses a low occipital craniotomy at the junction of the superior sagittal sinus and transverse sinus, may not provide the best trajectory to the pineal region in patients with a steep tentorium. In addition, this approach often necessitates retraction on the occipital lobe to access the tentorial incisura and pineal region, which can increase the risk of visual compromise. In this operative video, the author demonstrates an alternative route using an endoscopic-assisted interhemispheric parieto-occipital transtentorial approach to a pineal region tumor in a patient with a steep straight sinus and tentorium. The approach provided a shorter route and more direct trajectory to the tumor at the tentorial incisura, and avoided direct fixed retraction on the occipital lobe when performed using the lateral position, thereby minimizing visual complications. This video atlas demonstrates the operative technique and surgical nuances, including the application of endoscopic-assisted microsurgical resection and operative pearls for preservation of the deep cerebral veins. In summary, the parieto-occipital transtentorial approach with endoscopic assistance is an important approach in the armamentarium for surgical management of pineal region tumors.The video can be found here: https://youtu.be/Ph4veG14aTk.

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