Occipital posterior interhemispheric supratentorial approach for resection of midbrain cavernous malformation

Approaches to the pineal region are various, and each has its advantages and disadvantages. The authors present a case of a 50-year-old woman who presented with progressive hemiparesis and vertical gaze palsy; she was diagnosed with a midbrain cavernous malformation. The patient underwent an occipital posterior interhemispheric supratentorial transpineal approach with gross-total resection. On long-term follow-up, her symptoms significantly improved. The authors review the regional anatomy and present the operative video. They also discuss the various approaches with their indications, advantages, and disadvantages. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2133.

Oligodendroglioma of the pineal region

✓ The authors describe an oligodendroglioma of the pineal region in a 59-year-old woman. The patient presented with intermittent confusion, memory disturbance, and headache associated with a cystic pineal region mass demonstrated on magnetic resonance imaging. Gross-total resection was performed via a suboccipital supratentorial approach. Pathological and genetic evaluation showed the tumor to be an anaplastic oligodendroglioma. Although the spectrum of tumors arising within the region of the pineal gland is broad, to the authors’ knowledge this is the first report of an oligodendroglioma occurring in this area.

Surgical Approaches to Aneurysms of the Vertebral and Basilar Arteries

ABSTRACT This report details the surgical treatment of 44 patients with aneurysms of the vertebral and basilar arteries. Three different surgical approaches were utilized depending on the location of the aneurysm. These were an anterior supratentorial approach, a lateral suboccipital approach, and a combined supratentorial and infratentorial approach along the petrous apex, with section of the lateral sinus and the tentorium. Using these operative exposures, aneurysms located anywhere on the vertebral-basilar arteries may be safely visualized and clipped. In this series, 1 patient died, 4 other patients had significant, long-lasting morbidity as a result of operation, and 32 patients returned to work and a normal life-style. These data support operative intervention under proper conditions and with selection of the correct exposures for the treatment of vertebral-basilar aneurysms.