Abstract
Background
The occipital interhemispheric transtentorial (OITT) approach is frequently used for accessing the pineal region. There are scarce reports of using the OITT to access superior cerebellar lesions. This approach affords the patient several advantages over traditional posterior fossa approaches.
Purpose
This study is to describe and evaluate clinical outcomes in a single surgeon case series of the OITT approach for pediatric patients with lesions of the superior cerebellum.
Methods
All pediatric patients who underwent an OITT craniotomy for a superior cerebellar lesion by a single surgeon over a 5-year period were included in this retrospective analysis. Patient demographics and clinical data were collected.
Results
Thirteen pediatric patients were identified. Cases included twelve tumors and one arteriovenous malformation. Gross total resection was achieved in 92% of cases. No patients developed posterior fossa syndrome. Two patients had transient homonymous hemianopsia that resolved by 1 month post-operatively. There were no permanent neurological deficits.
Conclusion
For superomedial cerebellar lesions presenting to the tentorial surface of the superior cerebellum in patients with normal to steep tentorial angles, the OITT approach is effective and safe. This approach has a low risk of posterior fossa syndrome and permanent visual deficits when applied appropriately. Patient selection is critical for maximizing the advantages of the OITT for superior cerebellar lesions.
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Availability of data and material
Data and materials are available upon request.
Abbreviations
- OITT:
-
Occipital interhemispheric transtentorial
- SCIT:
-
Supracerebellar infratentorial
- EVD:
-
External ventricular drain
- CSF:
-
Cerebrospinal fluid
References
Mottolese C et al (2015) The sub-occipital transtentorial approach revisited base on our own experience. Neurochirurgie 61(2–3):168–175
Sonabend AM, Bowden S, Bruce JN (2016) Microsurgical resection of pineal region tumors. J Neurooncol 130(2):351–366
Chi JH, Lawton MT (2006) Posterior interhemispheric approach: surgical technique, application to vascular lesions, and benefits of gravity retraction. Neurosurgery 59(1 Suppl 1): p. ONS41–9; discussion ONS41–9
Lopez-Gonzalez MA et al (2019) Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space. Surg Neurol Int 10:130
Ma Y, Lan Q (2013) An anatomic study of the occipital transtentorial keyhole approach. World Neurosurg 80(1–2):183–189
McLaughlin N, Martin NA (2014) The occipital interhemispheric transtentorial approach for superior vermian, superomedian cerebellar, and tectal arteriovenous malformations: advantages, limitations, and alternatives. World Neurosurg 82(3–4):409–416
Soleman J et al (2019) The interhemispheric approach in children: our experience and review of the literature. Childs Nerv Syst 35(3):445–452
Kawashima M, Rhoton AL Jr, Matsushima T (2008) Comparison of posterior approaches to the posterior incisural space: microsurgical anatomy and proposal of a new method, the occipital bi-transtentorial/falcine approach. Neurosurgery 62(6 Suppl 3):1136–1149
Reid WS, Clark WK (1978) Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3(1):1–8
Cobourn K et al (2020) Cerebellar mutism syndrome: current approaches to minimize risk for CMS. Childs Nerv Syst 36(6):1171–1179
Gora NK, Gupta A, Sinha VD (2017) Cerebellar Mutism Syndrome following Midline Posterior Fossa Tumor Resection in Children: An Institutional Experience. J Pediatr Neurosci 12(4):313–319
Slot EMH et al (2021) Cerebrospinal fluid leakage after cranial surgery in the pediatric population-a systematic review and meta-analysis. Childs Nerv Syst
Nazzaro JM, Shults WT, Neuwelt EA (1992) Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg 76(5):746–751
Yoshimoto K et al (2013) Clinical features and pathophysiological mechanism of the hemianoptic complication after the occipital transtentorial approach. Clin Neurol Neurosurg 115(8):1250–1256
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David Peters: writing of the manuscript. Trent VanHorn and Brandon Karimian: data collection, critically revising the paper, and preparation of figures. Scott Wait: design and supervision of the paper, critically revising the paper, and clinical management of patients presented.
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This retrospective chart review involving two human patients was under the ethical standards established by the 1964 Helsinki Declaration. Institutional review board (IRB) approval at Atrium Health Carolinas Medical Center hospital was obtained. Written informed consent by the patients was deemed not applicable since there was no information of the participants in the manuscript that compromise anonymity.
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Peters, D.R., VanHorn, T., Karimian, B. et al. Occipital interhemispheric transtentorial approach in pediatric patients for lesions of the superomedial cerebellum: operative findings and results. Childs Nerv Syst 39, 491–496 (2023). https://doi.org/10.1007/s00381-022-05761-8
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DOI: https://doi.org/10.1007/s00381-022-05761-8