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A surgical technique to expand the operative corridor for supracerebellar infratentorial approaches: technical note

Abstract

Background

The supracerebellar infratentorial approach is a commonly used route in neurosurgery. It provides a narrow and deep corridor to the dorsal midbrain and pineal region. The authors describe a surgical technique to expand the operative corridor and the surgeon’s working angles during this approach.

Methods

Thirteen cases of patients who underwent resection of their lesions using this extended approach were reviewed. During their suboccipital craniotomy, additional bone over the transverse sinus (paramedian approach) and the confluence of the sinuses (midline approach) were removed. Two sutures (tentorial stay sutures) were anchored to the tentorium anterior to the transverse sinus and tension was applied. A video narrated by the senior author describes the details of technique.

Results

This additional bone removal and tentorial stay sutures led to gentle elevation of the tentorium and partial mobilization of the dural venous sinuses superiorly. This technique enhanced operative viewing through improved illumination and expanded working angles for microsurgical instruments while minimizing the need for fixed retractors and extensive cerebellar retraction. All patients underwent satisfactory removal of their lesions. No patient suffered from any related complication.

Conclusion

The use of stay sutures anchored on the tentorium is a simple and effective technique that expands the surgical corridor during supracerebellar infratentorial approaches.

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Abbreviations

CSF:

Cerebral spinal fluid

SC-IT:

Supracerebellar infratentorial

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Conflicts of interest

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Corresponding author

Correspondence to Aaron A. Cohen-Gadol.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video demonstrating the discussed technique: Removal of additional bone over the dural sinuses and their gentle elevation/mobilization as well as elevation of the posterior tentorium using the tentorial sutures expands the supracerebellar infratentorial operative corridor. The video describing this technique in the case of a patient with a mesencephalic tumor is accessible via: http://bcove.me/u8jzohlm (MP4 47337 kb)

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Rey-Dios, R., Cohen-Gadol, A.A. A surgical technique to expand the operative corridor for supracerebellar infratentorial approaches: technical note. Acta Neurochir 155, 1895–1900 (2013). https://doi.org/10.1007/s00701-013-1844-4

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  • DOI: https://doi.org/10.1007/s00701-013-1844-4

Keywords

  • Supracerebellar infratentorial approach
  • Stay sutures
  • Retraction
  • Operative corridor
  • Surgical procedures
  • Operative