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The sub-occipital transtentorial approach for pineal region tumors: how I do it

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Abstract

Background

Two major approaches exist for the surgical removal of pineal region tumors: the supracebellar infratentorial and the sub-occipital transtentorial.

Methods

We present the Lyon’s technique of the sub-occipital transtentorial approach for pineal region tumors and our tricks to avoid complications. The principle is to expose the pineal region under the occipital lobe and not through the interhemispheric fissure.

Conclusions

The sub-occipital transtentorial approach is a direct, extra cerebral, safe, and effective way to access tumors of the pineal region.

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Author information

Author notes

  1. Pierre-Aurélien Beuriat and Alexandru Szathmari participated equally to this work.

Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France

    Pierre-Aurélien Beuriat, Alexandru Szathmari, Federico Di Rocco & Carmine Mottolese

  2. Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France

    Pierre-Aurélien Beuriat & Federico Di Rocco

Authors
  1. Pierre-Aurélien Beuriat
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  2. Alexandru Szathmari
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  3. Federico Di Rocco
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  4. Carmine Mottolese
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Corresponding author

Correspondence to Pierre-Aurélien Beuriat.

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All authors report no conflict of interest.

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Summary key points

- Use the sitting position (if possible).

- Perform a large skin, bone, and dural approach.

- Expose the pineal region under the occipital lobe and not through the interhemispheric fissure.

- Do not compress the calcarine region to avoid post-operative lateral homonymous hemianopia.

- Open the tentorium posteriorly going to its free edge.

- Open the arachnoid to expose the Galen vein, both basilar veins, the feeding arteries of the tumor, the tumor, the tectal plate, the opposite tentorium, and the splenium of the corpus callosum.

- Start the dissection of the tumor at the inferior pole and then laterally.

- Finish the dissection of the tumor superiorly (coagulate and cut the pineal veins near the tumor and not near the Galen vein).

- Perform an endoscopic control of the cavity to look for residual tumor.

- Dura mater is closed in a watertight fashion, filling the operative field with saline solution to reduce the risk of pneumocephalus.

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Beuriat, PA., Szathmari, A., Di Rocco, F. et al. The sub-occipital transtentorial approach for pineal region tumors: how I do it. Acta Neurochir 165, 3461–3465 (2023). https://doi.org/10.1007/s00701-023-05813-1

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  • DOI: https://doi.org/10.1007/s00701-023-05813-1

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