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Pineal Region Tumor (Occipital Transtentorial Approach)

Last Updated: March 13, 2020

For general considerations, diagnosis and evaluation, indications for surgery, and preoperative considerations, please refer to the Pineal Region Tumor (Infratentorial Supracerebellar Approach) chapter.

For the occipital transtentorial route, preoperative magnetic resonance venogram or computed tomography venogram may be considered to locate the bridging veins in the parasagittal occipital region.

The occipital transtentorial approach enters the cranial vault through a unilateral occipital craniotomy. This approach offers wide exposure of the quadrigeminal plate and is particularly useful for large pineal region tumors that extend laterally and inferiorly. This approach is especially favorable for reaching lesions arising from the precentral cerebellar fissure, posterior incisural space, and adjacent structures.

Multicompartment lesions that occupy the pineal region and extend into the posterior thalamus, lateral ventricle, medial temporal lobe, and over the corpus callosum require expanded working angles and may benefit from the use of the occipital transtentorial route. Masses that expand into the depth of the precentral cerebellar fissure and toward the roof of the fourth ventricle are especially reasonable targets for this approach.

Arteriovenous malformations involving the splenium and pineal region can be widely exposed via this approach; early access to the feeding vessels from the posterior cerebral artery is possible without...