Modified Occipital Transtentorial Approach to the Pineal Region

Introduction: Because the pineal region is located in the center of the cranial cavity, many surgical approaches to this region have been introduced up to this time, but each surgical approach has high operative mortality and morbidity. The occipital transtentorial approach was initially described by Jamieson. We performed the modified original occipital transtentorial approach to this region, with the patient in the three quarter prone position and operative side down. We present our experience with the relevant anatomy, surgical indications, and operative technique of this approach.

Methods: We retrospectively analyzed 16 patients operated by this approach.

Results: The pathology included mature teratoma (two cases), immature teratoma (two cases), malignant mixed germ cell tumor (two cases), germinoma (two cases), cavernous hemangioma (two cases), meningioma (three cases), arachnoid cyst (two cases), and pineal cyst (one case). With this approach, we gained excellent results without any surgical mortality or severe morbidity.

Conclusion: This approach allows for excellent exposure of the pineal region and easy access to the midbrain, superior vermis, and posterior third ventricle. So, this approach may be used selectively for neoplastic and vascular lesions in the pineal region.