Supracerebellar transtentorial approach—resection of the tentorium instead of an opening—to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications

Oliveira, Jean Gonçalves de; Párraga, Richard Gonzalo; Chaddad-Neto, Feres; Ribas, Guilherme Carvalhal; Oliveira, Evandro P L de

doi:10.3171/2011.12.jns111256

Cited by 75 publications

(48 citation statements)

References 15 publications

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“…Only 1 new-onset neurological deficit has been reported in the literature: a visual deficit in a patient who underwent SCTT resection of a medial temporal tumor to treat epilepsy (Table 2). 3,21,28 In addition to being safe and feasible, the SCTT approach was effective in all of our patients: a gross-total resection was accomplished in all 5 cases, and excellent control of seizures was achieved.…”

Section: Discussionmentioning

confidence: 99%

“…16 In total, 44 cases of PMT-region lesions, including 21 tumors, have been resected through an SCTT approach. 3,13,21,24,28 Of these, only 4 have been performed in children. We report our results with the SCTT approach in 5 pediatric patients, all of whom were operated in the lateral park-bench position and in whom no procedure-related complications were observed.…”

Section: Discussionmentioning

confidence: 99%

“…Cadaveric studies have shown that the SCTT approach helps reach the entire length of the medial temporal region, showing the utility of this approach to treat tumors that extend beyond the PMT region into the temporal pole. 3,21 By avoiding lateral transgression into the temporal brain regions, this approach may avoid creating new cortical injuries and gliosis arising from transtemporal approach-related cortical damage, and may thus reduce the risk for postoperative recurrence of seizures. There are clear advantages of the SCTT approach over the more traditional approaches to the PMT region, including anterior approaches such as the pterional-transylvian approach; lateral approaches such as a standard subtemporal, supratentorial-infraoccipital, or transcortical (that is, temporal) approach; and posterior approaches such as an occipital-transtentorial or a parietooccipital interhemispheric approach.…”

Section: Discussionmentioning

confidence: 99%

“…3,9,13,24,28 The SCTT approach offers an alternative route to the PMT region, while avoiding the risks of injury to the superficial venous drainage of the temporal lobe and of injuries associated with temporal lobe retraction or with transgression through normal brain tissue. Thus, the SCTT approach may reduce the risk of producing surgery-related neurological deficits.…”

Section: 21mentioning

confidence: 99%

“…[1][2][3]9,15,19,21 Exposure of the PMT region through these traditional approaches increases the risk of eloquent visual, language, and limbic temporal lobe pathway damage due to vascular injury or tissue transgression or retraction. 3,9,19,21,24 The subtemporal approach offers access to the PMT region at the expense of retraction of the temporal lobe.aBBreviatiONS ECoG = electrocorticography; PHG = parahippocampal gyrus; PMT = posteromedial temporal; SCTT = supracerebellar-transtentorial. …”

mentioning

confidence: 99%

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The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

Weil¹,

Middleton²,

Niazi³

et al. 2015

PED

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OBJECT Operations on tumors of the posteromedial temporal (PMT) region, that is, on those arising from the posterior parahippocampal, fusiform, and lingual gyri, are challenging to perform because of the deep-seated location of these tumors between critical cisternal neurovascular structures and the adjacent temporal and occipital cortexes. Traditional surgical approaches require temporal or occipital transgression, retraction, or venous sacrifice. These approaches may result in unintended complications that should be avoided. To avoid these complications, the supracerebellar-transtentorial (SCTT) approach to this region has been used as an effective alternative treatment in adult patients. The SCTT approach uses a sitting position that offers a direct route to the posterior fusiform and lingual gyri of the temporal lobe. The authors report the feasibility, safety, and efficacy of this approach, using a modified lateral park-bench position in a small cohort of pediatric patients. METHODS The authors carried out a retrospective case review of 5 consecutive patients undergoing a paramedian SCTT approach between 2009 and 2014 at the authors' institution. RESULTS The SCTT approach in the park-bench position was used in 3 boys and 2 girls with a mean age of 7.8 years (range 13 months to 16 years). All patients presented with a seizure disorder related to a tumor in a PMT region involving the parahippocampal and fusiform gyri of the left (n = 3) or right (n = 2) temporal lobe. No procedure-related complications were observed. Gross-total resection and control of seizures were achieved in all cases. Tumor classes and types included 1 Grade II astrocytoma, 1 pleomorphic xanthoastrocytoma, 1 ganglioglioma, and 2 glioneural tumors. None of the tumors had recurred by the mean follow-up of 22 months (range 1–48 months). Outcomes of epileptic seizures were excellent, with seizure symptoms in all 5 patients scoring in Engel Class IA. CONCLUSIONS The SCTT approach represents a viable option when resecting tumors in this region, providing a reasonable working corridor and low morbidity. The authors' experience in a cohort of pediatric patients demonstrates that complete resection of the lesions in this location is feasible and is safe when involving an approach that involves using a park-bench lateral positioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: 21mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

Weil¹,

Middleton²,

Niazi³

et al. 2015

PED

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Optimizing the selection of the endoscopically assisted supracerebellar transtentorial approach to the medial temporo‐occipital region: Clinical application of one novel grid coordinate system

Lin,

Ju,

Lin

et al. 2024

Clinical Anatomy

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The endoscopically assisted supracerebellar transtentorial (eSCTT) approach is advocated for managing pathologies of the medial temporo‐occipital region, but quantitative analysis is currently lacking. The aims of this study were to establish a grid coordinate system on the tentorium to model the anatomical relationship between medial temporo‐occipital region pathology and the slope of the tentorium, and then to compare the paramedian eSCTT and extreme‐lateral eSCTT approaches quantitatively. Bilateral paramedian and extreme‐lateral eSCTT approaches were used to dissect three adult cadaveric heads anatomically. A grid coordinate system was established on the tentorium, and the angles of attack and depth of the surgical corridor of each coordinate point were obtained so that the two eSCTT approaches could be compared statistically. The measurements were then analyzed to determine the condition for selecting each eSCTT approach, and its clinical feasibility was assessed in three patients with large tumors in the medial temporo‐occipital region. For coordinate points where the X‐coordinate on the grid coordinate system was 1 cm outside the apex of the tentorium, the paramedian eSCTT approach had a significantly wider angle of attack and shorter depth of surgical corridor than the extreme‐lateral eSCTT approach. In contrast, the extreme‐lateral eSCTT approach was better for coordinate points where the Y‐coordinate on the grid coordinate system was 1 cm in front of the apex of the tentorium. The long axis of each patient's tumor was projected on to the tentorium and its corresponding coordinate points were used to match the more appropriate eSCTT approach. Preliminary results for three patients treated with the eSCTT approach for large tumors in the medial temporo‐occipital region were encouraging. When the eSCTT approach is applied to manage a large tumor of the medial temporo‐occipital region, assessment of the long axis of the tumor and knowledge of the selective condition for each eSCTT approach can help in clinical decision‐making.

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A Supracerebellar-Infratentorial Approach in Pineal Region Lesions

Beneš

Májovský

2020

Pineal Region Lesions

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Supracerebellar transtentorial approach—resection of the tentorium instead of an opening—to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications

Cited by 75 publications

References 15 publications

The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

Optimizing the selection of the endoscopically assisted supracerebellar transtentorial approach to the medial temporo‐occipital region: Clinical application of one novel grid coordinate system

A Supracerebellar-Infratentorial Approach in Pineal Region Lesions

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