Unilateral Occipital Transtentorial Approach with Multimodal Assistance for Resection of Large Supracerebellar Hemangioblastomas: Preliminary Experience of 2 Cases

Kawauchi, Daisuke; Higuchi, Yoshinori; Ikegami, Shiro; Adachi, Akihiko; Ozaki, Ko; Suda, Izumi; Kobayashi, Eiichi; Iwadate, Yasuo

doi:10.1016/j.wneu.2019.06.001

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…The preferred surgical approach to the upper, anterior part of the cerebellum is still controversial. The OTA and SCITA are the most commonly used among the various reported surgical approaches [5,[7][8][9]11,20,24,26,27,33] and the subtemporal transtentorial approach is used for some limited cases. [2,3] We performed the OTA for 3 tentorial and 2 quadrigeminal hemangioblastomas with midline location, and the SCITA for one tentorial hemangioblastomas with lateral extension.…”

Section: Classi Cations Of Cerebellar Hemangioblastomas Based On the Venous Drainage Systemmentioning

confidence: 99%

“…[6,13,34] Various surgical approaches for cerebellar hemangioblastoma are adopted according to tumor location. [1,[7][8][9][10][11]15,20,21,33] Cerebellar hemangioblastomas present unique operative challenges, despite current advances in microneurosurgical techniques, such as the narrow and deep surgical corridor in the posterior fossa, inability to debulk the tumor mass due to hypervascularity, di culty in early access to the feeding artery behind the tumor, and interference by large tortuous draining veins during the resection. [8][9][10]19,21] Consequently, selection of the optimal surgical approach and operative planning is quite important to access the pial surface and achieve panoramic exposure of the circumferential entire margin of the lesion for early management of the cortical feeding artery and identi cation of the main draining system.…”

Section: Introductionmentioning

confidence: 99%

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Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns

et al. 2021

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Cerebellar hemangioblastomas remain surgically challenging because of the narrow, deep surgical corridors and tumor hypervascularity. Various surgical approaches are used according to the location, but optimal approaches have not been established. We propose a system of surgical approaches based on the venous drainage systems to facilitate surgical planning and achieve acceptable neurological outcomes. Cerebellar hemangioblastomas were divided into vefour types based on the main drainage systems: suboccipital hemangioblastomas draining to the transverse sinus (TS) or torcular, tentorial hemangioblastomas draining to the tentorial and straight sinus, petrosal hemangioblastomas draining to the superior petrosal sinus (SPS),, and quadrigeminal hemangioblastomas draining to the galenic system, and tonsillar hemangioblastomas draining to the TS or torcular in conjunction with jugular bulb or SPS. Microsurgical approaches and patient outcome were retrospectively reviewed according to this classi cation. This study included 17 patients who underwent 21 operations for resection of 19 cerebellar hemangioblastomas, classi ed into 911 suboccipital, 4 tentorial, 2 petrosal, and 2 quadrigeminal, and 2 tonsillar. Standard suboccipital craniotomies were utilized for suboccipital hemangioblastomas, the occipital transtentorial approach (OTA) and supracerebellar infratentorial approach for tentorial hemangioblastomas, the retrosigmoid approach for petrosal hemangioblastomas, and OTA for quadrigeminal hemangioblastomas, and midline suboccipital approach for tonsillar hemangioblastomashemangioblastomass. Gross total resection was achieved in all patients except one.Two patients with large hemangioblastomas (tonsillarsuboccipital and quadrigeminal) required secondstage operation which nally achieved gross total removal. No single approach had a signi cantly higher incidence of postoperative neurological de cits. Selection of the optimum surgical approach for cerebellar hemangioblastomas was successful based on the main drainage systems. Understanding of tumor growth and extension with respect to the venous drainage system is critical to select the appropriate surgical approach.

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Section: Classi Cations Of Cerebellar Hemangioblastomas Based On the Venous Drainage Systemmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns

et al. 2021

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“…[17][18][19][20] Kawauchi et al reported the efficacy of the combined use of a microscope and an endoscope to remove supracerebellar hemangioblastomas. 21) In these reports, the panoramic view and minimal invasiveness have been emphasized as the advantages. There is only one report regarding endoscopic OTA for a cerebellar lesion, 22) where its feasibility was mainly shown using a computed tomography (CT) angiogram and cadaveric heads.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Occipital Transtentorial Approach for Supracerebellar Lesions

Takahara

Miwa

Iwama

et al. 2023

NMC Case Report Journal

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The occipital transtentorial approach (OTA), which is often applied for superior cerebellar lesions, has an inevitable risk of homonymous hemianopsia due to the retraction of the occipital lobe. The endoscopic approach provides increased visibility of the surgical field due to the wide-angled panoramic view and is minimally invasive in approaching deep brain lesions compared to the conventional microscopic approach. However, little is known regarding endoscopic OTA for the removal of cerebellar lesions. We experienced a case of a hemangioblastoma in the paramedian superior surface of the cerebellum that was successfully treated with endoscopic OTA combined with gravity retraction while avoiding postoperative visual dysfunction. A 48-year-old woman was diagnosed with a hemangioblastoma in the superior surface of the cerebellum. She underwent tumor removal with endoscopic OTA combined with gravity retraction of the occipital lobe instead of using brain retractors. The narrower space was sufficient for surgical manipulation with a panoramic view obtained by endoscopy. The simultaneous observation of the lesion with both an endoscope and a microscope revealed the superiority of infratentorial visualization with an endoscope. Gross total removal was achieved with no postoperative complications, including visual dysfunction. Endoscopic OTA may reduce the risk of postoperative visual dysfunction because of its minimally invasive nature, which is enhanced when combined with gravity retraction. Additionally, the panoramic view of the endoscope allows favorable visualization of an infratentorial lesion, which is otherwise hidden partly by the tentorium. The use of endoscopy is compatible with OTA, and endoscopic OTA could be an option for superior cerebellar lesions for avoiding visual dysfunction.

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Unilateral Occipital Transtentorial Approach with Multimodal Assistance for Resection of Large Supracerebellar Hemangioblastomas: Preliminary Experience of 2 Cases

Cited by 2 publications

References 20 publications

Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns

Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns

Endoscopic Occipital Transtentorial Approach for Supracerebellar Lesions

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