Infratentorial supracerebellar approach versus occipital transtentorial approach for pineal region tumors. Our technical considerations

Introduction: Despite the deep-seated location of pineal region tumors, surgical resection has become safer and more effective, and now plays an essential role in their management. Tissue diagnosis allows the initiation of chemotherapy or radiotherapy, and resection can be curative or improve the efficacy of adjuvant therapies. Objective: Infratentorial supracerebellar (ITSC) and occipital transtentorial (OTT) approaches are the most used for pineal tumors resection. This study aims to describe feasible criteria for better approach indication based on our surgical experience. Methods: Forty-two patients were divided for tumor resection, using tentorial surface angle in sagittal MRI view in the approach selection: Group 1 (25 ITSC); Group 2 (15 OTT); Group 3 (two combined approaches). Results: Group 1 achieved successful total removal. It was observed one visual impairment, one hydrocephalus patient with postoperative meningitis, and other one with postoperative hematoma. Group 2 presented 13 total resections, one visual impairment and transient contralateral hemianesthesia. Group 3 resulted in one air embolism and one ventriculitis after ventriculoperitoneal shunt. No surgical mortality registered. Conclusion: A descriptive analysis of 42 pineal tumor cases showed minimal complications. The ideal approach is well decided based on the angle between tentorial surface and vertical midline on sagittal plane.