gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Occipital transtentorial approach for the various tumors of the pineal region

Meeting Abstract

  • T. Ito - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan
  • J. Nakagawara - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan
  • Y. Seo - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan
  • K.I. Sato - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan
  • M. Oikawa - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan
  • Y. Ozaki - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan
  • H. Nakamura - Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital, Sapporo, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.14.06a

DOI: 10.3205/12dgnc129, URN: urn:nbn:de:0183-12dgnc1293

Published: June 4, 2012

© 2012 Ito et al.
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Outline

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Objective: We have selected occipital transtentorial approach (OTA) for the various tumors in and around the pineal region (PRTs), so we report important points of this approach and surgical results.

Methods: OTA was performed in 29 patients with PRTs. These were 15 patients with tumors in the pineal region (pineal parenchymal tumor:6, germ cell tumor:5, glioma, ependymoma, epidermoid, lipoma:1), 7 patients with tumors in the upper cerebellum (hemangioblastoma:3, metastatic tumor:2, meningioma, cavernoma:1), 5 with tumors in the falcotentorial junction (meningioma:5), and 2 patients with tumors in the dorsal midbrain (glioma, cavernoma:1). In recent cases, we evaluate the variations of the sinus confluence, tentorial sinus, occipital ascending vein, and Galenic system using 3D-CTA as preoperative planning. Surgery was performed in the lateral semi-prone position. Our modified methods on the operative techniques are as follows. 1. Dural incision is not extended to the lateral limit in order to prevent of excessive sinking of the occipital lobe. 2. Operative feeld is kept widely by cutting arachnoid around the deep venous system. 3. Infrasplenial approach is considered by tumor location (relationship between posterior edge of tumor and posterior edge of splenium) and length (between inferior edge of splenium and superior colliculus) in MR sagittal image. 4. Electromagnetic field system is useful in the hard tumors, such as teratoma. 5. Superior cerebellar artery should be coagulated before tumor resection. 6. One side colliculus is incised holizontally in order to preserve ocular movement and hearing.

Results: 1. We were able to resect the various PRTs sufficiently using OTA. 2. Post-operative visual field deficit was occurred transiently in a few cases. 3. 3D-CTA is useful to evaluate the variations of the sinus confluence, tentorial sinus, occipital ascending vein, and the relationship between the Galenic system and the tumor.

Conclusions: OTA is a very useful and safe approach for the tumors in and around the pineal region by typical surgical manipulation.