BACKGROUND The Infra-tentorial Supracerebellar approach (ITSC) to pineal region was described by Krause in 1911 and refined and popularized by Stein in 1982.Basically, ITSC offers an optimal exposure of the area between the vein of Galen complex and the cerebellomesencephalic fissure, so it is very useful for small to medium sized tumors confined to the micline and/or having a minimal para-median infratentorial extension. The authors critically review the personal series of pineal tumors removed via ITSC approach, also focusing on the selection criteria in the choice of the most suitable approach to pineal tumors. MATERIALS AND METHODS A wide review of pineal tumors treated in a range of 10 years (2004-2014) has been performed, with special emphasis to those cases treated via an ITSC route. This review regarded the type of lesion, indications to ITSC approach, choice of patient surgical position, complications and outcome. RESULTS In a range period of 10 years, 36 pineal region tumors have been treated. Among these, 15 were men and 21 female. The mean age was 43.1 years. The size of lesions were <3 cm in 30 cases and ≥3 cm in 6 cases. All lesions (14 meningiomas, 7 low grade gliomas, 2 high grade gliomas, 3 hemangioblastomas, 2 cavernomas, 2 pinealomas, 2 metastases, 2 dysgerminomas, 1 schwannoma, 1 medulloblastoma) were completely resected. In 16 cases an ITSC approach was performed, whereas an occipital trans-tentorial approach was employed in 20 cases. All tumors were completely removed surgically without any injury to the venous complex. There was no incidence of mortality or morbidity in our group of patients, and all functional outcomes were good to excellent postoperatively. CONCLUSIONS Pineal region is among the most complex intracranial areas to be reached mainly due to its deep location and the obstacle posed by the vascular structures in the midline. It derives that tumours involving this region are some of the most difficult lesions to expose and remove. Our review suggests that ITSC approach is an useful and safe approach, with a very low morbidity and zero mortality, for removing those pineal tumors with a midline infratentorial extension.

THE INFRA-TENTORIAL SUPRACEREBELLAR APPROACH

GALZIO, RENATO
2014-01-01

Abstract

BACKGROUND The Infra-tentorial Supracerebellar approach (ITSC) to pineal region was described by Krause in 1911 and refined and popularized by Stein in 1982.Basically, ITSC offers an optimal exposure of the area between the vein of Galen complex and the cerebellomesencephalic fissure, so it is very useful for small to medium sized tumors confined to the micline and/or having a minimal para-median infratentorial extension. The authors critically review the personal series of pineal tumors removed via ITSC approach, also focusing on the selection criteria in the choice of the most suitable approach to pineal tumors. MATERIALS AND METHODS A wide review of pineal tumors treated in a range of 10 years (2004-2014) has been performed, with special emphasis to those cases treated via an ITSC route. This review regarded the type of lesion, indications to ITSC approach, choice of patient surgical position, complications and outcome. RESULTS In a range period of 10 years, 36 pineal region tumors have been treated. Among these, 15 were men and 21 female. The mean age was 43.1 years. The size of lesions were <3 cm in 30 cases and ≥3 cm in 6 cases. All lesions (14 meningiomas, 7 low grade gliomas, 2 high grade gliomas, 3 hemangioblastomas, 2 cavernomas, 2 pinealomas, 2 metastases, 2 dysgerminomas, 1 schwannoma, 1 medulloblastoma) were completely resected. In 16 cases an ITSC approach was performed, whereas an occipital trans-tentorial approach was employed in 20 cases. All tumors were completely removed surgically without any injury to the venous complex. There was no incidence of mortality or morbidity in our group of patients, and all functional outcomes were good to excellent postoperatively. CONCLUSIONS Pineal region is among the most complex intracranial areas to be reached mainly due to its deep location and the obstacle posed by the vascular structures in the midline. It derives that tumours involving this region are some of the most difficult lesions to expose and remove. Our review suggests that ITSC approach is an useful and safe approach, with a very low morbidity and zero mortality, for removing those pineal tumors with a midline infratentorial extension.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11697/30918
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