How I do it--pineal surgery: supracerebellar infratentorial versus occipital transtentorial.

BACKGROUND

Resection of a pineal tumour requires fastidious pre-operative planning to select the optimal surgical approach and maximise resection while minimising morbidity.

METHOD

To describe and compare the supracerebellar infratentorial and occipital transtentorial approaches.

CONCLUSIONS

Specific considerations include patient-specific anatomy, extent and relationships of the tumour, and the techniques likely to be employed during resection. The supracerebellar infratentorial approach provides a direct corridor to pineal tumours caudal to the deep veins; for tumours invaginating the tectal plate in a caudal direction the occipital transtentorial provides a better view.