J Neurosurg. 2020 Apr 24;134(3):1198-1202. doi: 10.3171/2020.2.JNS192952. Print 2021 Mar 1.
Supracerebellar transtentorial (SCTT) approaches have become a popular option for treatment of a variety of pathologies in the medial and basal temporal and occipital lobes and thalamus. Transtentorial approaches provide numerous advantages over transcortical approaches, including obviating the need to traverse eloquent cortex, not requiring parenchymal retraction, and circumventing critical vascular structures. All of these approaches require a tentorial opening, and numerous techniques for retraction of the incised tentorium have been described, including sutures, fixed retractors, and electrocautery. However, all of these techniques have considerable drawbacks and limitations. The authors describe a novel application of clip retraction of the tentorium to the supracerebellar approaches in which an aneurysm clip is used to suspend the tentorial flap, and an illustrative case is provided. Clip retraction of the tentorium is an efficient, straightforward adaptation of an established technique, typically used for subtemporal approaches, that improves visualization and surgical ergonomics with little risk to nearby venous structures. The authors find this technique particularly useful for the contralateral SCTT approaches.
幕上经小脑幕（SCTT）入路已成为治疗中颅窝底、颞叶和枕叶及丘脑各种病变的一种流行选择。与经皮质入路相比，经小脑幕入路具有许多优势，包括避免穿过功能区皮质、无需牵拉脑实质以及避开关键的血管结构。所有这些入路都需要切开小脑幕，已经描述了许多用于牵拉切开的小脑幕的技术，包括缝线、固定牵开器和电凝。然而，所有这些技术都有相当大的缺点和局限性。作者描述了一种将夹钳牵拉小脑幕应用于幕上入路的新方法，即使用动脉瘤夹来悬吊小脑幕瓣，并提供了一个说明性病例。夹钳牵拉小脑幕是对通常用于经颞下入路的一种成熟技术的有效、直接的改进，它提高了可视化效果和手术的人体工程学，同时对附近的静脉结构几乎没有风险。作者发现这种技术对于对侧 SCTT 入路特别有用。
