Orestes López Piloto*, Tania Margarita Cruz Hernández, Norbery Rodriguez De La Paz, Manuel Dearriba Romanidy, Duniel Abreu Casa, Lianet Sanchez Leyva and Juvenal Huanca
Department of Neurosurgery, Lucía Iniguez Landin Surgical Clinical Hospital, CubaFulltext PDF
Introduction: The supracerebellar infratentorial approach was originally described by Sir Victor Horsley, and was later adapted by Stein who applied the microsurgical technique improving the results of surgeries of the pineal region. Objectives: To highlight and systematize the indications, technical-anatomical details in the supracerebellar infratentorial approach based on our surgical experience and the review of the microsurgical anatomy of the Pineal region. Material and Methods: A retrospective descriptive study was carried out analyzing the clinical histories of six patients surgically intervened by the author in the aforementioned hospitals, through a full endoscopic supracerebellar infratentorial approach, between January 2013 and June 2019. Results: During the 2013-2019 periods, 6 patients underwent surgery. All of them underwent a full endoscopic supracerebellar infratentorial approach. 3 tumors of the pineal region, 1 Pilocytic Astrocytoma and 2 Arachnoid Cyst were treated. The following steps were standardized for the completion of endoscopic Stein's supracerebellar infratentorial approach: presurgical preparation, sitting position, head position, cutaneous marking and antisepsis, sterile field placement, skin and subcutaneous tissue incision, muscular plane dissection, craniotomy, dural opening, preparation of the supracerebellar corridor, intradural dissection and microsurgical anatomy of the pineal region and considerations on closure. Conclusion: The supracerebellar infratentorial approach with which we could access pineal tumors was systematized. In all cases, the anatomical exposure was enough to adequately treat the aforementioned pathologies, with minimal retraction of the CNS structures.
Supracerebellar infratentorial approach; Suboccipital craniotomy; Pineal region
López Piloto O, Margarita Cruz Hernández T, Rodriguez De La Paz N, Dearriba Romanidy M, Abreu Casa D, Sanchez Leyva L, et al. Full Endoscopic Infratentorial Supracerebellar Approach to Lesion of Pineal Region - Case Report. Ann Psychiatr Clin Neurosci. 2019;2(2):1016.