Exclusive Endoscopic Occipital Transtentorial Approach for Pineal Region Tumors

Abstract OBJECTIVE Removal of pineal region tumors, which are deeply placed and encircled by intricate neurovascular structures, is still challenging to neurosurgeons. The authors present their experience with the exclusive endoscopic occipital transtentorial approach (EEOTA) utilized for removal of pineal region tumors. MEHODS The authors performed a retrospective review of patients who had undergone surgery using EEOTA to remove pineal region tumors during the period from May 2016 to August 2018, and confirmed the details of the EEOTA procedure. RESULTS Five patients underwent surgery via EEOTA for the treatment of pineal region tumors. In all cases, it was possible to perform the EEOTA less invasively through a key-hole craniotomy approximately 2.0 - 2.5 cm in size. The EEOTA produced an excellently exposed view and provided natural and automatic orientation. There was essentially no blind spot in this procedure, even for the floor or ipsilateral wall of the third ventricle. In four cases, it was possible to achieve gross total resection successfully. In the ATRT case, however, we abandoned gross total resection because of a hardened adhesion to the tectum and the great cerebral vein and its tributaries. Two patients presented with transient upper gaze palsy immediately after surgery, but experienced complete recovery during the follow-up period. CONCLUSIONS The authors consider the EEOTA to be a very promising technique for removal of pineal region tumors, and to have the potential for extensive and routine application for surgeons familiar with endoscopic surgery.