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Original Research| Volume 110, P39-47, April 2023

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The parietooccipital interhemispheric transtentorial approach for pineal tumors

  • Author Footnotes
    1 Orcid ID: 0000-0001-5824-3249.
    Baran Bozkurt
    Footnotes
    1 Orcid ID: 0000-0001-5824-3249.
    Affiliations
    Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey

    Center of Advanced Simulation Ant Education(CASE) Neuroanatomy Laboratory, School of Medicine, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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  • Author Footnotes
    2 Orcid ID: 0000-0001-9898-3807.
    Orhun Mete Çevik
    Footnotes
    2 Orcid ID: 0000-0001-9898-3807.
    Affiliations
    Center of Advanced Simulation Ant Education(CASE) Neuroanatomy Laboratory, School of Medicine, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Department of Neurosurgery, Afsin State Hospital, Kahramanmaras, Turkey
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  • Author Footnotes
    3 Orcid ID: 0000-0002-3695-8400.
    Ali Yayla
    Footnotes
    3 Orcid ID: 0000-0002-3695-8400.
    Affiliations
    Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey

    Center of Advanced Simulation Ant Education(CASE) Neuroanatomy Laboratory, School of Medicine, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Turkey
    Search for articles by this author
  • Author Footnotes
    4 Orcid ID: 0000-0001-8015-9916.
    Ayca Ersen Danyeli
    Footnotes
    4 Orcid ID: 0000-0001-8015-9916.
    Affiliations
    Department of Pathology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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  • Author Footnotes
    5 Orcid ID: 0000-0002-2071-0419.
    Cansu Ünal
    Footnotes
    5 Orcid ID: 0000-0002-2071-0419.
    Affiliations
    Center of Advanced Simulation Ant Education(CASE) Neuroanatomy Laboratory, School of Medicine, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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  • Author Footnotes
    6 Orcid ID: 0000-0002-3543-0401.
    Koray Özduman
    Footnotes
    6 Orcid ID: 0000-0002-3543-0401.
    Affiliations
    Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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  • Author Footnotes
    7 Orcid ID: 0000-0002-0751-1802.
    Mustafa Güdük
    Footnotes
    7 Orcid ID: 0000-0002-0751-1802.
    Affiliations
    Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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  • Author Footnotes
    8 Orcid ID: 0000-0002-6725-9004.
    Murat İmre Usseli
    Footnotes
    8 Orcid ID: 0000-0002-6725-9004.
    Affiliations
    Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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  • Author Footnotes
    9 Orcid ID: 0000-0002-5958-8625.
    M. Necmettin Pamir
    Correspondence
    Corresponding author at: Beyin ve Sinir Cerrahisi Cerrahisi Departmanı, Acıbadem Üniversitesi, Altunizade, Yurtcan Sokağı No:1, 34662 Üsküdar/İstanbul, Turkey.
    Footnotes
    9 Orcid ID: 0000-0002-5958-8625.
    Affiliations
    Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
    Search for articles by this author
  • Author Footnotes
    1 Orcid ID: 0000-0001-5824-3249.
    2 Orcid ID: 0000-0001-9898-3807.
    3 Orcid ID: 0000-0002-3695-8400.
    4 Orcid ID: 0000-0001-8015-9916.
    5 Orcid ID: 0000-0002-2071-0419.
    6 Orcid ID: 0000-0002-3543-0401.
    7 Orcid ID: 0000-0002-0751-1802.
    8 Orcid ID: 0000-0002-6725-9004.
    9 Orcid ID: 0000-0002-5958-8625.

      Highlights

      • The crucial point of pineal region surgery is picking the ideal approach for the extend of the lesion maximizing removal while minimizing surgical morbidity.
      • Better anatomical knowledge is necessary for surgical excision of pineal lesions.
      • In this study, we aimed to combine our clinical experiences and anatomic trick points of parietooccipital interhemispheric transtentorial approach.

      Abstract

      Access to the pineal region has always been a challenge for neurosurgeons. The parietooccipital interhemispheric transtentorial approach is a slight variation of the traditional occipital transtentorial approach that provides adequate exposure to the lesions of the pineal region without introducing additional risks. In this study, the modified parietooccipital interhemispheric transtentorial approach is discussed including step-by-step anatomical cadaveric dissections and operative images. 27 adult patients (age > 18) who were operated over a 30-year period (1992–2022) by the senior author (M.N.P.) at two clinics, Marmara University, Department of Neurosurgery, Istanbul, Turkey and Acibadem Mehmet Ali Aydinlar University, Department of Neurosurgery, Istanbul, Turkey were analyzed. Only pineal region tumors were included in the analysis. Falcotentorial meningiomas and vascular lesions including cavernomas were excluded. 5 cadaveric specimens were dissected step by step following the surgical approach. Each step was documented using a Canon EOS 5D Mark II camera with Canon 100 mm Macro Lens. Step by step images of the dissections were presented including comparison with surgical images. Additional illustrations were used to describe the surgical corridor. The surgical corridor is maintained anterior to the parietooccipital sulcus along the medial of the precuneus. No retraction to the calcarine sulcus resulted in no postoperative hemianopsia. The neurovascular structures along the surgical corridor along with the nuances of the tentorium incision and splenium resection are discussed. The parietooccipital interhemispheric transtentorial approach provides a wide and safe corridor for surgical resection of pineal tumors.

      Keywords

      Abbreviations:

      CSF (Cerebrospinal Fluid), PPTID (Pineal parenchymal tumor of intermediate differentiation), PTPR (Papillary tumor of the pineal region), WHO (World Health Organization), SCIT (Supracerebellar infratentorial), MRI (Magnetic resonance imaging), VP (Ventriculoperitoneal)
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