The supracerebellar infratentorial approach in pineal region tumors: Technique and outcome in an underprivileged setting

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 21 March 2018

Figures & data

Table 1 Summary of cases in our series.

Case no	Age	Sex	Clinical	Pathology	Markers	ETV	VPS	Extent of resection	Surgical complications	Progression	PFS	Follow up
1	24	M	HC, Parinaud	PPID	(−)	Yes	No	STR	None	Yes	32.7	59.8
2	2	M	HC, DLC	Pineoblastoma	(−)	No	Yes	STR	Left occulomotor Palsy	Yes	3.0	33.1
3	9	M	HC, abducent palsy	Germinoma	(−)	No	Yes	STR	None	No	48.1	48.1
4	15	M	HC, blurring of vision	Germinoma	(−)	No	No	STR	None	No	48.9	48.9
5	16	M	HC, DLC, quadriparetic	Anaplastic Astrocytoma	(−)	Yes	No	Partial resection	None	Yes	41.6	41.6
6	13	M	HC, DLC	Grade 2 tectal glioma	(−)	No	Yes	Partial resection	Severe cerebellar edema → decompressive craniectomy	No	18.7	18.7
7	20	F	HC, Parinaud, DLC	Anaplastic ependymoma	(−)	Yes	No	STR	None	Yes	12.2	16.7
8	52	M	HC, Dementia	Pineocytoma	(−)	No	No	GTR	None	No	31.8	31.8
9	9	M	HC, vomiting, Parinaud	Grade 2 tectal glioma	(−)	No	Yes	Partial resection	None	No	12.8	12.8
10	3	M	HC, vomiting, ataxia, Parinaud	Anaplastic ependymoma	(−)	No	Yes	STR	None	Yes	9.0	18.6
11	14	M	HC, DLC	Germinoma	(+)	Yes	No	GTR	None	No	15.1	15.1
12	9	M	HC, DLC	Pilomyxoid astrocytoma	(−)	No	Yes	GTR	None	No	15.1	15.1
13	10	F	HC, head tilt and abducent palsy	Pilocytic Astrocytoma	(−)	Yes	Yes	STR	Severe cerebellar edema treated by decompressive craniectomy	No	20.6	20.6
14	4	M	HC, Parinaud	Pineoblastoma	(−)	Yes	No	GTR	Pseudomeningocele	No	12.0	12.0
15	15	M	HC, Parinaud	Anaplastic astrocytoma	(−)	No	Yes	Partial resection	Hemorrhage treated conservatively	No	13.3	24.3

HC: hydrocephalus, DLC: Disturbed level of consciousness, PPID: Pineal parenchymal tumor with intermediate differentiation, ETV: Endoscopic third ventriculostomy, VPS: Ventriculoperitoneal shunt, STR: subtotal resection, GTR: gross total resection, PFS progression free survival.

Fig. 1 The concord position we used using simple doughnut head-rest in our approach.

Fig. 2 Exposure of the transverse sinus and the confluence of sinuses after the craniotomy procedure.

Fig. 3 The surgical exposure after durotomy, drainage of CSF from the cisterna magna and adequate dehydration.