Transtentorial Approach to Parahippocampal Lesions: A Technically Challenging Approach for Preserving Temporal Lobe...

In this installment of the Neurosurgical Atlas Series for WORLD NEUROSURGERY, the authors examine the paramedian supracerebellar transtentorial (SCTT) approach as a means of accessing the basal posteromedial temporal lobe for both intradural and extradural lesions. While other approaches, such as the subtemporal, transtemporal, and transsylvian routes, are often used to reach this otherwise impervious region, all of them do so at the expense of supratentorial structural integrity. Despite the long and narrow working distance provided by the SCTT approach, the access it provides to critical, deep-seated regions with little to no associated morbidity makes it our preferred approach in these patients. In this work, we highlight the perioperative considerations for this procedure, discuss the technical nuances of all aspects of the operation, and provide discussion on the approach in the context of its evolution and alternatives.