SURGICAL STRATEGY FOR LARGE EXTRACEREBRAL SUBTENTORIAL TUMORS

Radical surgery over large subtentorial tumors is associated with a high risk of postoperative complications. Despite significant development of imaging technology, intraoperative monitoring, and microsurgical treatment, problems one of tottal and safe large subtentorial tumors removal remain unsolved. The most critical problem relating to large tumors of this localization is postoperative edema. Also brainstem ischemic stroke is not rare and this would partly due to the tumors overgrowthing the vertebral and basilar arteries. Retrospective analysis of 59 patients with large (more than 3 cm) tumors to the posterior cranial fossa operated over 2015-2019 yy. There was gross total tumor removal in 49 (83%) patients; subtotal tumor removal in 5 (8,5%) patients; partial tumor removal in 5 (8,5%) cases. Complications occurred in 15 (25%) patients. The use of ventral craniobasal aprroaches and their combination with posterior-lateral approaches to the large subtentorial tumors allows rapid and early, effective brain stem decompression and subsequent safe and total tumor removal. Ventral decompression of the brain stem structures (endoscopic endonasal and transoral approaches, presigmoid approach, extreme lateral approach) prevents neurological complications thus early patients activation. Postoperative mortality of 3 (5.0%) out of 59 patients can be reduced by intensifying perioperative patient's management.