Surgical management of arteriovenous malformations that follow the tentorial ring

In a series of 200 intracranial arteriovenous malformations (AVMs) treated surgically, 33 malformations were situated very close to the tentorial incisura. All but one of these AVMs were totally removed. Four operative approaches were utilized in this group of patients: an interhemispheric approach for lesions of the medial hemispheres, splenium of the corpus callosum, and posterior 3rd ventricle; a subtemporal approach to the inferior and medial temporal lobe; a supracerebellar-infratentorial approach to anterodorsal cerebellum and quadrigeminal regions; and a subtemporal transtentorial exposure to the dorsolateral mesencephalon. There were no surgical deaths. Three patients had unsatisfactory outcomes. Our experience with this series indicates that deep cerebral AVMs in the region of the tentorial incisura may be safely removed if there is proper selection of operative approach and attention to surgical technique.