Surgical aspects of pineal region tumors in children

The use of the operating microscope and specialized anesthesiologic techniques make it possible to operate safely on tumors in the pineal region. A survey is presented of the main surgical and anesthesiologic techniques used: the supracerebellar infratentorial approach in the sitting position and the occipital transtentorial approach in the semi-sitting position. For selecting the optimal approach a CT scan with sagittal sections is very important to localize the tumor in relation to the tentorium cerebelli, the straight sinus and the great vein of Galen. Based upon the comparison of the two techniques the author concludes that nearly all tumors in the pineal region in children can be operated by the infratentorial supracerebellar route and that the transtentorial route offers relatively little advantage.