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Published on: August 11, 2015
The occipital interhemispheric transtentorial approach in infants and toddlers: efficacy and complications
Ashley Ricciardelli1,2, Rita Snyder1,2, William E Whitehead1,2
1Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Insights
The occipital interhemispheric transtentorial (OITT) approach is safe and effective for resecting brain tumors in children under 36 months. This technique achieved gross total resection with no major complications in a recent institutional study.
Area of Science:
- Pediatric Neurosurgery
- Surgical Oncology
- Neuroradiology
Background:
- Tumor resection in young children necessitates optimal surgical approaches for maximal resection and minimal morbidity.
- The occipital interhemispheric transtentorial (OITT) approach offers excellent exposure for pineal and superior cerebellar tumors but has raised safety concerns in infants.
- This study evaluates the OITT approach's efficacy and safety in very young pediatric patients.
Purpose of the Study:
- To assess the safety and effectiveness of the occipital interhemispheric transtentorial (OITT) approach for brain tumor resection in children aged 36 months or younger.
- To characterize the institutional experience with OITT in infants and toddlers, focusing on surgical outcomes and complications.
Main Methods:
- Retrospective analysis of pediatric patients (<36 months) undergoing OITT for tumor resection between 2016-2023.
- Inclusion criteria: minimum 3 months follow-up and postoperative MRI.
- Primary outcomes: extent of resection, complications, neurologic status; Secondary outcomes: length of stay, blood loss.
Main Results:
- Eight patients (median age 10 months) underwent OITT with stereotactic guidance.
- All patients achieved gross total resection without intraoperative complications or permanent neurologic deficits.
- No new ischemia in the cerebellum, brainstem, or occipital lobe was observed postoperatively.
Conclusions:
- The occipital interhemispheric transtentorial (OITT) approach is a viable and safe surgical strategy for tumor resection in very young children (≤36 months).
- This approach demonstrated an acceptable safety profile with no significant intraoperative or postoperative complications in the studied cohort.
- This is the first report detailing the OITT technique specifically for patients under 36 months of age.
Introduction:
Outcomes for pineal region and superior cerebellar tumors in young children often hinge on extent of microsurgical resection, and thus choosing an approach that provides adequate visualization of pathology is essential. The occipital interhemispheric transtentorial (OITT) approach provides excellent exposure while minimizing cerebellar retraction. However, this approach has not been widely accepted as a viable option for very young children due to concerns for potential blood loss when incising the tentorium. The aim of this paper is to characterize our recent institutional experience with the occipital interhemispheric transtentorial approach (OITT) for tumor resection in infants and toddlers.
Methods:
A retrospective study was performed between 2016 and 2023 of pediatric patients less than 36 months of age who underwent OITT for tumor resection at a high-volume referral center. Patients with at least 3 months of postoperative follow-up and postoperative MRI were included. Primary outcomes included extent of resection, intraoperative and postoperative complications, and neurologic outcome. Secondary outcomes included length of stay and estimated blood loss.
Results:
Eight patients, five male, were included. The median age at the time of surgery was 10 months (range 5-36 months). Presenting symptoms included macrocephaly, nausea/vomiting, strabismus, gait instability, or milestone regression. Hydrocephalus was present preoperatively in all patients. Average tumor volume was 38.6 cm3, ranging from 1.3 to 71.9 cm3. All patients underwent an OITT approach for tumor resection with stereotactic guidance. No intraoperative complications occurred, and no permanent neurologic deficits developed postoperatively. Gross total resection was achieved in all cases per postoperative MRI report, and no instances of new cerebellar, brainstem, or occipital lobe ischemia were noted.
Conclusions:
OITT approach for tumor resection in very young children (≤ 36 months) is an effective strategy with an acceptable safety profile. In our series, no significant intraoperative or postoperative complications occurred. To our knowledge, this is the first report describing this technique specifically in patients less than 36 months of age.
