Supracerebellar transtentorial approach to the parahippocampal gyrus

The supracerebellar transtentorial technique (SCTT) is a versatile approach that grants access to medial and basal temporal (MBT) regions without transgressing normal lateral cortex, damaging the hippocampus, or requiring significant brain retraction. This video illustrates the SCTT in resecting a cavernous malformation within the parahippocampal gyrus to alleviate associated epilepsy and preserve cognition. The authors outline the anatomical considerations, alternative approaches, positioning, craniotomy, and dural opening. They demonstrate how to access the supracerebellar space, elevate the dura toward the tentorial incisura, and resect the malformation. This video serves as a practical reference for management of MBT lesions via minimally invasive procedures.