Supracerebellar highway-fast and safe road to pediatric pineal tumor resection

Pineal tumors are rare and heterogeneous neoplasms that are more common in the pediatric population. Numerous limitations have resulted in the paucity of articles regarding the supracerebellar approach to these tumors in children. This study aims to present single-center experiences with a supracerebellar approach to pediatric pineal tumors and provide a thorough analysis regarding surgical technique, feasibility, safety, and resection rate.

We retrospectively analyzed patients operated by the supracerebellar infratentorial approach in the Neurosurgery Clinic, University Clinical Center of Serbia, from 2008 to 2021. Standard demographic data and data regarding tumor properties, hydrocephalus, and course of disease were collected and statistically analyzed.

The male sex was predominant. Most patients had hydrocephalus at presentation, and most required an initial diversion procedure. Only one patient had a biopsy safely conducted. Tumor volume, lateral propagation, and position superior to the venous system were significantly correlated with tumor residue. Tentorial angle was not a limiting factor in resection. Two patients had air embolism, and one surgery was discontinued. We observed no morbidity related to air embolism or venous injury.

The supracerebellar infratentorial approach is a simple, safe, and effective approach for pineal tumors localized below or dominantly below the deep veins. A steep tentorial angle is not a contraindication for this approach, but volume and lateral extension represent significant factors for subtotal resection. Very young age and other limitations for sitting positions are indications for one of the supratentorial approaches.