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Anatomical Assessment on Endoscopic Occipital Transtentorial Approach for Pineal Region Tumors
Ryota Fujinami1, Motoki Tanikawa1, Hiroshi Yamada1
1Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Background:
With recent advancements in neuroendoscopic surgery enabling smaller openings, the role of preoperative evaluation has become increasingly important. Endoscopic surgery has demonstrated particular efficacy in the occipital transtentorial approach (OTA) for pineal region tumors. This study evaluated anatomical factors influencing endoscopic OTA performance and established criteria for optimal side selection.
Methods:
This retrospective study included 150 patients who underwent venous-phase head computed tomography angiography between November 2020 and March 2022. Venous sinus configurations and their relationships with falx cerebri and tentorium cerebelli were evaluated. Surgical parameters, including occipital lobe retraction, operative axis angle, and tentorial incision, were measured and statistically analyzed. The optimal endoscopic OTA side was determined based on falx deviation and transverse sinus (TS) laterality.
Results:
Occipital lobe retraction was significantly reduced when approaching from the side of falx deviation, with leftward deviation in 70% and rightward in 30%. TS laterality was identified in 78%; approaching from the nondominant side allowed for smaller operative axis angles but required longer tentorial incisions. The falx deviated toward the nondominant TS side with an odds ratio of 6.55, and the optimal endoscopic OTA side was left in 61.3%. Superior sagittal sinus splitting with falx attachment to the dominant branch was found in 10.7%, and these patients required longer occipital lobe retraction even on the optimal side.
Conclusions:
This study reported that anatomical variations, including falx deviation, TS laterality, and superior sagittal sinus splitting, significantly influence endoscopic OTA feasibility. These results may contribute to optimizing endoscopic surgical strategies.
Insights
Anatomical variations like falx deviation and transverse sinus laterality significantly impact endoscopic occipital transtentorial approach (OTA) feasibility. Understanding these factors optimizes surgical strategies for pineal region tumors.
Area of Science:
- Neurosurgery
- Medical Imaging
- Surgical Anatomy
Background:
- Advancements in neuroendoscopic surgery necessitate improved preoperative evaluation.
- Endoscopic surgery, particularly the occipital transtentorial approach (OTA), shows efficacy for pineal region tumors.
Purpose of the Study:
- Evaluate anatomical factors influencing endoscopic OTA.
- Establish criteria for optimal side selection in endoscopic OTA.
Main Methods:
- Retrospective analysis of 150 venous-phase head CT angiographies.
- Evaluation of venous sinus configurations, falx cerebri, and tentorium cerebelli.
- Measurement and statistical analysis of surgical parameters (occipital lobe retraction, operative axis angle, tentorial incision).
Main Results:
- Falx deviation (70% leftward) reduced occipital lobe retraction.
- Non-dominant side approach yielded smaller operative angles but longer tentorial incisions.
- Falx deviation correlated with non-dominant transverse sinus (OR 6.55); left OTA optimal in 61.3%.
Conclusions:
- Anatomical variations (falx deviation, transverse sinus laterality, superior sagittal sinus splitting) significantly affect endoscopic OTA feasibility.
- Results aid in optimizing endoscopic surgical strategies for pineal region tumors.
