Anatomy & Cell Biology

Table 4

Various surgical approaches for pineal gland tumours

No	Surgical approach	Location of lesion/tumour	Drawback/advantage
1	Supra- cerebellar-infratentorial [3, 10, 16]	Midline tumours which extend into the lower part of the posterior incisural space displacing the collicular plate and the cerebellum.	Most commonly used–
1	Supra- cerebellar-infratentorial [3, 10, 16]		Safe, effective and provides a better visualisation of deep venous system compared to other approaches
2	Occipital interhemispheric transtentorial [3, 10, 16]	Lesions–extending supratentorially, above vein of Galen, posteriorly into corpus callosum, cerebral hemisphere, thalamus and third ventricle provided the lesion is not extending into the opposite side or into the posterior fossa	Internal occipital vein–is at risk of injury while retraction leading to lateral homonymous hemianopia
2	Occipital interhemispheric transtentorial [3, 10, 16]		Even though the operating space can be enlarged by splitting the tentorium, the dissecting of deep veins is challenging as the operating space is still too less
3	Posterior transcallosal approach [3, 10, 16]	Atrium, glomus of choroid plexus extending into pulvinar part of thalamus	Approached through superior parietal lobule to reach the posterior incisural space
4	Posterior trans ventricular approach [3, 10, 16]	Splenium, above vein of Galen	Posterior incisural space is reached by dividing the splenium of corpus callosum
5	Combined supra and infra tentorial approach [3]	Tumours extending above and below the tentorium, tumours extending into venous structures and Vascular tumours that cannot be debulked prior to the capsule dissection	Increase the exposure space but it carries th risk of injuring the confluence of sinuses and non-dominant transverse sinus as well as the increased exposure time

Anat Cell Biol 2023;56:32~38 https://doi.org/10.5115/acb.22.051