The extended supracerebellar transtentorial approach for resection of medial tentorial meningiomas
A 33-year-old female presented with severe headaches and an episode of receptive aphasia. MRI evaluation revealed a left medial tentorial meningioma associated with cerebral edema []. The tumor was situated completely in the supratentorial space. Angiography disclosed a relatively vascular tumor, not amenable to embolization []. Traditional subtemporal or transtemporal approaches were considered, as the vein of Labbe was posteriorly situated, but the risk of injury to the language cortex was likely due to the required brain retraction [].\nThrough a left hockey-stick incision, the SCTT route was used to remove the tumor []. The tentorium was coagulated early in the procedure and the tumor was devascularized. The anterior edge of the tentorium and the portion of the tumor protruding through the tentorial incisura were exposed during the initial portion of the operation. The early exposure of critical brainstem structures afforded by this approach allowed for early decompression of the brainstem and dissection and protection of the trochlear nerve []. The tumor was then debulked through the tentorium using an ultrasonic aspirator and microsurgically dissected from the surrounding vessels. Gross total resection was achieved and the patient did not suffer from any postoperative language or visual deficit. A 3-month MRI confirmed the intraoperative findings []. At 2-year follow-up, no tumor recurrence was present [].