title: Supracerebellar transtentorial approach-resection of the tentorium instead of an opening-to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications: clinical article.
abstract: OBJECTIVE
  The aim of this study was to describe the surgical anatomy of the mediobasal aspect of the temporal lobe and the supracerebellar transtentorial (SCTT) approach performed not with an opening, but with the resection of the tentorium, as an alternative route for the neurosurgical management of vascular and tumoral lesions arising from this region.
  
  
  METHODS
  Cadaveric specimens were used to illustrate the surgical anatomy of the mediobasal region of the temporal lobe. Demographic aspects, characteristics of lesions, clinical presentation, surgical results, follow-up findings, and outcomes were retrospectively reviewed for patients referred to receive the SCTT approach with tentorial resection.
  
  
  RESULTS
  Ten patients (83%) were female and 2 (17%) were male. Their ages ranged from 6 to 59 years (mean 34.5 ± 15.8 years). All lesions (3 posterior cerebral artery aneurysms, 3 arteriovenous malformations, 3 cavernous malformations, and 3 tumors) were completely excluded or resected. After a mean follow-up period of 143 months (range 10-240 months), the mean postoperative Glasgow Outcome Scale score was 4.9.
  
  
  CONCLUSIONS
  Knowledge of the surgical anatomy provides improvement for microsurgical approaches. The evolution from a small opening to a resection of the tentorium absolutely changed the exposure of the mediobasal aspect of the temporal lobe. The SCTT approach with tentorial resection is an excellent alternative route to the posterior part of mediobasal aspect of the temporal lobe, and it was enough to achieve the best neurosurgical management of tumoral and vascular lesions located in this area.
authors.affiliation: Institute of Neurological Sciences, Hospital Beneficência Portuguesa de São Paulo, Brazil.
authors.forename: Jean G
authors.initials: JG
authors.lastname: de Oliveira
authors.forename: Richard Gonzalo
authors.initials: RG
authors.lastname: Párraga
authors.forename: Feres
authors.initials: F
authors.lastname: Chaddad-Neto
authors.forename: Guilherme Carvalhal
authors.initials: GC
authors.lastname: Ribas
authors.forename: Evandro P L
authors.initials: EP
authors.lastname: de Oliveira
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D002426:Cavernous Sinus / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D002648:Child; D003399:Craniotomy / Q000379:methods*; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D055815:Young Adult