title: How I do it--pineal surgery: supracerebellar infratentorial versus occipital transtentorial.
abstract: BACKGROUND
  Resection of a pineal tumour requires fastidious pre-operative planning to select the optimal surgical approach and maximise resection while minimising morbidity.
  
  
  METHODS
  To describe and compare the supracerebellar infratentorial and occipital transtentorial approaches.
  
  
  CONCLUSIONS
  Specific considerations include patient-specific anatomy, extent and relationships of the tumour, and the techniques likely to be employed during resection. The supracerebellar infratentorial approach provides a direct corridor to pineal tumours caudal to the deep veins; for tumours invaginating the tectal plate in a caudal direction the occipital transtentorial provides a better view.
authors.affiliation: Department of Neurosurgery, Division of Neurosciences, Addenbrooke's Hospital, Box 166, Cambridge, CB2 0QQ, UK. mikehart82@me.com
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hart
authors.forename: Thomas
authors.initials: T
authors.lastname: Santarius
authors.forename: Ramez W
authors.initials: RW
authors.lastname: Kirollos
mesh_terms: D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002531:Cerebellum / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods; D004210:Dissection / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008866:Microsurgery / Q000379:methods*; D009777:Occipital Bone / Q000601:surgery*; D010870:Pineal Gland / Q000473:pathology / Q000601:surgery*; D010871:Pinealoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*