title: [Supracerebellar transtentorial approach to tumors of the posterior portions of the medial temporal region].
abstract: Despite the advances in microsurgery, the choice of the most adequate approach to the posterior part of the medial temporal region (MTR) remains a very controversial issue. The supracerebellar transtentorial approach (STA) is considered as the most preferable one, since it provides the optimal balance between retraction, incision, and resection of the brain tissue. Here, we present our consecutive series of 20 patients who underwent STA surgery.
  
  
  
  Twenty patients with glial tumors affecting the posterior MTR underwent STA surgery between 2006 and 2014. The mean age of the patients was 20 years. Benign tumors were predominant (18 out of 20 cases).
  
  
  
  Resection of the posterior and middle MTRs was conducted in 16 cases. The anterior MTR was accessed through STA in 1 patient only; in 2 patients, STA was combined with the infraoccipital approach. Cerebellar edema occurred in 4 patients, with hemiparesis persisting in one of the cases for 1 year after surgery. Of 8 patients with drug resistant epilepsy, the Engel class 1 or 2 outcome was achieved in 6 cases within 1 year after surgery.
  
  
  
  STA provides an excellent surgical route to the posterior and middle MTR portions; however, the anterior MTR portions cannot be reached safely. The operative risks of STA increase as the surgeon proceeds with resection of the anterior MTR portions. Anterior MTR structures can be removed using a combination of the supracerebellar and infraoccipital transtentorial approaches or two-stage resection.
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: A N
authors.initials: AN
authors.lastname: Konovalov
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: D I
authors.initials: DI
authors.lastname: Pitskhelauri
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: A G
authors.initials: AG
authors.lastname: Melikyan
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: L V
authors.initials: LV
authors.lastname: Shishkina
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: N K
authors.initials: NK
authors.lastname: Serova
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: I N
authors.initials: IN
authors.lastname: Pronin
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: N M
authors.initials: NM
authors.lastname: Eliseeva
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: A M
authors.initials: AM
authors.lastname: Shkatova
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: D Ya
authors.initials: DY
authors.lastname: Samborskiy
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: A E
authors.initials: AE
authors.lastname: Bykanov
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: A L
authors.initials: AL
authors.lastname: Golovteev
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: O A
authors.initials: OA
authors.lastname: Grinenko
authors.affiliation: Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: D N
authors.initials: DN
authors.lastname: Kopachev
mesh_terms: D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000601:surgery*; D001929:Brain Edema / Q000209:etiology*; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009778:Occipital Lobe / Q000601:surgery; D010291:Paresis / Q000209:etiology*; D013702:Temporal Lobe / Q000601:surgery*