title: Combined bi-occipital suboccipital transsinus transtentorial approach for resection of a pineal region falcotentorial meningioma: operative video and technical nuances.
abstract: Large deep-seated meningiomas of the falcotentorial region present a formidable surgical challenge. In this operative video, the author demonstrates the combined bi-occipital suboccipital transsinus transtentorial approach for microsurgical resection of a large falcotentorial meningioma. This approach involves division of the less dominant transverse sinus after assessment of the venous pressure before and after clipping of the sinus with continuous neurophysiologic monitoring. Mild retraction of the occipital lobe and cerebellum results in a wide supra- and infratentorial exposure of extensive pineal region tumors. This video atlas demonstrates the operative technique and surgical nuances, including patient positioning, supra- and infratentorial craniotomy, transsinus transtentorial incision, and tumor removal with preservation of the vein of Galen complex. In summary, the combined bi-occipital suboccipital transsinus transtentorial approach provides a wide supra- and infratentorial surgical corridor for removal of select falcotentorial meningiomas. The video can be found here: https://youtu.be/3aD8h2uwBAo .
authors.affiliation: Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D010871:Pinealoma / Q000175:diagnosis / Q000601:surgery*
keywords: bi-occipital suboccipital; combined supra- and infratentorial; falcotentorial meningioma; operative video; pineal region meningioma; technical nuances; transsinus transtentorial; video