Basic surgical nuances of the occipital transtentorial approach

Abstract

Here, we summarize the surgical nuances of the occipital transtentorial approach (OTA). OTA provides wider access and good visualization of the dorsal midbrain or pineal lesions. On the other hand, postoperative temporary or permanent visual field deficits are the most frequent complications. To avoid such complications, selection of the appropriate side to avoid venous congestion by excessive retraction of the occipital lobe, wide dissection of interhemispheric fissure, gentle retraction and anatomical-mechanical protection of the occipital lobe, careful dissection of the arachnoid around the lesion, and patient monitoring using visual evoked potentials are important technical points to consider. Midbrain injury and venous injury can also cause serious neurological deficits and should be avoided by employing meticulous technique. The importance of careful imaging analysis prior to surgery, appropriate anatomical knowledge, and meticulous surgical technique are also stressed.