Supracerebellar Trans-Tentorial Approach for Lesions in the Posterior Temporo-Mesial Region

Introduction: Lesions in the posterior temporomesial region are challenging to reach without damaging the surrounding brain. Typically, these lesions are approached through a subtemporal or a transcortical trans-temporal corridor. Because of the morbidity associated with these routes,we recently used a supracerebellar trans-tentorial (SCTT) approach.

Method: We retrospectively reviewed a series of patient operated through the SCTT approach since 2010. Lesions characteristic, localisation, extent of resection and surgical outcomes were reviewed.

Results: This series of 5 cases includes 1 left medial temporal avm,1medial temporal metastasis, and 3 large supratentorial tumors from the tentorium.Despite their large size, the approach permitted excellent exposure for gross total resection in all but one patient. There was no mortality and one patient developed a CSF fistula.

Conclusion: Large and highly vascular posterior temporo-mesial lesions can be safely and completely removed through a SCTT approach. The SCTT route represents a safe alternative to the subtemporal or trantemporal routes avoiding venous and temporal lobe damage. The surgical technique and limitations will be addressed.