The Lateral Position--dependant Occipital Approach--to Pineal and Medial Occipitoparietal Lesions. Technical Note

A recent modification of the occipital transtentorial approach to the pineal region and medial-posterior hemisphere is described. The patient is operated upon in a lateral reclining (park bench) position with the side to undergo occipitoparietal craniotomy, slightly dependant. Following dural opening to the margins of the superior sagittal and lateral sinuses, gentle traction with a brain spatula facilitates the occipital transtentorial and transfalcine approach to the incisural region. Ventricular or spinal fluid drainage is often helpful. The occipital lobe falls away from the midline and falcotentorial regions by gravity. Absence of occipital parasagittal bridging veins is a helpful feature and careful convexity dural opening allows the occipital lobe to move laterally. Microsurgical treatment of pineal, splenial, falcotentorial and medial posterior hemisphere lesions may be greatly facilitated. Our experience with six cases is presented. To date, published results of this operative approach have been excellent with the risk of hemianopsia, parenchymal venous infarction, and air embolus much lessened or eliminated.