Surgical treatment of posterior fossa tumors via the occipital transtentorial approach: evaluation of operative safety and results in 14 patients with anterosuperior cerebellar tumors

Object. To determine the safety and usefulness of performing surgery via th e occipital transtentorial approach to treat anterosuperior cerebellar tumo rs, evaluation of 14 patients was performed over a 5-year period. Methods. The study was performed in 14 patients, aged 6 months to 71 years, who harbored anterosuperior cerebellar tumors of the posterior fossa inclu ding four hemangioblastomas, three cerebellar astrocytomas, three medullobl astomas, two metastatic tumors, one recurrent astrocytoma, and one rhabdoid cell tumor. All patients underwent surgical treatment by the same surgical team and via the same surgical approach. Endoscopy combined with neuronavi gation was used for large, deep-seated tumors extending to the fourth ventr icle. Of the 14 patients, total or gross-total removal was achieved in 12 p atients and subtotal removal in two patients. There was no incidence of mor tality or morbidity in the 14 patients, and all functional outcomes were go od to excellent postoperatively. Postoperative magnetic resonance imaging r evealed that none of the patients had suffered brain damage or infarction a round the cerebellum, brainstem, or occipital lobe. Conclusions. Although this study was the first in which a specific examinat ion of the efficacy of the occipital transtentorial approach in patients wi th anterosuperior cerebellar tumors was undertaken, our findings suggest th at this surgical approach is very useful, safe, and accurate for removing t he primary tumor and evaluating the surrounding anatomy, as well as for det ermining operative strategy.