Transtentorial approach to posterior temporomedial structures

The supracerebellar transtentorial (SCTT) approach, a modification of the i nfratentorial supracerebellar approach, facilitates simple and minimally in vasive access to posterior temporomedial. structures without requiring retr action of the temporal or occipital lobe. The SCTT approach was used in 16 patients over a 3-year period. Eleven pati ents harbored tumors confined to, or located mainly within, the posterior h ippocampal formation, three patients harbored aneurysms (one ruptured poste rior cerebral artery [PCA] aneurysm at the P-2-P-3 junction, one ruptured g iant PCA [P-2] aneurysm, and one Giant basilar artery-superior cerebellar a rtery aneurysm), one patient had juvenile-type moyamoya disease, and one pa tient suffered from medically intractable epilepsy. In these patients, the SCTT approach enabled tumor removal, aneurysm clipping, and vascular bypass procedures. The authors' experience suggests that this approach can be used routinely i n treating lesions in the posterior temporomedial region.