Paramedian supracerebellar transtentorial approach for a medial tentorial meningioma with supratentorial extension: Technical case report

OBJECTIVE AND IMPORTANCE: The choice of surgical approach to treat medial t entorial meningiomas is crucial and sometimes difficult to make. Although t he subtemporal approach is most commonly used for lesions that extend mostl y supratentorially, it risks injury to the vein of LAW or the veins coursin g along the subtemporal surface. To avoid venous injury, a medial tentorial meningioma was removed transtentorially through the infratentorial space v ia the paramedian supracerebellar transtentorial (PSCTT) approach. CLINICAL PRESENTATION: A 35-year-old right-handed woman presented with a ge neralized convulsion. Magnetic resonance imaging scans revealed a left medi al tentorial meningioma with supratentorial extension at the dominant hemis phere. The main venous drainage route from the ipsilateral temporal lobe wa s a sphenopetrosal vein. INTERVENTION: An operation was performed with the patient in a sitting posi tion, and the tumor was resected totally via the paramedian supracerebellar transtentorial approach without perioperative complications. CONCLUSION: The paramedian supracerebellar transtentorial approach is usefu l for supratentorially located medial tentorial meningiomas without retract ion of the temporal lobe and without damage to the vein of LAW or the sphen opetrosal vein.