• Tao Xie, Chenghui Qu, Xiaobiao Zhang, Qiaoqiao Yang, Yuyang Yeh, Chen Li, Tengfei Liu, Shuang Liu, Zeyang Li, Fan Hu, Liangliang Yang, and Hantao Yang.
• Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China.
• World Neurosurg. 2022 Dec 1; 168: 637363-73.

ObjectiveThis study was to analyze the advantages and disadvantages of endoscopic midline and paramedian supracerebellar infratentorial approaches (EM-SCITA and EPM-SCITA) for pineal region tumors.MethodsWe retrospectively analyzed the clinical data of 58 patients who underwent EM-SCITA and EPM-SCITA for pineal region tumors. Among them, 23 patients were treated with EM-SCITA, and 35 with EPM-SCITA. The patients were followed up for 6-84 months with magnetic resonance imaging and Karnofsky Performance Status scores.ResultsThe average age of the patients was 37.98 years, and there were 16 women (27.6%). The average maximum diameter of the tumors was 2.92 cm. Gross total resection was achieved in 46 patients (79.31%). There were 45 patients (77.6%) whose Karnofsky Performance Status score was >70 at the final follow-up. There was no significant difference among the above items between EM-SCITA and EPM-SCITA. However, EM-SCITA required a longer craniotomy and closure time, with a larger bone and dural flap, with more bridging veins sacrificed. EPM-SCITA simplified the opening of the quadrigeminal cistern, and it was beneficial to expose the contralateral wall of the third ventricle. The longer and angled path limited the exposure of the anterior third ventricle and the ipsilateral wall of the third ventricle.ConclusionsBoth approaches had remarkable clinical effects. The anatomy of EM-SCITA was easy to understand and has a larger operating space; it is suitable for neurosurgical beginners. In contrast, EPM-SCITA has limited operation space, an intricate anatomy, and is suitable for experienced operators. The occurrence of postoperative hydrocephalus should be alerted by EPM-SCITA.Copyright © 2022. Published by Elsevier Inc.

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