• Filip Milisavljević, Rosanda Ilić, Ivan Bogdanović, Jelena Milin-Lazović, Aleksandar Miljković, Mihailo Milićević, Vuk Šćepanović, Aleksandar Stanimirović, Tijana Nastasović, Igor Lazić, Marija Jovanović, and Danica Grujičić.
• Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia. Electronic address: milisavljevic93@gmail.com.
• World Neurosurg. 2024 Aug 1; 188: e531e539e531-e539.

ObjectiveThis research aimed to determine whether an adequate surgical approach can be chosen based on clearly defined values of anatomical landmarks (tentorial angle) and tumor size and extension.MethodsWe conducted a retrospective analysis of patients operated on because of pineal tumors. The cohort was divided depending on the surgical approach. On preoperative magnetic resonance imaging, we measured maximal diameters, tumor volume, and tumor propagation. In the group of patients operated with the supracerebellar infratentorial approach, we also tested the correlation of tentorial angle with residual tumor. Differences among groups in resection, complications rate, and outcome were tested by the χ2 test. Finally, in both groups, the correlation of residual tumor with tumor volume, propagation, and diameters was tested using the receiver operating characteristic curve.ResultsIn the group operated with a supracerebellar approach, total resection was achieved in 78% of the patients. The critical value of cranio-caudal diameter correlated with tumor residue was 31 mm, for lateral-lateral diameter 25 mm, for the lateral extension 14 mm, and tumor volume 12 cm3. Tentorial angle did not influence the extent of the resection. In the group operated with an occipital transtentorial approach, the critical tumor volume related to tumor residue was 9 mm3, anterior-posterior diameter 29 mm, and cranio-caudal diameter 28 mm. The extent of the resection was significantly higher in the supracerebellar group.ConclusionsIn both approaches, tumors larger than 3 cm show an increased risk of subtotal resection. Except when most tumor volume is localized above the venous system, we advocate a supracerebellar corridor as an effective approach that is not limited by tentorial angle.Copyright © 2024 Elsevier Inc. All rights reserved.

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