• Motoki Tanikawa, Hiroshi Yamada, Tomohiro Sakata, Yasuhiko Hayashi, Yasuo Sasagawa, Tadashi Watanabe, Tetsuya Nagatani, and Mitsuhito Mase.
• Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: mtnkw@med.nagoya-cu.ac.jp.
• World Neurosurg. 2019 Nov 1; 131: 167-173.

ObjectiveRemoval of pineal region tumors, which are deeply placed and encircled by intricate neurovascular structures, is challenging to neurosurgeons. The aim of this study was to present our experience with the exclusive endoscopic occipital transtentorial approach (EEOTA) used for removal of pineal region tumors.MethodsA retrospective review was performed of patients who underwent surgery using the EEOTA to remove pineal region tumors from May 2016 to August 2018. The details of the EEOTA procedure were confirmed.ResultsFive patients underwent surgery via the EEOTA for treatment of pineal region tumors. In all cases, it was possible to perform the EEOTA less invasively through a keyhole craniotomy approximately 2.0-2.5 cm in size. The EEOTA produced an excellent view and provided natural and automatic orientation. There was essentially no blind spot in this procedure, even for the floor or ipsilateral wall of the third ventricle. Gross total resection was achieved in 4 cases. In the patient with atypical teratoid rhabdoid tumor, we abandoned gross total resection because of a hardened adhesion to the tectum and the great cerebral vein and its tributaries. Two patients presented with transient upper gaze palsy immediately after surgery but experienced complete recovery during the follow-up period.ConclusionsThe EEOTA is a very promising technique for removal of pineal region tumors and has the potential for extensive and routine application for surgeons familiar with endoscopic surgery.Copyright © 2019 Elsevier Inc. All rights reserved.

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