{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T04:29:32Z","timestamp":1741926572438,"version":"3.38.0"},"reference-count":7,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground<\/jats:title>\nPineal gland tumors are infrequent malignancies that predominantly manifest in children, comprising a mere 3\u201311% of all pediatric brain cancers and <1% of adult brain tumors. Pineal resection can be accessed through various approaches, most commonly the supracerebral infratentorial approach and the occipital transtentorial (OT) approach. Bilateral OT approach (BiOTA) on pineal gland complete resection allowed exposure and, therefore safer complete resection of the contralateral lesion, though the use is rarely reported before this case report.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThe patient was positioned in a prone\/Concorde position, with the operator alternating between the right and left sides. A lumbar cerebrospinal fluid drain was installed between the L3 and L4 vertebrae to induce brain relaxation. A linear midline incision was made, followed by occipital craniectomy using multiple burr holes to create a kite shape, and then, the bone flap was removed, and the dura mater was opened. The BiOTA was performed by first addressing the right side and then the left, completing the procedure by closing both sides of the tentorium.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nUsing BiOTA, we successfully achieved total removal of the tumor without postoperative visual disturbance, a common issue frequently reported with the use of the OT approach.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThe BiOTA is suitable for large pineal tumors with disturbed complete visualization of the tumors by cerebral falx that needed total resection.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_568_2024","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T01:54:45Z","timestamp":1741917285000},"page":"86","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining pineal gland tumor resection with bilateral occipital transtentorial approach: Technical insights"],"prefix":"10.25259","volume":"16","author":[{"given":"Muhammad Fakhri Raiyan","family":"Pratama","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Soeradji Tirtonegoro Hospital, Klaten, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wisnu","family":"Baskoro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Soeradji Tirtonegoro Hospital, Klaten, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel Jason","family":"Ganadhi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azriel Farrel Kresna","family":"Aditya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"10.25259\/SNI_568_2024\/ref-1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.3171\/2023.3.PEDS22468","article-title":"Outcomes and surgical approaches for pineal region tumors in children: 30 years\u2019 experience","volume":"32","author":"Cavalheiro","year":"2023","journal-title":"J Neurosurg Pediatr"},{"key":"10.25259\/SNI_568_2024\/ref-2","doi-asserted-by":"crossref","first-page":"503","DOI":"10.25259\/SNI_168_2021","article-title":"Occipital transtentorial approach for pineal region lesions: Addressing the controversies in conventional teaching","volume":"12","author":"Katyal","year":"2021","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_568_2024\/ref-3","doi-asserted-by":"crossref","first-page":"SHC1136","DOI":"10.1227\/01.NEU.0000333780.12058.44","article-title":"Comparison of posterior approaches to the posterior incisural space: Microsurgical anatomy and proposal of a new method, the occipital bi-transtentorial\/falcine approach","volume":"62","author":"Kawashima","year":"2008","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_568_2024\/ref-4","doi-asserted-by":"crossref","first-page":"E77","DOI":"10.1093\/ons\/opaa262","article-title":"Risk of brain herniation after craniotomy with preoperative lumbar spinal drainage: A single-surgeon experience of 365 patients among 3000 major cranial cases","volume":"20","author":"Lane","year":"2021","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"10.25259\/SNI_568_2024\/ref-5","doi-asserted-by":"crossref","first-page":"188","DOI":"10.3171\/2017.4.JNS162805","article-title":"Prevention of postoperative visual field defect after the occipital transtentorial approach: Anatomical study","volume":"129","author":"Matsuo","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_568_2024\/ref-6","first-page":"260","article-title":"Surgical considerations in the management of falcotentorial meningiomas: Advantages of the bilateral occipital transtentorial\/transfalcine craniotomy for large tumors","volume":"64","author":"Qui\u00f1ones-Hinojosa","year":"2009","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_568_2024\/ref-7","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.surneu.2008.04.013","article-title":"Use of lumbar drainage of cerebrospinal fluid for brain relaxation in occipital lobe approaches in children: Technical note","volume":"71","author":"Viswanathan","year":"2009","journal-title":"Surg Neurol"}],"container-title":["Surgical Neurology 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