{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:27Z","timestamp":1776096387924,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,16]]},"abstract":"\n BACKGROUND<\/jats:title>\n Midbrain-thalamic cavernous malformations located adjacent to eloquent neurovascular structures are surgically challenging. The authors evaluated the feasibility and safety of the endoscopic occipital transtentorial transrecess approach (EOTTA) for resection of these lesions.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 51-year-old woman presented with headache and acute, nonprogressive left hemiparesis. Imaging showed a 2.1 \u00d7 1.8 \u00d7 1.7\u2013cm lesion at the right thalamus-midbrain junction consistent with a cavernous malformation; preoperative diffusion tensor imaging (DTI) tractograms fused with neuronavigation delineated corticospinal tracts and informed corridor planning. Through use of a lateral decubitus, gravity-assisted approach, a paramedian occipital craniotomy and a tentorial incision were performed 1 cm below the straight sinus to provide a transrecess route into the third ventricle. High-definition endoscopy and neuronavigation guided staged intertumoral debulking and gross-total resection in 110 minutes with 20 mL of blood loss. Postoperative imaging confirmed gross-total resection; the patient recovered full strength and resumed normal activities by 3 months.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n EOTTA, combined with DTI-guided neuronavigation and endoscopic magnification, can permit safe, effective resection of selected midbrain-thalamic cavernous malformations while minimizing cortical retraction and injury to critical tracts.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25537<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25537","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:47:26Z","timestamp":1771847246000},"source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic occipital transtentorial transrecess approach for resection of a challenging midbrain-thalamic cavernous malformation: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Shuang","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailong","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qilu Hospital (Qingdao) of Shandong University, Qingdao, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chongjin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qilu Hospital (Qingdao) of Shandong University, Qingdao, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiaoqiao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhigang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qilu Hospital (Qingdao) of Shandong University, Qingdao, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaobiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Neurosurgery","first-page":"265","article-title":"Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes","volume":"76","author":"Garcia","year":"2015","unstructured":"Garcia RMIvan MELawton MT.Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes. Neurosurgery. 2015;76(3):265-278."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"676","article-title":"The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes","volume":"123","author":"Rangel-Castilla","year":"2015","unstructured":"Rangel-Castilla LSpetzler RF.The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes. J Neurosurg. 2015;123(3):676-685."},{"issue":"3","key":"bib3","series-title":"J Neurosurg","first-page":"814","article-title":"Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes. Clinical article","volume":"114","author":"Chang","year":"2011","unstructured":"Chang EFGabriel RAPotts MBBerger MSLawton MT.Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes. Clinical article. J Neurosurg. 2011;114(3):814-827."},{"key":"bib4","series-title":"World Neurosurg","first-page":"19","article-title":"Neuronavigation-guided transcortical-transventricular endoport-assisted endoscopic resection for thalamic lesions: preliminary experience","volume":"166","author":"Liu","year":"2022","unstructured":"Liu SWu SXie TNeuronavigation-guided transcortical-transventricular endoport-assisted endoscopic resection for thalamic lesions: preliminary experience. World Neurosurg. 2022;166:19-27."},{"issue":"6","key":"bib5","series-title":"Neurosurg Rev","first-page":"3817","article-title":"Endoscopic resection of thalamic lesions via supracerebellar infratentorial approach: a case series and technical note","volume":"45","author":"Liu","year":"2022","unstructured":"Liu SXie TWu SEndoscopic resection of thalamic lesions via supracerebellar infratentorial approach: a case series and technical note. Neurosurg Rev. 2022;45(6):3817-3827."},{"key":"bib6","series-title":"World Neurosurg","first-page":"63","article-title":"Endoscopic midline and paramedian supracerebellar infratentorial approaches to pineal region tumors: a clinical study and approach comparison","volume":"168","author":"Xie","year":"2022","unstructured":"Xie TQu CZhang XEndoscopic midline and paramedian supracerebellar infratentorial approaches to pineal region tumors: a clinical study and approach comparison. World Neurosurg. 2022;168:63-73."},{"issue":"6","key":"bib7","series-title":"J Clin Neurosurg","first-page":"601","article-title":"Endoscopic anatomy of occipital transtentorial transpineal-recess approach for third ventricle","volume":"21","author":"Xie","year":"2024","unstructured":"Xie TSun CZhang XEndoscopic anatomy of occipital transtentorial transpineal-recess approach for third ventricle. J Clin Neurosurg. 2024;21(6):601-606, 611."},{"issue":"2","key":"bib8","series-title":"Neurosurg Rev","first-page":"1017","article-title":"Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study","volume":"44","author":"Xin","year":"2021","unstructured":"Xin CXiong ZYan XEndoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study. Neurosurg Rev. 2021;44(2):1017-1022."},{"key":"bib9","series-title":"World Neurosurg","first-page":"e334","article-title":"The purely endoscopic supracerebellar infratentorial approach for resecting pineal region tumors with preservation of cerebellomesencephalic vein: technical note and preliminary clinical outcomes","volume":"128","author":"Gu","year":"2019","unstructured":"Gu YZhou QZhu WThe purely endoscopic supracerebellar infratentorial approach for resecting pineal region tumors with preservation of cerebellomesencephalic vein: technical note and preliminary clinical outcomes. World Neurosurg. 2019;128:e334-e339."},{"key":"bib10","series-title":"World Neurosurg","first-page":"123460","article-title":"Endoscopic occipital transtentorial approach for dorsal midbrain cavernous malformation: technical notes with illustrative case","volume":"194","author":"Liu","year":"2025","unstructured":"Liu SSun CChen PEndoscopic occipital transtentorial approach for dorsal midbrain cavernous malformation: technical notes with illustrative case. World Neurosurg. 2025;194:123460."},{"issue":"3","key":"bib11","series-title":"Neurosurgery","first-page":"689","article-title":"Quality of life after brainstem cavernoma surgery in 71 patients","volume":"69","author":"Dukatz","year":"2011","unstructured":"Dukatz TSarnthein JSitter HQuality of life after brainstem cavernoma surgery in 71 patients. 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J Neurosurg. 2016;125(6):1596-1607."},{"issue":"5","key":"bib16","series-title":"J Neurosurg","first-page":"1359","article-title":"Microsurgical anatomy of safe entry zones to the brainstem","volume":"124","author":"Cavalcanti","year":"2016","unstructured":"Cavalcanti DDPreul MCKalani MYSSpetzler RF.Microsurgical anatomy of safe entry zones to the brainstem. J Neurosurg. 2016;124(5):1359-1376."},{"issue":"5","key":"bib17","series-title":"Oper Neurosurg","first-page":"557","article-title":"One-point technique in brainstem cavernous malformation surgery: evaluation of approaches and outcomes from a different perspective","volume":"27","author":"Prashant","year":"2024","unstructured":"Prashant GNDehdashti AR.One-point technique in brainstem cavernous malformation surgery: evaluation of approaches and outcomes from a different perspective. Oper Neurosurg. 2024;27(5):557-565."},{"issue":"1","key":"bib18","series-title":"Acta Neurochir (Wien)","first-page":"45","article-title":"Colloid cyst of the third ventricle. Evaluation of 28 cases of colloid cyst of the third ventricle operated on by transcortical transventricular (25 cases) and transcallosal\/transventricular (3 cases) approaches","volume":"138","author":"G\u00f6kalp","year":"1996","unstructured":"G\u00f6kalp HZY\u00fcceer NArasil EErdogan ADincer CBaskaya M.Colloid cyst of the third ventricle. Evaluation of 28 cases of colloid cyst of the third ventricle operated on by transcortical transventricular (25 cases) and transcallosal\/transventricular (3 cases) approaches. Acta Neurochir (Wien). 1996;138(1):45-49."},{"issue":"4","key":"bib19","series-title":"Neurosurgery","first-page":"879","article-title":"Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results","volume":"46","author":"Winkler","year":"2000","unstructured":"Winkler PAIlmberger JKrishnan KGReulen HJ.Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results. 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Oper Neurosurg. 2024;27(2):187-193."},{"issue":"3-4","key":"bib22","series-title":"World Neurosurg","first-page":"409","article-title":"The occipital interhemispheric transtentorial approach for superior vermian, superomedian cerebellar, and tectal arteriovenous malformations: advantages, limitations, and alternatives","volume":"82","author":"McLaughlin","year":"2014","unstructured":"McLaughlin NMartin NA.The occipital interhemispheric transtentorial approach for superior vermian, superomedian cerebellar, and tectal arteriovenous malformations: advantages, limitations, and alternatives. World Neurosurg. 2014;82(3-4):409-416."},{"issue":"3","key":"bib23","series-title":"Neurosurgery","first-page":"554","article-title":"Occipital transtentorial approach to the precentral cerebellar fissure and posterior incisural space","volume":"65","author":"Moshel","year":"2009","unstructured":"Moshel YAParker ECKelly PJ.Occipital transtentorial approach to the precentral cerebellar fissure and posterior incisural space. Neurosurgery. 2009;65(3):554-564."},{"key":"bib24","series-title":"World Neurosurg","first-page":"e260","article-title":"Endoscopic high occipital interhemispheric transtentorial approach for lesions in the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem","volume":"159","author":"Tanikawa","year":"2022","unstructured":"Tanikawa MSakata TYamada HEndoscopic high occipital interhemispheric transtentorial approach for lesions in the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem. World Neurosurg. 2022;159:e260-e266."},{"issue":"4","key":"bib25","series-title":"Surg Neurol","first-page":"421","article-title":"Operative approach to mediosuperior cerebellar tumors: occipital interhemispheric transtentorial approach","volume":"51","author":"Kurokawa","year":"1999","unstructured":"Kurokawa YUede THashi K.Operative approach to mediosuperior cerebellar tumors: occipital interhemispheric transtentorial approach. Surg Neurol. 1999;51(4):421-425."},{"issue":"12","key":"bib26","series-title":"Acta Neurochir","first-page":"2253","article-title":"Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients","volume":"156","author":"Qi","year":"2014","unstructured":"Qi SFan JZhang XAZhang HQiu BFang L.Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir. 2014;156(12):2253-2262."},{"issue":"2","key":"bib27","series-title":"J Neurooncol","first-page":"351","article-title":"Microsurgical resection of pineal region tumors","volume":"130","author":"Sonabend","year":"2016","unstructured":"Sonabend AMBowden SBruce JN.Microsurgical resection of pineal region tumors. J Neurooncol. 2016;130(2):351-366."},{"issue":"3","key":"bib1","series-title":"Neurosurgery","first-page":"265","article-title":"Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes","volume":"76","author":"Garcia","year":"2015","unstructured":"Garcia RMIvan MELawton MT.Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes. Neurosurgery. 2015;76(3):265-278."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"676","article-title":"The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes","volume":"123","author":"Rangel-Castilla","year":"2015","unstructured":"Rangel-Castilla LSpetzler RF.The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes. J Neurosurg. 2015;123(3):676-685."},{"issue":"3","key":"bib3","series-title":"J Neurosurg","first-page":"814","article-title":"Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes. Clinical article","volume":"114","author":"Chang","year":"2011","unstructured":"Chang EFGabriel RAPotts MBBerger MSLawton MT.Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes. Clinical article. J Neurosurg. 2011;114(3):814-827."},{"key":"bib4","series-title":"World Neurosurg","first-page":"19","article-title":"Neuronavigation-guided transcortical-transventricular endoport-assisted endoscopic resection for thalamic lesions: preliminary experience","volume":"166","author":"Liu","year":"2022","unstructured":"Liu SWu SXie TNeuronavigation-guided transcortical-transventricular endoport-assisted endoscopic resection for thalamic lesions: preliminary experience. World Neurosurg. 2022;166:19-27."},{"issue":"6","key":"bib5","series-title":"Neurosurg Rev","first-page":"3817","article-title":"Endoscopic resection of thalamic lesions via supracerebellar infratentorial approach: a case series and technical note","volume":"45","author":"Liu","year":"2022","unstructured":"Liu SXie TWu SEndoscopic resection of thalamic lesions via supracerebellar infratentorial approach: a case series and technical note. Neurosurg Rev. 2022;45(6):3817-3827."},{"key":"bib6","series-title":"World Neurosurg","first-page":"63","article-title":"Endoscopic midline and paramedian supracerebellar infratentorial approaches to pineal region tumors: a clinical study and approach comparison","volume":"168","author":"Xie","year":"2022","unstructured":"Xie TQu CZhang XEndoscopic midline and paramedian supracerebellar infratentorial approaches to pineal region tumors: a clinical study and approach comparison. World Neurosurg. 2022;168:63-73."},{"issue":"6","key":"bib7","series-title":"J Clin Neurosurg","first-page":"601","article-title":"Endoscopic anatomy of occipital transtentorial transpineal-recess approach for third ventricle","volume":"21","author":"Xie","year":"2024","unstructured":"Xie TSun CZhang XEndoscopic anatomy of occipital transtentorial transpineal-recess approach for third ventricle. J Clin Neurosurg. 2024;21(6):601-606, 611."},{"issue":"2","key":"bib8","series-title":"Neurosurg Rev","first-page":"1017","article-title":"Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study","volume":"44","author":"Xin","year":"2021","unstructured":"Xin CXiong ZYan XEndoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study. Neurosurg Rev. 2021;44(2):1017-1022."},{"key":"bib9","series-title":"World Neurosurg","first-page":"e334","article-title":"The purely endoscopic supracerebellar infratentorial approach for resecting pineal region tumors with preservation of cerebellomesencephalic vein: technical note and preliminary clinical outcomes","volume":"128","author":"Gu","year":"2019","unstructured":"Gu YZhou QZhu WThe purely endoscopic supracerebellar infratentorial approach for resecting pineal region tumors with preservation of cerebellomesencephalic vein: technical note and preliminary clinical outcomes. World Neurosurg. 2019;128:e334-e339."},{"key":"bib10","series-title":"World Neurosurg","first-page":"123460","article-title":"Endoscopic occipital transtentorial approach for dorsal midbrain cavernous malformation: technical notes with illustrative case","volume":"194","author":"Liu","year":"2025","unstructured":"Liu SSun CChen PEndoscopic occipital transtentorial approach for dorsal midbrain cavernous malformation: technical notes with illustrative case. World Neurosurg. 2025;194:123460."},{"issue":"3","key":"bib11","series-title":"Neurosurgery","first-page":"689","article-title":"Quality of life after brainstem cavernoma surgery in 71 patients","volume":"69","author":"Dukatz","year":"2011","unstructured":"Dukatz TSarnthein JSitter HQuality of life after brainstem cavernoma surgery in 71 patients. Neurosurgery. 2011;69(3):689-695."},{"issue":"4","key":"bib12","series-title":"Neurosurgery","first-page":"573","article-title":"Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients","volume":"72","author":"Pandey","year":"2013","unstructured":"Pandey PWestbroek EMGooderham PASteinberg GK.Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients. Neurosurgery. 2013;72(4):573-589."},{"issue":"4","key":"bib13","series-title":"Neurosurgery","first-page":"620","article-title":"Impact of timing of intervention among 397 consecutively treated brainstem cavernous malformations","volume":"81","author":"Zaidi","year":"2017","unstructured":"Zaidi HAMooney MALevitt MRDru ABAbla AASpetzler RF.Impact of timing of intervention among 397 consecutively treated brainstem cavernous malformations. 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J Neurosurg. 2016;125(6):1596-1607."},{"issue":"5","key":"bib16","series-title":"J Neurosurg","first-page":"1359","article-title":"Microsurgical anatomy of safe entry zones to the brainstem","volume":"124","author":"Cavalcanti","year":"2016","unstructured":"Cavalcanti DDPreul MCKalani MYSSpetzler RF.Microsurgical anatomy of safe entry zones to the brainstem. J Neurosurg. 2016;124(5):1359-1376."},{"issue":"5","key":"bib17","series-title":"Oper Neurosurg","first-page":"557","article-title":"One-point technique in brainstem cavernous malformation surgery: evaluation of approaches and outcomes from a different perspective","volume":"27","author":"Prashant","year":"2024","unstructured":"Prashant GNDehdashti AR.One-point technique in brainstem cavernous malformation surgery: evaluation of approaches and outcomes from a different perspective. 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Acta Neurochir (Wien). 1996;138(1):45-49."},{"issue":"4","key":"bib19","series-title":"Neurosurgery","first-page":"879","article-title":"Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results","volume":"46","author":"Winkler","year":"2000","unstructured":"Winkler PAIlmberger JKrishnan KGReulen HJ.Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results. Neurosurgery. 2000;46(4):879-890."},{"issue":"2","key":"bib20","series-title":"Oper Neurosurg","first-page":"E44","article-title":"Infratentorial supracerebellar approach for resection of midbrain cavernous malformation: 3-dimensional operative video","volume":"18","author":"Patel","year":"2020","unstructured":"Patel KBudohoski KPOlijnyk LDInfratentorial supracerebellar approach for resection of midbrain cavernous malformation: 3-dimensional operative video. Oper Neurosurg. 2020;18(2):E44."},{"issue":"2","key":"bib21","series-title":"Oper Neurosurg","first-page":"187","article-title":"Endoscopic supracerebellar infratentorial transpineal approach for posterior-medial thalamic lesions: surgical technique and clinical experience","volume":"27","author":"Xie","year":"2024","unstructured":"Xie TLiu SZhang XEndoscopic supracerebellar infratentorial transpineal approach for posterior-medial thalamic lesions: surgical technique and clinical experience. Oper Neurosurg. 2024;27(2):187-193."},{"issue":"3-4","key":"bib22","series-title":"World Neurosurg","first-page":"409","article-title":"The occipital interhemispheric transtentorial approach for superior vermian, superomedian cerebellar, and tectal arteriovenous malformations: advantages, limitations, and alternatives","volume":"82","author":"McLaughlin","year":"2014","unstructured":"McLaughlin NMartin NA.The occipital interhemispheric transtentorial approach for superior vermian, superomedian cerebellar, and tectal arteriovenous malformations: advantages, limitations, and alternatives. 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World Neurosurg. 2022;159:e260-e266."},{"issue":"4","key":"bib25","series-title":"Surg Neurol","first-page":"421","article-title":"Operative approach to mediosuperior cerebellar tumors: occipital interhemispheric transtentorial approach","volume":"51","author":"Kurokawa","year":"1999","unstructured":"Kurokawa YUede THashi K.Operative approach to mediosuperior cerebellar tumors: occipital interhemispheric transtentorial approach. Surg Neurol. 1999;51(4):421-425."},{"issue":"12","key":"bib26","series-title":"Acta Neurochir","first-page":"2253","article-title":"Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients","volume":"156","author":"Qi","year":"2014","unstructured":"Qi SFan JZhang XAZhang HQiu BFang L.Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir. 2014;156(12):2253-2262."},{"issue":"2","key":"bib27","series-title":"J Neurooncol","first-page":"351","article-title":"Microsurgical resection of pineal region tumors","volume":"130","author":"Sonabend","year":"2016","unstructured":"Sonabend AMBowden SBruce JN.Microsurgical resection of pineal region tumors. 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