{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T01:05:40Z","timestamp":1779843940917,"version":"3.53.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"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":[[2026,5,25]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cavernous malformations of the superior cerebellar vermis beneath the tentorium are rare and surgically challenging because approach selection must account for lesion location and venous anatomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 69-year-old man presented with vertigo, nausea, and truncal ataxia caused by hemorrhage from a cavernous malformation of the superior cerebellar vermis. Repeated CT during the first 5 days after admission showed hematoma enlargement with worsening symptoms. Preoperative CT venography revealed bilateral hypoplastic transverse sinuses with dominant occipital and marginal sinuses, indicating atypical posterior fossa venous drainage. No major occipital bridging vein was identified along the planned operative corridor. Because of hematoma enlargement, symptom progression, and the risk of sudden deterioration associated with a posterior fossa lesion, early surgery was performed. An occipital interhemispheric transtentorial approach was selected to avoid dominant midline venous drainage pathways and provide a direct trajectory to the lesion. Indocyanine green videoangiography confirmed the absence of a major tentorial sinus along the planned incision line. Complete resection was achieved without venous injury, ischemic complications, or postoperative visual field deficit on clinical assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In superior vermian lesions, patient-specific venous drainage patterns may be decisive in approach selection.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25996\">https:\/\/thejns.org\/doi\/10.3171\/CASE25996<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25996","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:52:32Z","timestamp":1779288752000},"source":"Crossref","is-referenced-by-count":0,"title":["Occipital transtentorial approach selected based on venous anatomy for a vermian cavernous malformation: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2779-984X","authenticated-orcid":true,"given":"Mizuto","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akimitsu","family":"Shirokihara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1096-5680","authenticated-orcid":true,"given":"Natsumi","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaki","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7548-3107","authenticated-orcid":true,"given":"Takahiro","family":"Miyata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Nakatsukasa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5076-2455","authenticated-orcid":true,"given":"Joji","family":"Inamasu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Neurosurg Clin N Am","first-page":"395","article-title":"Pathology of cerebral vascular malformations","volume":"10","author":"Zabramski","year":"1999","unstructured":"Zabramski JMHenn JSCoons S.Pathology of cerebral vascular malformations. Neurosurg Clin N Am. 1999;10(3):395-410. doi:10.1016\/S1042-3680(18)30174-8"},{"issue":"7","key":"bib2","series-title":"Expert Rev Neurother","first-page":"771","article-title":"Cerebral cavernous malformations: natural history and clinical management","volume":"15","author":"Gross","year":"2015","unstructured":"Gross BADu R.Cerebral cavernous malformations: natural history and clinical management. Expert Rev Neurother. 2015;15(7):771-777. doi:10.1586\/14737175.2015.1055323"},{"issue":"2","key":"bib3","series-title":"J Neurosurg","first-page":"190","article-title":"Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage","volume":"87","author":"Porter","year":"1997","unstructured":"Porter PJWillinsky RAHarper WWallace MC.Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage. J Neurosurg. 1997;87(2):190-197. doi:10.3171\/jns.1997.87.2.0190"},{"issue":"2","key":"bib4","series-title":"Neurosurgery","first-page":"403","article-title":"Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients","volume":"68","author":"Abla","year":"2011","unstructured":"Abla AALekovic GPTurner JDDe Oliveira JGPorter RSpetzler RF.Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. Neurosurgery. 2011;68(2):403-414. doi:10.1227\/NEU.0b013e3181ff9cde"},{"issue":"6","key":"bib5","series-title":"Neuroradiology","first-page":"373","article-title":"Anatomical study of the occipital sinus using contrast-enhanced magnetic resonance venography","volume":"48","author":"Kobayashi","year":"2006","unstructured":"Kobayashi KSuzuki MUeda FMatsui O.Anatomical study of the occipital sinus using contrast-enhanced magnetic resonance venography. Neuroradiology. 2006;48(6):373-379. doi:10.1007\/s00234-006-0087-y"},{"issue":"3","key":"bib6","series-title":"Interv Neuroradiol","first-page":"215","article-title":"The marginal sinus normal anatomy and involvement with arteriovenous fistulae","volume":"2","author":"Evans","year":"1996","unstructured":"Evans AJKallmes DFJensen MEDion JE.The marginal sinus normal anatomy and involvement with arteriovenous fistulae. Interv Neuroradiol. 1996;2(3):215-221. doi:10.1177\/159101999600200307"},{"issue":"3","key":"bib7","series-title":"J Neurosurg","first-page":"429","article-title":"The marginal sinus","volume":"104","author":"Tubbs","year":"2006","unstructured":"Tubbs RSAmmar KLiechty PThe marginal sinus. J Neurosurg. 2006;104(3):429-431. doi:10.3171\/jns.2006.104.3.429"},{"issue":"3","key":"bib8","series-title":"Neuroradiology","first-page":"325","article-title":"Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus","volume":"60","author":"Mizutani","year":"2018","unstructured":"Mizutani KMiwa TAkiyama TSakamoto YFujiwara HYoshida K.Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus. Neuroradiology. 2018;60(3):325-333. doi:10.1007\/s00234-018-1980-x"},{"issue":"1","key":"bib9","series-title":"Asian J Neurosurg","first-page":"15","article-title":"Timing of surgery and surgical strategies in symptomatic brainstem cavernomas: review of the literature","volume":"14","author":"Rajagopal","year":"2019","unstructured":"Rajagopal NKawase TMohammad AASeng LBYamada YKato Y.Timing of surgery and surgical strategies in symptomatic brainstem cavernomas: review of the literature. Asian J Neurosurg. 2019;14(1):15-27. doi:10.4103\/ajns.AJNS_158_18"},{"issue":"2","key":"bib10","series-title":"J Neurosurg","first-page":"365","article-title":"Microsurgical anatomy of the region of the tentorial incisura","volume":"60","author":"Ono","year":"1984","unstructured":"Ono MOno MRhoton ALJrBarry M.Microsurgical anatomy of the region of the tentorial incisura. J Neurosurg. 1984;60(2):365-399. doi:10.3171\/jns.1984.60.2.0365"},{"issue":"1","key":"bib11","series-title":"J Neurosurg","first-page":"1","article-title":"Cavernous angiomas: deconstructing a neurosurgical disease","volume":"131","author":"Awad","year":"2019","unstructured":"Awad IAPolster SP.Cavernous angiomas: deconstructing a neurosurgical disease. J Neurosurg. 2019;131(1):1-13. doi:10.3171\/2019.3.JNS181724"},{"issue":"1","key":"bib12","series-title":"Surg Neurol","first-page":"36","article-title":"Occipital transtentorial approach for removal of pineal region tumors: report of 64 consecutive cases","volume":"32","author":"Luo","year":"1989","unstructured":"Luo SQLi DZZhang MZWang ZC.Occipital transtentorial approach for removal of pineal region tumors: report of 64 consecutive cases. Surg Neurol. 1989;32(1):36-39. doi:10.1016\/0090-3019(89)90032-3"},{"issue":"6","key":"bib13","series-title":"Surg Neurol","first-page":"576","article-title":"Microsurgical management of pineal region lesions: personal experience with 119 patients","volume":"70","author":"Hernesniemi","year":"2008","unstructured":"Hernesniemi JRomani RAlbayrak BSMicrosurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol. 2008;70(6):576-583. doi:10.1016\/j.surneu.2008.07.019"},{"issue":"3-4","key":"bib14","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. doi:10.1016\/j.wneu.2013.07.075"},{"issue":"6","key":"bib15","series-title":"J Neurosurg","first-page":"982","article-title":"Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery","volume":"103","author":"Raabe","year":"2005","unstructured":"Raabe ANakaji PBeck JProspective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg. 2005;103(6):982-989. doi:10.3171\/jns.2005.103.6.0982"},{"issue":"3","key":"bib1","series-title":"Neurosurg Clin N Am","first-page":"395","article-title":"Pathology of cerebral vascular malformations","volume":"10","author":"Zabramski","year":"1999","unstructured":"Zabramski JMHenn JSCoons S.Pathology of cerebral vascular malformations. Neurosurg Clin N Am. 1999;10(3):395-410. doi:10.1016\/S1042-3680(18)30174-8"},{"issue":"7","key":"bib2","series-title":"Expert Rev Neurother","first-page":"771","article-title":"Cerebral cavernous malformations: natural history and clinical management","volume":"15","author":"Gross","year":"2015","unstructured":"Gross BADu R.Cerebral cavernous malformations: natural history and clinical management. Expert Rev Neurother. 2015;15(7):771-777. doi:10.1586\/14737175.2015.1055323"},{"issue":"2","key":"bib3","series-title":"J Neurosurg","first-page":"190","article-title":"Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage","volume":"87","author":"Porter","year":"1997","unstructured":"Porter PJWillinsky RAHarper WWallace MC.Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage. J Neurosurg. 1997;87(2):190-197. doi:10.3171\/jns.1997.87.2.0190"},{"issue":"2","key":"bib4","series-title":"Neurosurgery","first-page":"403","article-title":"Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients","volume":"68","author":"Abla","year":"2011","unstructured":"Abla AALekovic GPTurner JDDe Oliveira JGPorter RSpetzler RF.Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. Neurosurgery. 2011;68(2):403-414. doi:10.1227\/NEU.0b013e3181ff9cde"},{"issue":"6","key":"bib5","series-title":"Neuroradiology","first-page":"373","article-title":"Anatomical study of the occipital sinus using contrast-enhanced magnetic resonance venography","volume":"48","author":"Kobayashi","year":"2006","unstructured":"Kobayashi KSuzuki MUeda FMatsui O.Anatomical study of the occipital sinus using contrast-enhanced magnetic resonance venography. Neuroradiology. 2006;48(6):373-379. doi:10.1007\/s00234-006-0087-y"},{"issue":"3","key":"bib6","series-title":"Interv Neuroradiol","first-page":"215","article-title":"The marginal sinus normal anatomy and involvement with arteriovenous fistulae","volume":"2","author":"Evans","year":"1996","unstructured":"Evans AJKallmes DFJensen MEDion JE.The marginal sinus normal anatomy and involvement with arteriovenous fistulae. Interv Neuroradiol. 1996;2(3):215-221. doi:10.1177\/159101999600200307"},{"issue":"3","key":"bib7","series-title":"J Neurosurg","first-page":"429","article-title":"The marginal sinus","volume":"104","author":"Tubbs","year":"2006","unstructured":"Tubbs RSAmmar KLiechty PThe marginal sinus. J Neurosurg. 2006;104(3):429-431. doi:10.3171\/jns.2006.104.3.429"},{"issue":"3","key":"bib8","series-title":"Neuroradiology","first-page":"325","article-title":"Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus","volume":"60","author":"Mizutani","year":"2018","unstructured":"Mizutani KMiwa TAkiyama TSakamoto YFujiwara HYoshida K.Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus. Neuroradiology. 2018;60(3):325-333. doi:10.1007\/s00234-018-1980-x"},{"issue":"1","key":"bib9","series-title":"Asian J Neurosurg","first-page":"15","article-title":"Timing of surgery and surgical strategies in symptomatic brainstem cavernomas: review of the literature","volume":"14","author":"Rajagopal","year":"2019","unstructured":"Rajagopal NKawase TMohammad AASeng LBYamada YKato Y.Timing of surgery and surgical strategies in symptomatic brainstem cavernomas: review of the literature. Asian J Neurosurg. 2019;14(1):15-27. doi:10.4103\/ajns.AJNS_158_18"},{"issue":"2","key":"bib10","series-title":"J Neurosurg","first-page":"365","article-title":"Microsurgical anatomy of the region of the tentorial incisura","volume":"60","author":"Ono","year":"1984","unstructured":"Ono MOno MRhoton ALJrBarry M.Microsurgical anatomy of the region of the tentorial incisura. J Neurosurg. 1984;60(2):365-399. doi:10.3171\/jns.1984.60.2.0365"},{"issue":"1","key":"bib11","series-title":"J Neurosurg","first-page":"1","article-title":"Cavernous angiomas: deconstructing a neurosurgical disease","volume":"131","author":"Awad","year":"2019","unstructured":"Awad IAPolster SP.Cavernous angiomas: deconstructing a neurosurgical disease. J Neurosurg. 2019;131(1):1-13. doi:10.3171\/2019.3.JNS181724"},{"issue":"1","key":"bib12","series-title":"Surg Neurol","first-page":"36","article-title":"Occipital transtentorial approach for removal of pineal region tumors: report of 64 consecutive cases","volume":"32","author":"Luo","year":"1989","unstructured":"Luo SQLi DZZhang MZWang ZC.Occipital transtentorial approach for removal of pineal region tumors: report of 64 consecutive cases. Surg Neurol. 1989;32(1):36-39. doi:10.1016\/0090-3019(89)90032-3"},{"issue":"6","key":"bib13","series-title":"Surg Neurol","first-page":"576","article-title":"Microsurgical management of pineal region lesions: personal experience with 119 patients","volume":"70","author":"Hernesniemi","year":"2008","unstructured":"Hernesniemi JRomani RAlbayrak BSMicrosurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol. 2008;70(6):576-583. doi:10.1016\/j.surneu.2008.07.019"},{"issue":"3-4","key":"bib14","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. doi:10.1016\/j.wneu.2013.07.075"},{"issue":"6","key":"bib15","series-title":"J Neurosurg","first-page":"982","article-title":"Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery","volume":"103","author":"Raabe","year":"2005","unstructured":"Raabe ANakaji PBeck JProspective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg. 2005;103(6):982-989. doi:10.3171\/jns.2005.103.6.0982"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/21\/article-CASE25996.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/21\/article-CASE25996.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/21\/article-CASE25996.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:39:45Z","timestamp":1779842385000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/21\/article-CASE25996.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":30,"journal-issue":{"issue":"21"},"URL":"https:\/\/doi.org\/10.3171\/case25996","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}