How I do it-pineal surgery: supracerebellar infratentorial versus occipital transtentorial

Resection of a pineal tumour requires fastidious pre-operative planning to select the optimal surgical approach and maximise resection while minimising morbidity. To describe and compare the supracerebellar infratentorial and occipital transtentorial approaches. Specific considerations include patient-specific anatomy, extent and relationships of the tumour, and the techniques likely to be employed during resection. The supracerebellar infratentorial approach provides a direct corridor to pineal tumours caudal to the deep veins; for tumours invaginating the tectal plate in a caudal direction the occipital transtentorial provides a better view.