Pure Endoscopic Supracerebellar Infratentorial Approach to the Pineal Region: A Case Series

BACKGROUND: Surgical approaches to pineal lesions present a challenge because of limited visibility and maneuverability within the posterior fossa. The supracerebellar infratentorial (SCIT) technique has emerged as an approach to pineal lesions. We aim to demonstrate the efficacy of the endoscopic SCIT technique through a case series conducted at our institution and highlight the advantages of the endoscopic technique over the microscopic alternative. OBJECTIVE: To evaluate the effectiveness and safety of the endoscopic SCIT approach. METHODS: We conducted a retrospective review of pure endoscopic SCIT cases conducted at our institution. Demographic information, preoperative and postoperative imaging, neurological status, surgical data, and complications were recorded. RESULTS: Six patients who underwent pure endoscopic SCIT surgery were identified for analysis. The average lesion volume was 14.12 +/- 7.24 cm(3). The median postoperative length of stay was 5.0 days. The average surgical duration was 3.54 +/- 0.71 hours. All operations were performed in prone position with zero- and 30-degree endoscopes. Pathology included one each of the following lesions: Pineoctyoma, metastatic melanoma, atypical teratoma rhabdoid tumor, ependymoma, epidermoid, abscess. Gross total resection (GTR) was achieved in 5/6 patients, and near-total resection was achieved in 1/6 patients. Surgical complications included one case of postoperative infection. CONCLUSION: The purely endoscopic SCIT approach is a safe and effective approach for deep-seated pineal lesions. This approach allows for visibility and maneuverability around the lesion and facilitates high rates of GTR.