====== Infra-Occipital Supra-Tentorial Approach ======

see also [[Occipital transtentorial approach]].
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[[Surgical treatment]] of lesions involving the postero-medial [[occipitotemporal]] [[region]] is challenging because of the high risk of [[morbidity]] due to damage or excessive [[retraction]] of critical neurovascular structures, especially within the [[dominant hemisphere]].

De Benedictis et al. from the [[Bambino Gesù Children's Hospital]], IRCCS, [[Rome]] described the case of a 17-yr-old patient who underwent resection of an epileptogenic [[low-grade glioma]] located within the left-dominant [[lingual gyrus]]. [[Seizure]]s were characterized, as a first symptom, by the right-sided simple [[visual hallucination]] that pointed to the left peri[[calcarine]] [[region]], corresponding to the lesion location. No signs of primary involvement of anterior temporal-mesial structures ([[hippocampus]]/[[amygdala]]) were found. As the anatomic-electroclinical correlation was concordant, direct tumor [[removal]] was indicated through an infra-occipital supratentorial approach. This route allowed direct access to the target through a safe extra-axial corridor, which limits intraparenchymal dissection until the tumor margin is identified and avoids critical vascular structures, such as the [[vein of Labbé]].

External [[cerebrospinal fluid drainage]] was used to facilitate [[brain relaxation]], minimizing brain and venous retraction and, consequently, reducing the risk of postoperative [[neurological complication]]s, especially for [[vision]]. Postoperative [[magnetic resonance imaging]] (MRI) demonstrated no surgical complications. Pathological examination revealed a [[ganglioglioma]]. At 9-mo follow-up, the neurological examination was normal, [[antiepileptic]] 
[[therapy]] was stopped, and the patient was seizure-free. The [[video]] describes the main surgical steps, using both intraoperative videos and advanced 3-dimensional modeling of neuroimaging pictures
((De Benedictis A, de Palma L, Herur-Raman A, Pepi C, Colafati GS, Carboni A, Randi F, Savioli A, Ricci G, Mastronuzzi A, Carai A, Specchio N, Marras CE. Infra-Occipital Supra-Tentorial Approach for Resection of Low-Grade Tumor of the Left Lingual Gyrus: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2021 May 22:opab172. doi: 10.1093/ons/opab172. Epub ahead of print. PMID: 34022047.)).