The subtemporal transtentorial approach provides excellent exposure of the middle incisural space. A modification of the subtemporal transtentorial approach with use of a partial mastoidectomy is presented to avoid damage to the temporal lobe as a result of retraction as well as damage to venous structures 1).
Microvascular decompression (MVD) via lateral suboccipital approach is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. Ogiwara et al. describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach 2).
Through anatomic comparative analysis the Extended pterional transtemporal transtentorial approach EPTT approach provides better exposure and is more appropriate than the subtemporal transtentorial approach (ST approach) for large and giant petroclival tumors predominantly in the posterior cranial fossa with extensive invasion to parasellar structures and the cavernous sinus 3).
Pontine cavernoma surgery through subtemporal transtentorial approach