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Results for “supratentorial extension”

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8 recordsLinked to original sources

PubMed2026

Paramedian supracerebellar transtentorial approach for Yaşargil T2 tentorial incisura meningiomas.

OBJECTIVE: Tentorial incisura meningiomas, particularly those arising from the middle incisural region (Yaşargil T2), are surgically challenging because of their deep location and compression of critical neurovascular structures. These lesions typically have supratentorial or infratentorial extension but can also extend across both compartments. Although approach selection is often guided by the dominant compartment of tumor extension, for lesions with supratentorial-dominant extension, the optimal approach remains controversial, and a standardized strategy has not been established. Authors of this study evaluated the feasibility and outcomes of the paramedian supracerebellar transtentorial (PST) approach for Yaşargil T2 tentorial incisura meningiomas with a supratentorial-dominant or combined extension. METHODS: The authors retrospectively reviewed data from consecutive patients with radiographic and intraoperative findings consistent with a Yaşargil T2 tentorial incisura lesion treated via the PST approach from September 2005 through December 2025. Patients were placed in a semisitting position whenever feasible and in a semilateral position when semisitting was contraindicated. Collected data included demographics, tumor extension patterns, extent of resection on postoperative MRI, neurological outcomes, histopathology, rate of recurrence, and follow-up. RESULTS: Six patients, 1 male and 5 female, with an overall mean age of 43 years, underwent resection via the PST approach. Four lesions had predominantly supratentorial extension, and 2 had combined supra- and infratentorial growth, with no cases of isolated infratentorial extension. Five patients had been placed in the semisitting position and 1 in a semilateral position because of a cardiac contraindication to the semisitting position. No new permanent neurological deficits were observed. Postoperative MRI showed Simpson grade I resection in all 6 patients. The mean follow-up was 8.6 years. Histopathological analysis revealed 3 WHO grade 1 meningiomas, 1 WHO grade 2 meningioma (clear cell), and 2 solitary fibrous tumors (meningioma mimics). These diagnoses were evaluated according to the 2021 WHO classification. CONCLUSIONS: In this consecutive series, the PST approach was a viable single-corridor strategy for Yaşargil T2 tentorial incisura lesions, including supratentorial-dominant tumors, achieving Simpson grade I resection with no permanent neurological deficits. By providing early devascularization at the tentorial attachment and a gravity-assisted, retractorless working corridor with favorable deep venous visualization, the PST approach challenges compartment dominance as the primary determinant of approach selection.

Humans↗

PubMed1979

Subdural hematomas: an unusual appearance on computed tomography.

It may at times be difficult to separate supra- from infratentorial and intra- from extraaxial pathology on the basis of axial transverse computed tomography (CT) scans. Coronal CT scans may be quite useful in more accurate localization of compartments. Three head injured patients with subdural hematomas were studied with axial transverse CT scans. In addition to the typical appearance of subdural hematomas, unusually shaped areas of increased attenuation were noted in the region of the tentorium cerebelli separate from the mass of the subdural collection. Coronal scans confirmed the supratentorial, extraaxial collection as an extension of the subdural hematoma into the supratentorial subdural space.

Cerebral Ventriculography↗

PubMedDate not supplied

The infratentorial-supracerebellar exposure of tumors in the pineal area.

Nine pineal area lesions were operated upon by the infratentorial-supracerebellar approach. There was one operative death and one death due to disseminated germinoma recurrence 2 1/2 years postoperatively. The remaining seven patients have shown no sign of recurrence and are neurologically normal. The surgical method that has evolved through these nine cases is discussed. The infratentorial-supracebebellar exposure is an excellent one for lesions in the region of the pineal gland, posterior 3rd ventricle, and superior cerebellar vermis. Access is less hampered by the major tributaries of the vein of Galen than with the supratentorial operations. This approach is also a useful extension of the standard posterior fossa exploration when dealing with primarily subtentorial lesions that involve the dorsal midbrain or herniate upward.

Adolescent↗

PubMed1979

Pleomorphic xanthoastrocytoma: a distinctive meningocerebral glioma of young subjects with relatively favorable prognosis. A study of 12 cases.

Twelve cases of a distinctive form of supratentorial astrocytoma occurring in young subjects (ages 7 to 25) are reported. The tumors were superficial and involved the leptomeninges extensively. The tumor cells display marked pleomorphism, including bizarre giant cells and a number of mitotic figures, but no necrosis. Many contain large amounts of lipid in their cytoplasm and are surrounded by reticulin fibers, thus simulating a mesenchymal tumor. For these reasons, some examples of this tumor have been previously interpreted to represent meningocerebral fibrous xanthomas. Immunoperoxidase technique performed in nine of the twelve cases has, however, established the presence of glial fibrillary acidic protein in the tumor cells, which are therefore considered to be astrocytic. By electron microscopy many tumor cells are surrounded by basal laminae, accounting for the abundant reticulin network demonstrable in silver preparations. Since subpial astrocytes are known to be partly covered by a basal lamina, it is likely that they are the cells of origin for this neoplasm. In contrast to its pleomorphic cytology, the biological behavior of this tumor appears to be relatively favorable, and long survival times (up to 25 years) have been recorded in some cases. (These tumors are distinct from intracranial fibrous xanthomas of mesenchymal derivation. Cells of the latter are negative on GFAP stain.)

Adolescent↗

PubMed1977

The tentorium in axial section. II. Lesion localization.

Most juxtatentorial lesions may be localized accurately on contrast-enhanced axial section CT scans by use of the opacified tentorial bands. Lesions that lie lateral edge of the diverging bands are supratentorial. Lesions that lie medial to the V-shaped tentorial bands are infratentorial and/or incisural. Flattening of the tentorial border of a lesion helps to identify its location. Use of the tentorial bands identifies transincisural extension of meningioma reliably, but does distinguish well between true transtentorial growth of meningioma and marked upward bulging of the tentorium from purely infratentorial meningioma.

Brain Neoplasms↗

PubMedDate not supplied

[Posterior fossa angiomata with slow evolution: clinical aspects (author's transl)].

The AA. report 9 cases of arteriovenous angiomata in the posterior cranial fossa with chronic evolution: in 8 of these the diagnosis was made before a subarachnoid haemorrhagic episode precipitated the symptomatology. Angiomata in the posterior cranial fossa are detected less often than sopratentorial angiomata, and the possible reasons of this are considered. During the last 11 years in the Neurosurgical Institute of the University of Padua the incidence was 23%, one of the highest reported in literature. The clinical diagnostic criteria of angioma in the posterior cranial fossa with chronic evolution are also discussed. The importance of a fluctuating development of the symptomatology is emphasised with an almost constant association of signs of pyramidal and cerebellar involvement, as well as the differential diagnostic problems with multiple sclerosis. In six of the cases the malformation was so extensive to make it impossible to determine afferences and drainages, so that a surgical operation could not be carried out. This finding seemed rather peculiar, owing to the relatively poor simptomatology, mainly if compared with smaller supratentorial malformations. It appears from the literature that angiomata in the posterior cranial fossa including those found at autopsy are as common as the supratentorial ones; this would suggest that many of these lesions are not diagnosed in life.

Adult↗

PubMed1978

Assessing segmental excitability after acute rostral lesions. I. The F response.

F responses were elicited from both hands of patients shortly after they sustained unilateral cerebrovascular lesions. In 17 of 29 patients, significant abnormalities were found; F responses occurred with decreased persistence and/or amplitude on the clinically involved side, a change which was seen only in patients studied within 4 weeks of the ictus. The most prominent changes (in comparison with the clinically uninvolved side) occurred with extensive lesions. The abnormalities of F response correlated clinically with severity of the weakness, decrease in tone, and decrease in deep tendon reflexes. These changes in F response are consistent with a decreased "central excitatory state" at the spinal segmental level during the early phase after a supratentorial stroke.

Cerebrovascular Disorders↗

PubMedDate not supplied

Clinical evaluation of the action of dexamethasone.

The antioedematous action of dexamethasone was assessed in 28 patients with supratentorial and infratentorial intracranial tumours and craniocerebral trauma. The criteria of evaluation included the state of consciousness, signs of focal cerebral injury, autonomic disturbances and signs of raised intracranial pressure. The greatest improvement was obtained in patients having intracranial tumours with herniation of the brain stem. In cases of extensive craniocerebral trauma no evident improvement was achieved.

Adult↗