Posterior Interhemispheric Approach (Occipital Transtentorial Approach: OTA)(<SPECIAL ISSUE>Selection of Surgical Approach and Pitfall II)

Abstract

The posterior interhemispheric approach (occipital transtentorial approach: OTA) is a useful approach to obtain supra- and infra-tentorial wide operative fields including the splenium, pineal region, quadrigeminal cistern and anterosuperior surface of the cerebellum. Lesions with a downward extension are very suitable for OTA because of its downward trajectory, but lateral lesions are difficult to expose with OTA. For pineal lesions, the Galenic venous complex obstructs the approach route and the anterosuperior part of such lesions is slightly difficult to observe. The occipital lobe and tentorial sinus venous systems are explained as they make up the important microsurgical anatomy for OTA. A comparison between OTA and the infratentorial supracerebellar approach is also discussed.