Occipital interhemispheric transtentorial approach for microsurgical resection of a posterior fossa medulloblastoma: 2-dimensional operative video.
- 1Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil.
- 2Department of Neurosurgery, Hospital São Vicente, Curitiba, PR, Brazil.
- 3Division of Neurosurgery / Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo and Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil.
Abstract
Background
Medulloblastoma is a highly aggressive tumor, usually arising in the posterior fossa in children. Adult cases have different features compared to younger patients.Case description
We present the case of a 26-year-old male patient, presenting with several posterior fossa symptoms progressing over months. During this time, he underwent a ventriculoperitoneal shunt performed by an external department. Pre-operative magnetic resonance imaging (MRI) depicted a lesion with heterogeneous contrast enhancement in the tentorial surface of the cerebellum insinuating over the brainstem. Extensive cerebellar edema was also observed, including tonsillar bulging causing middle cerebellar peduncle compression and eighth cranial nerve disturbance. Considering a vertical straight sinus and the lesion to be adjacent to the vein of Galen and brainstem, we preferred to employ an occipital interhemispheric transtentorial approach to get a more direct and shorter pathway to the lesion. It was possible to successfully resect the mass, preserving the surrounding neurovascular structures. Post-operative MRI demonstrated complete tumor resection and expressive improvement of cerebellar edema, including the compressive effect over the middle cerebellar peduncle. The patient presented a favorable outcome with no new neurological deficits, improvement of previous complaints, and no significant alteration in campimetry. Pathology confirmed the lesion to be a medulloblastoma, and he was referred next for adjuvant therapy. No tumor dissemination was observed in the pre-operative and post-operative spine MRI, with negative oncotic cytology on 1.5-month post-operative lumbar puncture. The patient consented to the procedure and publication of this operative video.Conclusion
Careful pre-operative planning can guide successfully throughout the surgical procedure to achieve a favorable outcome.
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BibTeX
@article{ceccato2026occipital,
title = {{Occipital interhemispheric transtentorial approach for microsurgical resection of a posterior fossa medulloblastoma: 2-dimensional operative video.}},
author = {Guilherme Henrique Weiler Ceccato and Denys Amilcar Quispe Alcocer and Matheus Soares Flor and Ivan Carlos Ramos Júnior and João Victor Rodrigues Bubicz and Jean Gonçalves de Oliveira and Luis Alencar Biurrum Borba},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_955_2026},
url = {https://europepmc.org/article/MED/42974263},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Occipital interhemispheric transtentorial approach for microsurgical resection of a posterior fossa medulloblastoma: 2-dimensional operative video.
AU - Guilherme Henrique Weiler Ceccato
AU - Denys Amilcar Quispe Alcocer
AU - Matheus Soares Flor
AU - Ivan Carlos Ramos Júnior
AU - João Victor Rodrigues Bubicz
AU - Jean Gonçalves de Oliveira
AU - Luis Alencar Biurrum Borba
PY - 2026
DA - 2026/10/16
JO - Surgical neurology international
DO - 10.25259/sni_955_2026
UR - https://europepmc.org/article/MED/42974263
AB - Background Medulloblastoma is a highly aggressive tumor, usually arising in the posterior fossa in children. Adult cases have different features compared to younger patients.Case description We present the case of a 26-year-old male patient, presenting with several posterior fossa symptoms progressing over months. During this time, he underwent a ventriculoperitoneal shunt performed by an external department. Pre-operative magnetic resonance imaging (MRI) depicted a lesion with heterogeneous contrast enhancement in the tentorial surface of the cerebellum insinuating over the brainstem. Extensive cerebellar edema was also observed, including tonsillar bulging causing middle cerebellar peduncle compression and eighth cranial nerve disturbance. Considering a vertical straight sinus and the lesion to be adjacent to the vein of Galen and brainstem, we preferred to employ an occipital interhemispheric transtentorial approach to get a more direct and shorter pathway to the lesion. It was possible to successfully resect the mass, preserving the surrounding neurovascular structures. Post-operative MRI demonstrated complete tumor resection and expressive improvement of cerebellar edema, including the compressive effect over the middle cerebellar peduncle. The patient presented a favorable outcome with no new neurological deficits, improvement of previous complaints, and no significant alteration in campimetry. Pathology confirmed the lesion to be a medulloblastoma, and he was referred next for adjuvant therapy. No tumor dissemination was observed in the pre-operative and post-operative spine MRI, with negative oncotic cytology on 1.5-month post-operative lumbar puncture. The patient consented to the procedure and publication of this operative video.Conclusion Careful pre-operative planning can guide successfully throughout the surgical procedure to achieve a favorable outcome.
SN - 2229-5097
SN - 2152-7806
ER -