Supracerebellar Transtentorial Approach: Anatomic Description, Operative Technique, and Clinical Applications

Historical Perspective The supracerebellar infratentorial approach was first used by Stein in the 1970s for accessing pineal region tumors. The SCTT, as a supratentorial extension of this approach, was first described by Yaşargil and Voigt in 1976, to remove a cavernous malformation in the posterior parahippocampal gyrus without injuring the optic radiation. Later, Yaşargil used this approach in 2 patients with parahippocampal dysplasia, and in 1 patient with an oligodendroglioma. Yonekawa et al. rejuvenated the SCTT to access the posterior mediobasal region, while avoiding retraction or transgression of the parenchyma in the temporal or occipital lobes, for 16 patients with neoplastic or vascular lesions. Yaşargil developed the idea of a paramedian SCTT for selective amygdalohippocampectomy, where his main concern was the potential difficulty of removing the amygdala and piriform cortex. Since these seminal descriptions of the SCTT, many other reports have described its application for the management of multiple pathologies including intraand extra-axial tumors, vascular malformations, aneurysms, and hippocampal sclerosis.