Introduction: Many approaches have been used to treat surgically pineal tumors and the specific indications for supracerebellar infratentorial approach and sub-occipital transtentorial approach have not been yet systematized in order to define a useful and practical guideline to determine which approach would be indicated for a specific pineal tumor. The objective of this study is to describe a guideline method for trialing and screening patients for the two most important approaches to access the pineal region based on our surgical and technical experience as well as in anatomical landmarks.

Methods: The records of all patients who had undergone trialing and surgical resection of pineal tumor region at the main author’s institutions over a 17-year period (July 1, 2000–February 18, 2017) were examined in this retrospective case series. The search revealed 42 patients, 25 who had undergone a supracerebellar infratentorial technique and 15 who had undergone a interhemispheric suboccipital trantentorial procedure and 2 who had undergone to combined approaches.

Results: Regarding to the Group I, of these 25 patients, the grade of resection was total in 100% , all positioned in semi-sitting position Visual impairment after the surgery was observed in 1 patient, hydroccephalus in 1 patients with post operative meningitis. Air embolism was detected in 2 patients (1 with lymphoma and other with meningioma), however without clinical picture. No mortality was observed in this group. Regarding to group II, of these 15 patients, 12 had their tumor totally resected and 2 partially. The third group, combined approach, treated in semi sitting position showed air embolism in 1 case and ventriculitis after ventricle peritoneal shunt.

Conclusions: The guideline based on the angle between the tentorial surface and horizontal plan is feasible in screening patients for ideal individual approach to pineal region tumors.

Patient Care: Guide to choose the ideal approach for each anatomical position of pineal tumor

Learning Objectives: By the conclusion of this paper, the participants should be able to determine the idela approach for each pineal tumor according to its anatomical positon

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