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Neurosurgery: Supratentorial tumors
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Monica S. Tandon, Kashmiri Doley, Daljit Singh
Intra- or peritumoral hemorrhage (particularly GBM, metastatic tumors) results in acute and marked increase in the ICP; life-threatening cerebral herniation can ensue when this rapidly expanding tumor mass forces the brain tissue from one intracranial compartment to another (through the relatively rigid dural openings between compartments), tearing the blood vessels and compressing the neuropil in the process. STTs usually cause cingulate (herniation of cingulate gyrus beneath the falx cerebri) or transtentorial herniation; tonsillar herniation (displacement of brain tissue through the foramen magnum) may also occur, though it is more common with posterior fossa lesions. Transtentorial herniation may be central (bilateral/symmetrical mass effect causes a downward shift of the diencephalon and upper brainstem, resulting in sequential failure of the diencephalon, midbrain, pons, and medulla) or uncal (unilateral mass effect which displaces the medial temporal lobe inferiorly and medially through the tentorial notch). A depressed level of consciousness, obtundation, lethargy, and irregular breathing are ominous signs which point toward a life-threatening neurosurgical emergency.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The tentorium cerebelli separates the occipital lobes of the cerebral hemispheres from the cerebellum. It is attached anteriorly to the posterior clinoid process of sphenoid, laterally to the petrous temporal bone, and posteriorly to the transverse sulci of the occipital bone. The falx cerebri attaches to the tentorium in the midline, pulling it upwards, giving it a tent-like appearance. The tentorium cerebelli divides the cranial cavity into supratentorial and infratentorial compartments. The free concave anteromedial border forms a U-shaped gap called the tentorial notch, filled by the midbrain and the anterior part of the superior aspect of the cerebellar vermis.
Back and central nervous system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Tentorium cerebelli– has free margin (tentorial notch)– separates cerebellum from occipital lobe– tentorial notch encircles midbrain– fuses with falx cerebri– superior petrosal sinus along attachment to petrous bone– transverse sinus along attachment to occipital bone
Endoscopic supracerebellar infratentorial approach to pineal and posterior third ventricle lesions in prone position with head extension: a technical note
Published in Neurological Research, 2020
Peter Spazzapan, Tomaz Velnar, Roman Bosnjak
In our experience, the endoscope provides an excellent illumination, view of sharp details and magnification of the vascular structures, thus reducing the risk of haemorrhage. The limited brain retraction, the possibility of looking beyond the tentorial notch and behind vascular and neural structures to ‘see around the corner’ [20] are additional advantages of this tool. Furthermore, the endoscope provides a complete insider view of the third ventricle from a posterior perspective. This enabled us to use the endoscopic SCIT approach for several types of pineal lesions, even for infiltrative and large tumours of hard consistency and high vascularity.