Evaluation of Surgical Approaches for Tumor Resection in the Deep Infratentorial Region and Impact of Virtual Reality Technique for the Surgical Planning and Strategy.

Objective: Tumors in the deep infratentorial region can be accessed via the supracerebellar-infratentorial (SCIT) or suboccipital-transcerebellar (SOTC) approaches in the sitting or prone position. Diagnosis of tumors in this region and review of their therapies are inseparably connected with cranial tomographic imaging. We retrospectively evaluate a cohort of patients who underwent tumor resection in this region and correlate complication rates to the literature, and evaluate the potential influence of a virtual reality (VR) visualization technique on surgery planning and strategy.

Methods: Patient files were retrospectively analyzed regarding operative performance parameters, histopathological findings, surgical outcomes, and complications. Preoperative magnetic resonance imaging scans were visualized via VR software. The influence of 3-dimensional VR images compared to 2-dimensional magnetic resonance imaging scans on surgical planning and surgical strategy was evaluated using a questionnaire.

Results: Ninety-three patients were included, 80% placed in a sitting and 20% in a prone position. The SCIT approach was performed in 59% patients and SOTC approach in 41%. Surgical tumor resections were associated with an overall complication rate comparable to the literature. Image presentation using VR had a significant influence on the recommended surgical approach (P = 0.02), but no influence on the recommended patient positioning (P = 0.37) or placement of craniotomy (P = 0.09).

Conclusion: Tumor resection in the deep infratentorial region, despite frequent use of the sitting position and SCIT approach, was associated with a complication rate comparable to the literature. Preoperative surgical planning using VR technology may increase understanding of the anatomy and pathology, and thus influence operation planning.