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

Abstract

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. 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. 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). 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.