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^1,2Neurosurgery Department, Meram Faculty of Medicine, Selçuk University, Konya, Turkey
³Pathology Department, Meram Faculty of Medicine, Selçuk University, Konya, Turkey An 11-year-old boy with a large pineal region mass was admitted to our clinic. The preliminary diagnosis was teratoma. Tumor resection was carried out via combined occipital, transtentorial, supracerebellar, transsinus approach. The tumor tissue was completely resected, and no operative complication other than transient Parinaud syndrome was noted. The histological diagnosis was teratoma, grade 2. After three courses of chemotherapy, the patient underwent external irradiation. He remained asymptomatic with no signs of recurrence 15 months after the surgery. The combination of occipital, transtentorial, supracerebellar, transsinus approach provides excellent views and workspace above and below the tentorial notch. Transverse sinus section is not mandatory for this approach, but sectioning of the unilateral transverse sinus and the tentorium along the rectal sinus allows retraction of the falx and the underlying brain to the opposite side. Thus, a much wider horizontal and vertical projection is obtained. This approach enables more extensive tumor removal for large pineal region tumors. Keywords : Combined approach, pineal region teratoma, transsinus, transtentorium approach.