Surgical Management and Outcome in Meningiomas with Tentorial Involvement

Background: Meningiomas involving the tentorium can be classified into petroclival, sphenopetroclival, tentorial, and cavernous sinus. The tentorial meningiomas are rare with an incidence of 2 to 4% of all intracranial meningiomas with a preponderance in women. The tumors frequently encase the pertinent critical structures in the neighborhood such as venous sinus, pons, and cranial nerves. The surgical management in these cases is still a challenge. Materials and Methods: We analyzed the surgical treatment and outcome of 27 patients (17 tentorial and 10 petroclival and sphenopetroclival tumors). There were 24 female and 3 male patients of 33 to 86 years with a mean age of 59 years. The follow-up period was between 3 and 49 months. The most present symptoms were headache as well as ataxia/vertigo each in 10 patients, followed by cranial nerves V and VIII disorder in 6 patients. The onset of the symptoms prior to admission was between hours and 2 years. The meningiomas involved the venous sinus in 10 patients, the pons in 11 patients, the cranial nerves in 11 patients. We prefer to remove the tumor via a suboccipital approach (14 patients). In 6 patients, an extended pterional/zygomatic approach was used, in 4 patients a pterional approach, and only in 1 patient a combined suprainfratentorial approach. There were 2 patients who underwent the occipital approach. Results: Overall, complete resection could be achieved in 23 cases. With Simpson grade I, there were 2 cases; with Simpson grade II, 16 cases; with Simpson grade III, 5 cases. A partial resection was done in 4 cases (Simpson grade IV). Two patients underwent a surgery for recurrent meningiomas. A revision surgery had to be performed in 3 patients due to hemorrhaged infarction, liquorrhea repair, and hydrocephalus needing a VP-shunt. Radiologic tumor recurrence was established in 5 cases. Ten patients improved, 8 patients were unchanged, and 9 patients worsened. Conclusions: The initial operative procedure is the best opportunity for cure of the tumor. The success of this procedure is, however, dependent on the tumor location (supra- or infratentorial), the tumor extension (involvement of vascular structures such as the venous sinus, of the cranial nerves, and of the extent of arachnoidal and dural infiltration), and the clinical presentation.