Surgical Management of Tentorial Meningiomas: Analysis of 14 Cases Experience

Background: Tentorial meningiomas (TM) are relatively uncommon tumors; they represent about 5% of reported intracranial meningiomas. Depending on their site of origin, direction of growth and size, tentorial meningiomas differ in their mode of presentation, surgical difficulties and morbidity. To discuss the proper surgical management of tentorial meningiomas it must be based on their site of origin. Objective: To study the clinical and radiological features, surgical management, complications, and final outcome of tentorial meningiomas patients. Patients Methods: This is a retrospective study of 14 patients with tentorial meningiomas (TM). The clinical data were reviewed from the medical records. Preoperative diagnostic tests included brain CT scan and MRI brain in all patients and digital subtraction angiography (DSA) in 5 patients. The operative approaches were infratentorial in 10 patients and supratentorial in 4. Data regarding surgery, histopathology and postoperative course were analyzed and reviewed. Evaluation of tumor resection was done using Simpson s grade and final outcome using Glasgow outcome score (GOS) Results: 9 patients were females and 5 were males. Mean age was 53.5 years (44-71). The average duration of the presenting symptoms was 24 months. Headache was the most frequent presenting symptom. Complete surgical resection (Simpson I-II) was achieved in 12 cases. Final outcome was good recovery in 12 cases, severe disability in 1 case and death of 1 case. Conclusion: Despite the advances in neuro-radiology and microsurgery tentorial meningiomas represent a challenge for the neurosurgeons. In most cases, complete surgical resection should be the objective in order to minimize the recurrence risk. Subtotal tumor resection should be considered in TMs which have close relationship to critical structures as the brain stem or important vascular channels.