Abstract
Background
From a surgical perspective, tentorial fold (TF) meningiomas (TFM) are a unique entity of tumors. They involve the supra- and infratentorial space and often are in close contact to the cavernous sinus, cranial nerves, and the mesencephalon. Complete resection is challenging and can be hazardous. We present our experience with this rare tumor entity and demonstrate the surgical outcome related to a topographical classification.
Methods
A retrospective analysis on 21 consecutive patients (female/male ratio 17/4) with meningiomas originating from the TF, who underwent surgery between 1992 and 2005 in our clinic, was performed. The follow-up period ranged from 6 to 93 months. The cases were classified according to tumor extension in three different types: type I, TF meningiomas with compression of the brain stem; type II, with extension into the anterior portion of middle fossa; and type III, a combination of type I and II. Depending on tumor location, surgical approaches consisted of pterional (nine cases), subtemporal (nine cases), or combined subtemporal–pterional craniotomies (three cases). We defined transient and persistent operative complications in relation to Simpson grade and TF classification.
Results
Tumor size ranged from 1 to 6 cm in diameter, with a median at 2.5 cm. The presenting symptoms of the patients were anisocoria (six cases), diplopia (six cases), ptosis (five cases), hemianopia (four cases), and ataxia (two cases). Extent of tumor resection was Simpson grade II in 19 patients, grade III in one patient, and grade IV in one patient. There was no operative mortality (first 30 days after surgery). The rate of postoperative transient new neurological deficits was found at 9.5%, the rate of permanent at 33%. The neurological deficits at admission recovered in two patients.
Conclusion
In the majority of patients with TF meningiomas, total resection can be achieved through a pterional, subtemporal, or combined approaches but at a substantial toll in terms of permanent morbidity. Radiotherapy after volume reductive surgery in TFM type II and III and decompression of eloquent anatomical structures with low tolerance of radiation should be considered.
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Hashemi et al. review 21 patients with tentorial fold meningiomas treated at their institution over a 13-year period. They define three types of meningiomas arising from the tentorial fold. All tumors were approached using a pterional (9), subtemporal (9), or combined (3) approach. They have critically assessed the risk of surgical resection, relating it to the tentorial fold meningioma type. They note that subtotal resection of type II and III tentorial meningiomas followed by SRS may yield superior results than aggressive surgical resection in these types. This is a useful observation, considering the risk of causing permanent cranial nerve dysfunction with tumor involving the cranial nerves in more anteriorly located tumors.
WT Couldwell
Utah, USA
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Hashemi, M., Schick, U., Hassler, W. et al. Tentorial meningiomas with special aspect to the tentorial fold: management, surgical technique, and outcome. Acta Neurochir 152, 827–834 (2010). https://doi.org/10.1007/s00701-009-0591-z
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DOI: https://doi.org/10.1007/s00701-009-0591-z