MGHbanner BulfinchBldg
Cranial Base Ceneter at MGH
Cranial Base Center at MGH
Otolaryngology at MEEINeurosurgery at MGHRadiation Oncology at MGH
MEEI

Massachusetts General HospitalHarvard Medical School

MGH  Neurosurgical Service HomeMGH ShieldHvd Med Sch ShieldPartners Logo
A joint program of the Departments of Otolaryngology, Neurosurgery, and Radiation Oncology dedicated to the evaluation and treatment of patients with cranial base lesions. Including the Cranial Base Center News - A newsletter with information regarding lesions affecting the base of the skull including acoustic neuromas (vestibular schwannoma) and other tumors of the cranial nerves).
Neurosurgery @ MGHPeople @ MGH NeurosurgeryClinical Centers @ MGH NeurosurgeryResearch @ MGH NSEducation @ MGH NeurosurgerySupport Groups @ MGH NeurosurgeryNews @ MGH NeurosurgeryReferrals @ MGH Neurosurgery
Management of Meningiomas
File 16: TENTORIAL MENINGIOMA

To the MGH/Harvard Meningioma Treatment Homepage
To the Introduction and Contents of Management of Cranial and Spinal Meningiomas

CBC Members | Referrals | Newsletter | Guestbook | Links | Selected Publications | CBC HomePage


by ROBERT G. OJEMANN, M.D.
Congress of Neurological Surgeons Honored Guest Presentation
Originally Published Clinical Neurosurgery, Volume 40, Chapter 17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.

HTML Editor: Stephen B. Tatter, M.D., Ph.D.
CAT Scan of Meningioma
FIG. 17.27. Tentorial meningioma. This 63-year-old woman presented with facial pain. At operation through a subtemporal approach the tumor was totally removed. There was dense adherence and partial encasement of the fourth nerve. A postoperative fourth nerve palsy gradually resolved. (A and B) CT scans show a small left medial tentorial meningioma.


Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.

Contents


CAT Scan of Meningioma
FIG. 17.28. Tentorial meningioma. This 73-year-old woman had gradual onset of unsteady gait and slurred speech. A right frontal meningioma had been removed 7 years previously. Total removal of the tentorial meningioma was followed by full recovery. (A-D) CT scans after contrast show a large tentorw meningioma with both supratentorial and infratentorial extension. (E-H) Angiography defines the arterial blood supply from both Vertebra and external carotid artery branches and the relationship to the transverse sinuses.

TENTORIAL MENINGIOMAS

(Meningioma Management, File 16)

Management

These meningiomas may arise from any location on the tentorium (10, 23, 26, 47, 64, 66, 73). From a clinical standpoint they can be best divided into medial tumors involving the tentorial edge (FIG. 17.27), posterior and lateral tumors (FIG. 17.28), and those that involve both the falx and tentorium (73).

MRI usually gives most of the information that is needed. In larger meningiomas involving the tentoiial edge, angiography should be done to define the location of the arterial branches and determine the status of the transverse sinus (FIG. 17.28, E-H).

The indications for operation are increasing neurological disability due to cerebellar or brainstem compression and cranial nerve deficits in younger patients. Radiation therapy has not been used. Some older patients with only cranial nerve deficits have been observed.

Key considerations in the operation include the following.

  1. A subtemporal approach is used for tumors involving the medial edge, with preservation of the vein of Labbe and avoidance of excessive retraction on the temporal lobe.
  2. A combined supratentorial and infratentorial approach is used for posterior lateral tentorial meningiomas (Fig. 17.29). In smaller tumors it is possible to remove the lesion by carefully elevating the occipital lobe and making a circumferential cut around the tumor.
  3. In some patients it may be necessary to occlude the petrosal sinus.
  4. If the transverse sinus is involved, it may be resected if it is known from angiography that the opposite sinus is open.
Line drawing of Meningioma
FIG. 17.29. Tentorial meningioma. A combined supratentorial and infratentoiial approach is used for posterior lateral tumors.

Results

In this series there were 20 patients, 19 women and one man, ranging in age from 32 to 79 years, with five over 70 years of age (Table 17.15). In six

the tumor involved the medial edge and adjacent tentorium. A total removal was done in four and a subtotal removal in two because of arteiial and cranial nerve involvement. Five of the six patients had a good result. Transient diplopia was noted in two. Two had hemorrhagic infarction in the temporal lobe. One required reoperation and, while that patient is fully functional, she has an unsteady gait. There has been no regrowth of tumor over 1-10 years. In two other patients the tumor involved the falx and medial edge of the tentorium. In one a subtotal removal and shunt were performed with a good result and no change on follow-up scans over 12 years. The other patient had a good result with subtotal removal and has been stable for eight years.

In 12 patients the meningioma involved the posterior and/or lateral tentorium and in some cases the transverse sinus and/or petrous dura. All had a total removal, including an occluded transverse sinus in six. There were no postoperative complications. All made a good recovery.
TABLE 17.15 Tentorial Meningiomas
aRemoval bOutcome Complications Recurrence
Medial Posterior
Lateral
Medial Posterior
Lateral
T 4 12 Good 7 12 Temporal
lobe
hematoma
2 None
RST 0 0 Fair 1 0
ST 4 0 Poor 0 0
aT, total removal
RST, radical subtotal removal
ST, subtotal removal
bGood, free of major neurological deficit and able to return to previous activity level
Fair, independent but not able to return to full activity because of new neurological
deficit or significant preoperative deficit that did not fully recover
Poor, dependent.

Sugita and Suzuki (73) reported on 49 patients operated upon for tentorial meningiomas, with 88% excellent or good results. The operative mortality was 4%. In the last several years of the series reported by Cantore and Ciappetta (10) there was no operative mortality.

 

To the MGH/MEEI/Harvard Cranial Base Center or the MGH Proton Beam Radiosurgery Homepage.
Ceanial Base Center at MGH Members | Referrals | Newsletter | Guestbook
Links | Selected Publications | CBC HomePage
[Divider]

Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreement." See also: the MGH Disclaimer, the MGH Privacy Policy, and the MGH Interactive Program Disclaimer - Copyright 2005.
[Divider]
electronswebs
MGH  Neurosurgical Service Home
Research@NeurosurgeryVisitors must read the disclaimer - legal agreement.
All Rights Reserved. Copyright 20005 MGH Neurosurgical Service
Neurosurgery@MGH
IntraNet

(internal access only)
System Info Contact: WebServant or the PageServant or e-mail C.Owen
Last modified: May 11, 2005
Referral@Neurosurgery.MassGeneral.org