File 16: TENTORIAL MENINGIOMA
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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.
| 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.
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
| 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.
(Meningioma Management, File 16)
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.
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.
- 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
- 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.
- In some patients it may be necessary
to occlude the petrosal sinus.
- If the transverse sinus is involved,
it may be resected if it is known from angiography that the opposite
sinus is open.
| FIG. 17.29. Tentorial
meningioma. A combined supratentorial and infratentoiial
approach is used for posterior lateral tumors.
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
aT, total removal
RST, radical subtotal removal
ST, subtotal removal
bGood, free of major
neurological deficit and able to return to previous activity
Fair, independent but not able
to return to full activity because of new neurological
deficit or significant preoperative deficit that did not fully
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.
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