Related Experiment Video
Updated: Aug 30, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Pitfalls in surgery of meningeomas of the free tentorial edge
R Firsching1, H J Synowitz, C Grimm
1Klinik für Neurochirurgie der Otto von Guericke Universität Magdeburg. neurochirurgie@uni-magdeburg.de
Abstract:
Clinical experiences from 15 meningeomas located on the free edge of the tentorium are reported. Unexpected findings and complications found in five patients are presented in detail: Despite successful removal without postoperative morbidity after a presigmoid approach the preoperative loss of function of the ophthalmic nerve may cause increasing keratitis, which may result in blindness over the years after surgery. Before a presigmoid approach is performed, angiography or magnetic resonance angiography is advised, because the patient may have only one sigmoid sinus on the tumor side. An acute subdural hematoma as a complication of surgery may not only occur after, but also during surgery with the patient in the semi-sitting position. When a space occupying tumor of the tentorium is discovered, there may be an additional spinal one. If total removal of an extensive tumor of the free edge of the tentorium appears too hazardous, a two-stage strategy with a one year interval may lead to success.
Insights
This study details 15 tentorial edge meningiomas, highlighting potential complications like vision loss and the need for pre-operative angiography. A two-stage surgical approach may be safer for extensive tumors.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Meningiomas on the free edge of the tentorium are rare tumors requiring specialized surgical consideration.
- Previous literature has not extensively detailed the specific challenges and potential complications associated with these tumors.
Purpose of the Study:
- To report clinical experiences with 15 meningiomas located on the free edge of the tentorium.
- To detail unexpected findings and complications encountered in five patients undergoing surgical removal.
Main Methods:
- Retrospective review of clinical data from 15 patients with tentorial edge meningiomas.
- Detailed analysis of surgical approaches, including the presigmoid approach.
- Documentation of preoperative, intraoperative, and postoperative findings and complications.
Main Results:
- Successful tumor removal was achieved in most cases, often without immediate postoperative morbidity.
- Complications included delayed blindness due to ophthalmic nerve dysfunction, the need for angiography to assess sigmoid sinus patency, acute subdural hematoma during surgery, and the possibility of concurrent spinal tumors.
- A two-stage surgical strategy was considered successful for extensive tumors where complete removal was deemed too hazardous.
Conclusions:
- Surgical management of tentorial edge meningiomas requires careful preoperative planning, including vascular imaging.
- Potential long-term complications such as vision loss necessitate vigilant follow-up.
- A staged surgical approach may be a viable option for managing large or complex tumors.