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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Microsurgical treatment of tentorial meningiomas: Report of 30 patients
Paulo Henrique Aguiar1, Adriana Tahara, Antonio Nogueira de Almeida
1Department of Neurology, São Paulo University Hospital, Dr Eneas de Carvalho Aguiar Avenue, 647 - Cerqueira César, 05403-900, São Paulo, Brazil.
Background:
Tentorial meningiomas represent about 5% of intracranial meningiomas. This article reviews our recent institutional series of patients with tentorial meningiomas, proposes a simplified classification and analyzes postoperative evolution, discussing the salient features in the management of these patients.
Methods:
From 1998 to 2005, 30 patients (22 female and 8 male) with tentorial meningiomas were operated at our institution. Thirteen patients had tumor restricted to the infratentorial space; 12, to the supratentorial space; and in 5 cases, the tumor involved both compartments. Follow-up ranged from 1 to 8 years. A total of 35 surgical procedures were performed in 30 patients, where 26 procedures were performed through a single approach (2, ITSC; 10, RS; 5, SOIH; 5, ST; and 4, TT); and 9, through combined approaches (7, ITSC/ SOIH; and 2, RS/ST).
Results:
Simpson I resection was achieved in 17 patients. Tumors involving both compartments, involving the petrous sinus, and attached to the torcula limited complete resection. Twenty-two out of 30 patients were able to return to their regular life with no or minimal neurological sequelae. Most frequent complications in our series were shunt dependence, CSF fistulae, diffuse brain injury and visual field defects. Overall, our series revealed 3% mortality and 23% morbidity.
Conclusion:
Tentorial meningiomas are associated with significant morbidity related to the nervous and vascular structures surrounding the tumor. Partial tumor removal may be necessary in some cases.
Insights
Tentorial meningiomas, a rare brain tumor, pose surgical challenges. While complete resection is ideal, partial removal may be necessary, with most patients experiencing good recovery despite potential complications.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Tentorial meningiomas constitute approximately 5% of all intracranial meningiomas.
- This study reviews a recent institutional series, proposing a classification and analyzing outcomes.
- Key management features are discussed.
Purpose of the Study:
- To review institutional experience with tentorial meningiomas.
- To propose a simplified classification system.
- To analyze surgical outcomes and patient evolution.
Main Methods:
- Retrospective review of 30 patients (1998-2005) with tentorial meningiomas.
- Tumors classified by location: infratentorial, supratentorial, or both.
- Analysis of surgical approaches, including single and combined strategies.
Main Results:
- Simpson I resection achieved in 17 patients; complete resection was limited by tumor location.
- 22 of 30 patients returned to normal life with minimal sequelae.
- Common complications included shunt dependence, CSF fistulae, and visual field defects; mortality was 3%, morbidity 23%.
Conclusions:
- Tentorial meningiomas present significant morbidity due to proximity to critical neurovascular structures.
- Partial tumor resection may be a necessary surgical consideration.
- Careful surgical planning is crucial for managing these complex tumors.
