Microsurgical Treatment of Meningiomas in the Torcular Herophili Region

The Torcular Herophili region of the brain is anatomically complex, and surgery in this area requires much skill and care. Retrospective analysis on 35 cases of meningiomas in the Torcular Herophili region treated by microsurgery and confirmed by pathology. Tumor resection range was evaluated using the Simpson grading criteria. Postoperative complications and tumor recurrence were evaluated. Patients were followed up. The Karnofsky performance status was used to evaluate neurologic functions. Magnetic resonance venography (MRV) and magnetic resonance imaging (MRI) revealed the extent of disease in all patients. Simpson level I excision was done in 27 patients, level II in 5 patients, and level IV in 3 patients. Gamma knife treatment after surgery was performed in 3 patients. Symptoms of increased intracranial pressure were relieved after surgery. No patient died, and no patient suffered from any relevant operative complications and disabilities. Pathology reported typical meningioma (World Health Organization [WHO] level I) in 32 patients, and atypical meningioma (WHO level II) in 3 patients. Thirty-two patients were followed up for 0.5 to 5 years: 1 patient relapsed 2 years after operation (Simpson level IV excision), and 2 patients relapsed 3 years after operation (one Simpson level I and one level II). These results indicated that MRV should be performed to confirm the exact relationship between the tumor and venous sinus. The operative approach should be planned according to the MRI results, and the venous sinus should be preserved. Gamma knife might be a beneficial auxiliary treatment of meningioma in the Torcular Herophili region.