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The 6 Surgical Approaches for Tentorial Meningiomas Based on Site of Origin and Extension
Eldaniz Mammadli1,2, Burhaneddin Sahin1, Yener Sahin1
1Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey.
Background And Objectives:
This study aims to classify the surgical approaches used in the resection of tentorial meningiomas (TMs), correlating the site of origin and extension with the appropriate surgical approach. In addition, our objective was to analyze characteristics of TMs.
Methods:
A retrospective review was conducted on 63 patients who underwent surgery for TMs between 2011 and 2024. Clinical and surgical data, including age, sex, symptoms, neuroradiological findings, and postoperative outcomes, were collected. Tumors were classified based on Yasargil's classification system, and surgical approaches were selected based on the site of origin and extension. The extent of resection was evaluated using postoperative imaging, with outcomes assessed using the modified Rankin Scale.
Results:
The cohort consisted of 51 (81%) female and 12 (19%) male patients, with a median age of 51.4 years. Headache was the most common presenting symptom (54%), followed by cranial nerve deficits (17.5%). Tumor classification according to Yasargil's system showed that the most frequent types were T7 (34.9%) and T2 (20.6%). A majority of tumors extended infratentorially (58.7%). Surgical approaches used included retrosigmoid (42.9%), paramedian supracerebellar infratentorial (20.6%), subtemporal (15.9%), and others. Gross total resection was achieved in 73% of cases, whereas subtotal resection was performed in 27%. The most common postoperative complication was cerebrospinal fluid leakage (4 patients). Gamma Knife® radiosurgery was performed for 18 patients. At a median follow-up of 6 years, 90% of patients had a good outcome (modified Rankin Scale 0-2) and 10% of patients died because of other conditions.
Conclusion:
This study presents a large surgical series of TMs and provides a surgical classification system based on the site of origin and extension. We believe that the choice of surgical approach has an influence on postoperative outcomes. Tailoring the surgical route to each tumor's characteristics is crucial for achieving better results.
