Tentorial meningiomas: surgical management and results

We report the clinical features, radiological studies, operative management, and follow-up data in a series of 27 patients with tentorial meningiomas. Headache and extremity or gait ataxia were the most common presenting symptoms. Signs of elevated intracranial pressure and cranial nerve, pyramidal, or cerebellar deficits were the most common findings on neurological examination. Computed tomography was the single most important diagnostic tool. Cerebral arteriography was considered important to define arterial and venous relationships to the tumor. Two patients in the series underwent cerebrospinal fluid shunting only. The others underwent an operation on the tumor, with or without a shunt. There were 2 postoperative deaths early in the series, 1 due to cerebellar swelling and the other due to brain stem infarction. With an average follow-up of 5.5 years, 19 patients are independent and have resumed their premorbid level of activity. The pathological anatomy of these lesions is described. The different operative approaches to this tumor are discussed.