Tentorial Meningiomas: Reappraisal of Surgical Approaches and Their Outcomes.

ABSTRACT

BACKGROUND: Tentorial meningiomas are notorious for their critical location. Selection of a suitable approach that exposes the multicompartmental growth of tumor is important for a complete and safe resection. This paper discusses about various operative approaches and their overall surgical outcome. METHODS: We retrospectively reviewed our 41 patients with tentorial meningiomas. They were classified according to the modified Yasargil classification. The symptomatic improvement and progression-free survival (PFS) were analyzed at follow-up. RESULTS: Tumors were almost equally distributed in all location groups. Tumors along the lateral tentorial hiatus were operated on via a subtemporal or transsylvian approach. Tumors along the posterior tentorial hiatus, tentorial membrane, or torcula were operated on by an occipital interhemispheric transtentorial, infratentorial supracerebellar, or a combined approach. Tumors along the petrous attachment were operated on by a retromastoid suboccipital or a combined presigmoid-retrosigmoid approach. Seventy-six percent had total excision (Simpson grade 1 and 2). Group II tumors had the highest total resection rate (100%). Headache and diplopia were the symptoms that significantly improved postoperatively. Over a median follow-up of 65 months, 13 patients (31.7%) had recurrence. There was no significant difference in recurrence rates and PFS in tumors at different locations. Extent of excision and tumor grade were the significant factors affecting PFS in both univariate and multivariate analysis (P = 0.01 and 0.03, respectively). CONCLUSIONS: Similar to intracranial meningiomas at other locations, extent of resection and tumor grade significantly affect the PFS for tentorial meningiomas. Careful preoperative planning based on the location and extension of the tumor guides the optimal surgical approach that translates into maximal safe resection.