Tentorial meningiomas: surgical options, clinical feature and management experience in 43 patients

Objective: To investigate the optimal treatments and the prognostic factors of the tentorial meningiomas (TMs).

Methods: The data of clinical symptom, imaging examination, surgical approaches as well as the influence factors of gross total resection (GTR) of 43 TMs cases were analyzed retrospectively.

Result: Imaging examinations of computer tomography (CT) and magnetic resonance image (MRI) were performed in all 43 cases. The angiographies such as computer tomography angiography (CTA), digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) were obtained in part of these cases. The TMs can be classified into 2 types as superior/inferior to the tentorium, and subtypes as medial/lateral, anterior/middle/posterior according its location and the origination of the tumor. Six different surgical approaches were utilized in the study mainly depending on the tumor location and the surgeon's preference. CT scan was performed in all patients 6h after the operation. Follow-up MRI with contrast was also obtained 3 months later. Simpson's grade of excision was applied. GTR was defined as Simpson grade I and II, and was acquired in 34 cases, in which Simpson grade I resection was accomplished in 15 cases, and subtotal resection (STR) was defined as more than 90% of the tumor volume was removed and was acquired in 7 cases; histopathology revealed 34 benign (grade I), 8 atypical (grade II), and 1 malignant (grade III) cases.

Conclusion: Elaborate imaging examination, microsurgical skills as well as the choices of approaches and management of the sinus involved are the main prognostic factors of the TMs.