Results for microsurgical removal of tentorial meningiomas

Abstract

Neurological deficits following microsurgical removal of tentorial meningiomas are transient in the majority of patients. The apparently high rate of incomplete tumor resection (app. 60% Simpson grades II and III) is due to the close topographical relationship of these tumors with important neurovascular structures. Thus, the operative strategy should not be excessively aggressive, but rather take into account the option to observe residual tumor or to apply additional stereotactic convergent beam radiation in selected cases.

Volumetric Analysis of the Growth Rate of Incompletely Resected Intracranial Meningiomas

“…Although meningiomas are common tumors accounting for 14± 18 % of intracranial neoplasms, there is little information available on the growth rate and natural history of these tumors. The behavior of a meningioma, which is either incidentally diagnosed by modern neuroimaging (CT and MRI) or which is left as a residual tumor after neurosurgical resection of tumors in challenging locations [5,20], is difficult to predict. Possible predictive factors for tumor growth were analysed previously but results differed and the methods for the measurement of tumor growth or recurrence varied, ranging from simple measurement of the maximum diameter to volume calculation.…”

Surgical Treatment of the Tentorial and Falco-Tentorial Junction Meningiomas

“…In neoplastic lesions of huge size located bilaterally on the notch of the tentorium the authors use a bilateral occipital-transtentorial opening [10] . The bioccipital interhemispheric approach is also used by other surgeons [1] .Tentorial and rarely, falco-tentorial meningiomas may be successfully operated through a subtemporal approach or subtemporal-transtentorial approach [1,2,8,18,21] . However, this approach poses a considerable risk of the temporal lobe traumatization and the Labb é vein damage.…”

“…This is mainly due to the large volume of these meningiomas, as well as to their location close to important anatomic formations. The invalidity risk factor is smaller in the case of a partial resection of the lesion [8] , but then the risk of relapse of the tumour increases [6] . Consequently, choosing the right surgical approach seems to be crucial for the course of operation and the prognosis the tentorial and falco-tentorial junction meningiomas.…”

Spontaneous, Multiple Meningiomas

“…We prefer to leave an eventual residue in place rather than to achieve a complete tumor removal when the tumor is located in a critical site. This is a general concept for the surgical management of meningiomas [12,29]. We have had excellent results with reversible operative complications in only three patients.…”