Surgical and Functional Outcome after Resection of 57 Tentorial Meningiomas

Abstract

Tentorial meningiomas (TMs) may challenge the surgeon with their close association to neurovascular structures. We analyzed a consecutive series with regard to surgical and functional outcome following microsurgical resection. We retrospectively reviewed patient charts and imaging data of every patient with a TM resected at a single institution and compared surgical and functional outcomes between groups stratified by choice of approach. 57 consecutive patients from October 2006 to September 2017 were included, of which 75.4% were female; mean age was 60 years (range 31–90), follow-up data was available for 85.4% and reached a mean of 18.3 (range 2–119) months with a median of 14.5 months. 54.4% of TMs were located at the medial compartments of the tentorium, 45.6% at the lateral edges. Complete resection defined as Simpson grades I and II was achieved in 72% of all cases, without statistically significant differences for both subgroups (p = 0.532). 9 patients (15.8%) developed a new cranial nerve palsy postoperatively with the vestibulocochlear nerve affected exclusively in the lateral subgroup (8.8% of total), followed by disturbances of oculomotion (5.4%). After 12 months, 93.0% of patients with available follow-up after 12 months retained fully independent functional status without deficit. Despite providing a surgical challenge due to potentially complicated anatomical relations, the choice of an appropriate surgical strategy overall results in favourable oncological and functional outcome after resection of TMs.

Surgical management of tentorial meningiomas: case series

“…Recent series were devoid of dead cases [14,16,18]. Wagner and coworkers reported a 1.8% mortality [15]. Two of our cases died of pulmonary complications during the post-operative ICU stay, which if excluded, we would get a lower (6.25%) mortality rate that would be directly attributed to surgical complications.…”

“…Mortality is different among authors and through the past 30 years. Mortality rate decreased from 9.8% in 1988 to 2.7% in 1995 [15]. Recent series were devoid of dead cases [14,16,18].…”

“…Complications rate is up to 35% in early series records [11][12][13][14]. Complications rate is highly dependent on tumor location [15,16]. Hydrocephalus and CSF fistula are the main drawbacks in the natural history of a surgically removed tumor [1,8,17].…”

“…Medially located tumors seem resistant for complete resection as well as those with venous sinuses invasion [15,19,20].…”

“…They are the most common deficits in literature followed by diplopia. They are transient damages and gaining functional recovery in most literatures happened by the end of follow-up [15,16].…”