TENTORIAL MENINGIOMAS

WE REPORT OUR experience with and long-term results of 37 patients wit h tentorial meningiomas who underwent surgery between 1972 and 1993. T he average age was 43 years, and the mean duration of symptoms was 36 months. Headache (83.8%) and extremity or gait ataxia (35.1%) were the most common complaints. On neurological examination, signs of elevate d intracranial pressure and cerebellar deficits (51.4%) were the most common findings, followed by third nerve involvement (35.1%). Computed tomography, angiography, and, in recent years, magnetic resonance ima ging were used as diagnostic tools and for planning the surgical proce dure. According to the primary site of attachment, the tentorial menin giomas were divided into three subgroups: medial, lateral, and falcote ntorial. The lateral and medial tumors, with mainly supratentorial dev elopment, were approached from above by using a temporal, temporooccip ital, or parietooccipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy was performed. I n six patients who showed medial tentorial and petrous apex attachment , a combined subtemporal transpetrosal and retromastoid approach was p erformed. In 31 patients, the tumors were totally removed, and, in 6 p atients, only subtotal excision could be done. Seven patients had post operative complications, but only one of them died of severe brain ede ma. Our mortality rate was 2.7%. In this article, appropriate preopera tive studies, surgical techniques, and surgical results are discussed.