Tentorial meningiomas. Report on twenty-seven cases

Objective. Report our experience with 27 tentorial meningiomas (TM) surgica lly treated between 1985 and 1998. Methods. The records of 27 patients with TMs were retrospectively reviewed for clinical presentation, neuroradiological evaluation, surgical treatment and long-term outcome. The extent of tumor resection was scored according to the Simpson's grading for tumor removal. Long-term results were evaluate d according to the Glasgow Outcome Score (GOS). Results. The average age was 53 years. Female predominance was 74%. The mos t common complaints at presentation were headaches (51%), gait ataxia (33%) , memory disturbances (30%) and hypoacousia (30%). A classification of TMs into 5 subgroups according to tumor site is proposed on the basis of imagin g studies. A cerebrospinal fluid shunt was established prior to direct appr oach in 7 patients and as the sole procedure in one inoperable patient. Twe nty-seven direct approaches were undertaken in 26 patients, including 17 in fratentorial and 10 supratentorial approaches. Total tumor removal was achi eved in 20 patients (77%) and subtotal removal in 6 (23%). Fifteen patients (55%) experienced 22 postoperative complications. One patient died three m onths after a subtotal resection (mortality = 3,7%). With a mean follow-up of 54 months, all 26 survivors are currently alive with 23 having resumed t heir normal activities and 3 needing assistance. Five of 6 patients with su btotal resection survived and were followed for a period ranging from 72 to 132 months: none showed residual tumor progression and no re-operation was considered. An additional patient experienced a <<true>> recurrence 6 year s after total removal, with no tumor progression 2 years after his recurren ce was recognized. Discussion. The best surgical approach to TMs is still a controversial matt er. The advantages and drawbacks of conventional versus transbasal approach es are reviewed. Our experience suggests that subtotal removal can be assoc iated with long recurrence-free intervals and preserved quality of life. TM s located at the tentorial edge carried a definitely worse prognosis than p eripheral forms.