21Cases Of Tentorial Fold Meningioma: Classification, Surgical Technique And Outcome Analysis

Objective:To study the classification, surgical technique of the tentorial foldmeningioma, to present experience with this rare tumor entity and demonstrate thesurgical outcome related to a topographical classification. Method:A retrospectiveanalysis on21consecutive patients (female/male ratio17/4) with meningiomasoriginating from the TF, who underwent surgery between2002and2012in our clinic,was performed. The follow-up period ranged from1to36months. The cases wereclassified according to tumor extension in three different types: type I, TF meningiomaswith compression of the brain stem; type II, with extension into the anterior portion ofmiddle fossa; and type III, a combination of type I and II.Depending on tumor location,surgical approaches consisted of pterional (nine cases), subtemporal (nine cases), orcombined subtemporal-pterional craniotomies (three cases). Result:Tumor size rangedfrom1to6cm in diameter, with a median at2.76cm. The presenting symptoms of thepatients were anisocoria (six cases), diplopia (six cases),ptosis (five cases), hemianopia(four cases), and ataxia (two cases). Extent of tumor resection was Simpson grade II in19patients, grade III in one patient, and grade IV in one patient. There was no operativemortality (first30days after surgery). The rate of post operative transient newneurological deficits was found at9.5%, the rate of permanent at33%. The neurologicaldeficits at admission recovered in two patients. Conclusion:In the majority of patientswith TF meningiomas, total resection can be achieved through a pterional,subtemporal,or combined approaches but at a substantial toll in terms of permanent morbidity.Radiotherapy after volume reductive surgery in TFM type II and III and decompression ofeloquent anatomical structures with low tolerance of radiation should be considered.