gms | German Medical Science

Objective: A consecutive microsurgical series of patients harboring a tentorial meningioma was analyzed in regard to long-term surgical outcome.

Methods: Clinical data in a consecutive series of 108 patients treated microsurgically for a tentorial Meningioma in our institutions from January 1989 to June 2008 were retrospectively reviewed.

Results: Main presenting symptoms in the 92 women and 16 men (mean age 55 years) were headache (70%), dizziness (46%), and gait unsteadiness (43%). Clinical examination revealed a gait ataxia in 50% and a cranial nerve deficit in 28% of the patients. Most tumors were located in the cerebello-pontine angle, accordingly, the suboccipital retromastoid approach was the most common surgical route for tumor resection. A Simpson Grade I and II tumor removal was achieved in 91% of the patients. Infiltration of a dural venous sinus was present in 31% patients, however complete occlusion of the sinus was confirmed intraoperatively in only 4 patients. A gross tumor remnant (Simpson Grade IV) was left in 7 patients (7%) due to ‘en plaque’ growth or tight adherence of the tumor to critical neurovascular structures. Permanent surgical morbidity and mortality rates were 18% and 2%, respectively. Twelve (11%) tumor recurrences were observed after a mean follow-up period of 7.4 years (1 to 18 years) with clinical and MRI examination. Of these, seven patients underwent a second surgery. 95 patients (88%) resumed full-daily activity after surgery with either no or minor symptoms (KPS score 80–100).

Conclusions: With application of meticulous microsurgical technique and careful selection of an approach tailored to location and extent of the tentorial meningioma radical tumor resection with acceptable morbidity rates can be achieved in most patients. Aggressive removal of tumor tightly adherent to critical neurovascular structures and resection of an infiltrated but patent dural venous sinus is not recommended.