gms | German Medical Science

Objective: Meningioma surgery involving the Tentorium is technically challenging. Various classifications were proposed in order to optimize handling [1], [2]. Despite technical advances, operative results still have space for amelioration. Our policy is to operate all tumors of the posterior fossa under an intraoperative monitoring protocol containing SEP's, MEP's, EMG of cranial nerves and BAEP's [3].

Methods: We retrospectively reviewed 93 patients (68 tentorial and 25 petroclival meningiomas with tentorial involvement) treated surgically between 1996 and 2010. Data collected contained patients' characteristics, symptoms and signs at presentation, Histology, complications, GOS at follow-up and Simpson's resections Grade.

Results: Female / Male ratio was 74 / 19, Age ranged from 26 to 87 years (Mean 58). Mean follow-up was 17.8 months (range 3–80). All patients except of 7, who presented with atypical meningioma (WHO Grade 2), were Grade 1 meningiomas. Gross-Total resection (Simpson Grade 1/2) was achieved in 70 cases (76.1%), whereas partial resection (Simpson Grade 3/4) was achieved in 23 cases. One patient died due to generalized brain edema (1%). 13 patients (14%) needed a second procedure due to complications. Tumor recurrence occurred in 17 cases (14 were primarily graded as Simpson 4 and 3 as Simpson 1/2). On follow-up 64, 23 and 5 patients have reached GOS of 5, 4 and 3 respectively. When asked subjectively of their outcome, 82 patients (88%) where satisfied with the operative results.) while only 11 patients were not satisfied with the operative results

Conclusions: Meningioma resection in the tentorial region is challenging, and can be very hazardous. Our operative strategy containing an obligatory intraoperative neurophysiological monitoring is in our opinion justified in order to reduce the risk of postoperative complications. This case series shows that Gross-Total resection is possible with good results. Caution should be taken not to force Gross-Total resection on costs of morbidity or mortality.