gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Surgical management and outcome of meningiomas with tentorial involvement – our institutional experience

Meeting Abstract

  • D.B. Schul - Klinik für Neurochirurgie, Klinikum München-Bogenhausen, Akademisches Lehrkrankenhaus der Technischen Universität München
  • M.J. Krammer - Klinik für Neurochirurgie, Klinikum München-Bogenhausen, Akademisches Lehrkrankenhaus der Technischen Universität München
  • J.F. Landscheidt - Klinik für Neurochirurgie, Klinikum München-Bogenhausen, Akademisches Lehrkrankenhaus der Technischen Universität München
  • C.B. Lumenta - Klinik für Neurochirurgie, Klinikum München-Bogenhausen, Akademisches Lehrkrankenhaus der Technischen Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.05.08

DOI: 10.3205/12dgnc201, URN: urn:nbn:de:0183-12dgnc2014

Published: June 4, 2012

© 2012 Schul et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

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.


References

1.
Al-Mefty O. Meningiomas. Lippincott Williams and Wilkins; 1991.
2.
Guidetti B, Ciappetta P, Domenicucci M. Tentorial meningiomas: surgical experience with 61 cases and long-term results. J Neurosurg. 1988 Aug;69(2):183-7. DOI: 10.3171/jns.1988.69.2.0183 External link
3.
Krammer MJ, Wolf S, Schul DB, Gerstner W, Lumenta CB. Significance of intraoperative motor function monitoring using transcranial electrical motor evoked potentials (MEP) in patients with spinal and cranial lesions near the motor pathways. Br J Neurosurg. 2009 Feb;23(1):48-55. DOI: 10.1080/02688690802563349 External link