In this article, we retrospectively analyzed a series of 32 patients with tentorial meningioma at our center. We described our experience in managing tentorial meningioma through different approaches. Various publications discussed such pathology as a part of posterior fossa pathologies [1, 8, 9]. However, tentorial meningioma is a difficult category of posterior fossa meningiomata due to interdigitating with cranial nerves, arterial tree, and venous drainage [1, 10]. Complications rate is up to 35% in early series records [11,12,13,14]. Complications rate is highly dependent on tumor location [15, 16]. Hydrocephalus and CSF fistula are the main drawbacks in the natural history of a surgically removed tumor [1, 8, 17]. Even in meticulous procedures that aimed to preserve neurological function, complications rate ranged between 24 and 33% in these reports.
Mortality is different among authors and through the past 30 years. Mortality rate decreased from 9.8% in 1988 to 2.7% in 1995 [15]. Recent series were devoid of dead cases [14, 16, 18]. Wagner and coworkers reported a 1.8% mortality [15]. Two of our cases died of pulmonary complications during the post-operative ICU stay, which if excluded, we would get a lower (6.25%) mortality rate that would be directly attributed to surgical complications. This would be a more acceptable mortality rate compared to other case series. However, this points out the importance of post-operative care, especially ICU care, which has a great impact on the overall outcome of cases.
Complete resection of tentorial meningioma (Simpson grades I and II) was achieved in our study (81.25%). Medially located tumors seem resistant for complete resection as well as those with venous sinuses invasion [15, 19, 20].
Postsurgical neurological deficit is a common phenomenon for both medially and laterally located tumors; indeed, they are temporary in most of the literatures by 12 months follow-up [14, 16, 18]. Gait ataxia and vestibulocochlear nerve affection might be seen perioperatively. They are the most common deficits in literature followed by diplopia. They are transient damages and gaining functional recovery in most literatures happened by the end of follow-up [15, 16].
In our study, we used an objective crude tool for judgment of patient recovery (GOS) instead of retrieving patients’ satisfaction as in the study of Wagner and colleagues. The presence of a ‘temporary’ deficit reflected negatively on patient satisfaction even after the complete emphasis of complications [15].
Choosing a surgical approach for an individual case was highly dependent on the best strategy to attack the tumor and to avoid endangering a neighbor’s structure [21]. However, our small series did not permit us to split comparable cases into two arms or options to measure resectability in the statistical method.
Our series pointed out the importance of paying special attention to the surgical treatment of such tumors by expert skull-base surgeons. It demands meticulous knowledge of the neurovascular structure and great care during dissection [13, 22]. If this paradigm was followed, the complications rate will be at its minimum for such lesions and resectability will be much more achieved.
Our study limitations are small sample size in comparison to recent onset articles. Absence of long-term follow-up is also reported as a limitation to this study, in the future, we might conduct a retrospective analysis for tentorial meningioma with long-term follow-up.
