TENTORIAL MENINGIOMA

Tentorial Meningioma

Tentorial Meningiomas are tumors that arise from a large dual fold called tentorium. The tentorium separates the brain into infra and supratentorial compartments. The infratentorial compartment contains the cerebellum and the supratentorial compartment contains the brain. Tentorial Meningioma can grow towards the infratentorial or supratentorial compartment with respective compression of the cerebellum or brain. Tentorial Meningioma can grow to a formidable size causing significant pressure and swelling or edema to the cerebellum or brain before coming to medical attention. These tumors can cause obstruction of the CSF flow and hydrocephalus

Symptoms

Tentorial Meningiomas can present with headaches localized in the back of the head, seizures, dizziness, balance or gait difficulties, blurred vision, or double vision. Speech difficulties can occur when the tumor is associated with compression of the dominant temporal lobe brain. Less commonly patients can experience swallow difficulties or voice changes. Patients with associated hydrocephalus can develop cognitive dysfunction or acute mental status change. Patients with hydrocephalus may need emergency intervention to alleviate intracranial pressure.

Treatment

Large symptomatic tentorial Meningiomas, in general, need surgical intervention. Smaller tumors may be treated primarily with CiberKnife radiation therapy or Proton bean Radiation Therapy. Incidental tumors in elderly patients may be managed with observation with surveillance MRIs. 

Surgical Treatment at the Meningioma Center

Tentorial Meningiomas are approached through craniotomies in the back of the head. At the Meningioma Center, we have refined a modified focused posterior fossa craniotomy approach which allows accessing these Meningiomas using a small focused approach. This focused approach has mostly eliminated the post-operative chronic occipital headache associated with the more traditional approaches. The approach allows direct access to the parts of the tumor above and below the tentorium. Moreover, it offers the potential for complete resection of the tumor including the tentorial meningeal root of the tumor.

Prognosis

Treatment of tentorial Meningiomas through focused posterior fossa craniotomy enhances the greatest tumor removal, tumor cure, and the possibility for recovery from preoperative deficits. Moreover, patients have the potential for returning to their lifestyle and job occupation.