Overview

Tentorial meningiomas are tumor that arise from a large dural fold called the tentorium. The tentorium separates the brain into infratentorial 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 obstruct the CSF flow and hydrocephalus.

Presentation

Tentorial meningiomas can present with headache 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 of the brain. Less commonly, patients can experience swallowing difficulties or voice changes. A patient with associated hydrocephalus can develop cognitive dysfunction or acute mental status change. Patients with hydrocephalus may need emergency intervention to alleviate intracranial pressure. 

Management

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

Surgical Difficulties

• Deep location covered by brain and cerebellum
• Involvement of the supra and infra tentorial compartments
• Extension of meningeal origin of the tumor 

SURGICAL  MANAGEMENT AT THE CENTER FOR MENINGIOMA SURGERY

Tentorial meningiomas are approached through craniotomies in the back of the head. At the Center for Meningioma Surgery, we have refined a modified focused posterior fossa craniotomy approach that allows for the access of 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 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 to return to their pre-morbid lifestyle and job occupation.