Neurosurgery Blog

Icon

Daily bibliographic review of the Neurosurgery Department. La Fe University Hospital. Valencia, Spain

Tentorial meningiomas: operative nuances and perioperative management dilemmas

Acta Neurochir (2009) 151:1037–1051.DOI 10.1007/s00701-009-0421-3

Tentorial meningiomas (TM), comprising approximately 3–6% of all intracranial meningiomas, are complex entities with an intricate relationship to surrounding structures and require multiple surgical approaches. In the present study, the rationale for deciding the approaches for TMs and the perioperative management dilemmas were evaluated.
Methods  Thirty-seven patients (28 primary [supratentorial (2), infratentorial (20) and both (6)] and nine complex [cerebellopontine (CP) angle (5) and petroclival (4)] TM) underwent surgery using the occipital transtentorial, supracerebellar infratentorial, subtemporal transtentorial, bioccipital suboccipital, midline suboccipital, retrosigmoid, and combined pre and retrosigmoid approaches. The extent of excision was categorized according to Simpson’s grade.
Results  Simpson’s grade of excision was I in six, II in 11, III in nine and IV in 11 patients, respectively. Follow-up assessment (2 months to 9 years) in 27 patients (72.9%) showed that 23 patients returned to their previous activity level with either no or minimal symptoms, three returned to previous activity level with major cranial nerve palsy, and one patient required permanent assistance. One patient had recurrence and four others underwent resurgery for residual tumor. Two patients with petroclival lesions died due to aspiration pneumonitis and meningitis, respectively; one with CP angle TM presented in a poor general condition and expired following emergency ventriculoperitoneal shunt and subsequent definite surgery. Pseudomeningocele, cerebrospinal fluid leak, and cranial nerve palsy were the major morbidities.
Conclusions  Classifying TM into medial and lateral, supra and infratentorial groups helps in deciding an appropriate and safe approach. Meticulously preserving venous sinuses is important since the risk of venous infarction cannot be predicted even with radiological good venous collaterization and apparent venous sinus blockade by tumor. Laterally situated tumors carry a better prognosis when compared to the medially situated ones. Leaving a small residual tumor in an effort to preserve important neurovascular structures does not obviate the expectation of a good long-term prognosis with minimal morbidity and low recurrence rates.

Category: Oncology, Surgical technique

Tagged: , , , ,

Comments are closed.

The Safety and Feasibility of Image-Guided BrainPath-Mediated Trans-Sulcal Hematoma Evacuation

Haptic Virtual Reality Aneurysm Clipping

Subtemporal Approach for AICA Aneurysm Clipping

MCA Aneurysm Anatomical Classification Scheme

Blister Aneurysms of the Internal Carotid Artery

Bypass for Complex Basilar Aneurysms

Basilar Invagination and Atlanto-Axial Dislocation Video 1

Indocyanine Green Videoangiography “In Negative” Video 2

Indocyanine Green Videoangiography “In Negative” Video 1

Management of a Recurrent Coiled Giant Posterior Cerebral Artery Aneurysm

Bypass for Complex Basilar Aneurysms

Expanded Endonasal Approach for 2012 MERC

Endoscopic Endonasal Middle Clinoidectomy Video 1

Endoscopic Endonasal Middle Clinoidectomy Video 2

Neurosurgery CNS: Flash Fluorescence for MCA Bypass Video 2

Neurosurgery CNS: Flash Fluorescence for MCA Bypass Video 1

Neurosurgery CNS: Endoscopic Transventricular Lamina Terminalis Fenestration Video 2

Neurosurgery CNS: Endoscopic Transventricular Lamina Terminalis Fenestration Video 1

Neurosurgery CNS: Surgery for Giant PCOM Aneurysms Video 2

Neurosurgery CNS: Surgery for Giant PCOM Aneurysms Video 1

NeurosurgeryCNS: Endovascular-Surgical Approach to Cavernous dAVF

Neurosurgery CNS: Lateral Supraorbital Approach Applied to Anterior Clinoidal Meningiomas Video 4

Neurosurgery CNS: Lateral Supraorbital Approach Applied to Anterior Clinoidal Meningiomas Video 3

Neurosurgery CNS: Lateral Supraorbital Approach Applied to Anterior Clinoidal Meningiomas Video 2

Neurosurgery CNS: Lateral Supraorbital Approach Applied to Anterior Clinoidal Meningiomas Video 1

NeurosurgeryCNS: Surgery of AVMs in Motor Areas

NeurosurgeryCNS: The Fenestrated Yaşargil T-Bar Clip

NeurosurgeryCNS: Cotton-Clipping Technique to Repair Intraoperative Aneurysm Neck Tear Video 3

NeurosurgeryCNS: Cotton-Clipping Technique to Repair Intraoperative Aneurysm Neck Tear Video 2

NeurosurgeryCNS: Cotton-Clipping Technique to Repair Intraoperative Aneurysm Neck Tear Video 1

NeurosurgeryCNS. ‘Double-Stick Tape’ Technique for Offending Vessel Transposition in Microvascular Decompression

NeurosurgeryCNS: Advances in the Treatment and Outcome of Brain Stem Cavernous Malformation Surgery: 300 Patients

3T MRI Integrated Neuro Suite

NeurosurgeryCNS: 3D In Vivo Modeling of Vestibular Schwannomas and Surrounding Cranial Nerves Using DIT

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 7

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 6

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 5

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 4

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 3

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 2

NeurosurgeryCNS: Microsurgery for Previously Coiled Aneurysms: Experience on 81 Patients: Video 1

NeurosurgeryCNS: Corticotomy Closure Avoids Subdural Collections After Hemispherotomy

NeurosurgeryCNS: Operative Nuances of Side-to-Side in Situ PICA-PICA Bypass Procedure

NeurosurgeryCNS. Waterjet Dissection in Neurosurgery: An Update After 208 Procedures: Video 3

NeurosurgeryCNS. Waterjet Dissection in Neurosurgery: An Update After 208 Procedures: Video 2

NeurosurgeryCNS. Waterjet Dissection in Neurosurgery: An Update After 208 Procedures: Video 1

NeurosurgeryCNS: Fusiform Aneurysms of the Anterior Communicating Artery

NeurosurgeryCNS. Initial Clinical Experience with a High Definition Exoscope System for Microneurosurgery

NeurosurgeryCNS: Endoscopic Treatment of Arachnoid Cysts Video 2

NeurosurgeryCNS: Endoscopic Treatment of Arachnoid Cysts Video 1

NeurosurgeryCNS: Typical colloid cyst at the foramen of Monro.

NeurosurgeryCNS: Neuronavigation for Neuroendoscopic Surgery

NeurosurgeryCNS:New Aneurysm Clip System for Particularly Complex Aneurysm Surgery

NeurosurgeryCNS: AICA/PICA Anatomical Variants Penetrating the Subarcuate Fossa Dura

Craniopharyngioma Supra-Orbital Removal

NeurosurgeryCNS: Use of Flexible Hollow-Core CO2 Laser in Microsurgical Resection of CNS Lesions

NeurosurgeryCNS: Ulnar Nerve Decompression

NeurosurgeryCNS: Microvascular decompression for hemifacial spasm

NeurosurgeryCNS: ICG Videoangiography

NeurosurgeryCNS: Inappropiate aneurysm clip applications


32,788
Unique
Visitors
Powered By Google Analytics

Total views

  • 0
%d bloggers like this: