Tag: Tentorium

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Tentorial Dural Arteriovenous Fistulas: A Retrospective Cohort Study

Operative Neurosurgery 29:678–685, 2025

This single-center retrospective cohort study analyzes 275 patients with tentorial dural arteriovenous fistulas (TDAVFs) treated between 2001 and 2022, detailing demographic, angiographic, and treatment data across six Lawton-classified subtypes. Results highlight a predominance of middle-aged male patients, high immediate occlusion rates with endovascular techniques, and subtype-specific differences in venous drainage patterns and complication rates.

The manuscript compares treatment modalities and outcomes, noting superior petrosal sinus TDAVFs more often require microsurgery, while Galenic and torcular subtypes showed lower immediate cure rates and higher complications or new fistula formation. Follow-up angiographic and clinical data emphasize favorable functional recovery for most patients despite treatment-related risks.

• Patient Demographics: Tentorial dural arteriovenous fistulas (TDAVFs) predominantly affect middle-aged men, with 85.8% of cases occurring in males and a mean age of 51.1 years.

• Subtype Distribution: The most common TDAVF subtype is superior petrosal sinus (34.9%), followed by tentorial sinus (31.6%), Galenic (15.6%), torcular (7.3%), incisural (5.5%), and straight sinus (5.1%).

• Aggressiveness and Presentation: TDAVFs are less common than other DAVFs but are the most aggressive, frequently presenting with hemorrhage or progressive neurological deficits; more than half of patients present with intracranial hemorrhage or nonhemorrhagic neurological deficits (NHNDs).

• Treatment Approach: Most TDAVFs (83.0%) can be effectively treated with endovascular embolization, but superior petrosal sinus TDAVFs more often require microsurgical intervention (31.6% in this group).

• Immediate Occlusion and Complications: Immediate complete occlusion was achieved in 92.8% of treated cases, with Galenic TDAVFs showing a lower occlusion rate and both Galenic and superior petrosal sinus TDAVFs exhibiting higher complication rates (12.5% overall).

• Outcomes: Favorable clinical outcomes (mRS <3) were achieved in 82.6% of patients, with torcular and tentorial sinus TDAVFs associated with better outcomes compared to other subtypes.

• Recurrence and New Fistulas: Recurrence after complete occlusion was rare (0.9%), but torcular TDAVFs had a higher tendency to develop new fistulas post-treatment (2.6% of cases).

• Key Technical Considerations: Endovascular treatment is preferred when feasible, but surgical approaches are indicated for lesions with unfavorable arterial access or higher risk of complications, particularly in superior petrosal sinus TDAVFs.

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Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches

J Neurosurg 140:260–270, 2024

OBJECTIVE The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins.

METHODS A series of 141 patients with various pathological processes in different locations was operated on via perimedian or paramedian supracerebellar approaches by the senior author from July 2006 through October 2022 and was retrospectively evaluated. During surgery, the number and locations of all CHTB veins were recorded to establish a distribution map on the tentorial surface, divided into nine zones. Patients were classified into four groups according to the surgical technique used to manage CHTB veins: 1) group 1 consisted of CHTB veins preserved without intervention during surgery or no CHTB veins found in the surgical route; 2) group 2 included CHTB veins coagulated during surgery; 3) group 3 included CHTB veins preserved with arachnoid and/or tentorial dissection from the cerebellar or tentorial surface, respectively; and 4) group 4 comprised CHTB veins preserved using a novel tentorial cut technique.

RESULTS Overall, 141 patients were included in the study. Of these 141 patients, 38 were in group 1 (27%), 32 in group 2 (22.7%), 47 in group 3 (33.3%), and 24 in group 4 (17%). The total number of CHTB veins encountered was 207 during surgeries on one side. According to the distribution zones of the tentorium, zone 5 had the highest density of CHTB veins, while zone 7 had the lowest. Of the patients in group 4, 6 underwent the perimedian supracerebellar approach and 18 had the paramedian supracerebellar approach. There were 39 CHTB veins on the surface of the 24 cerebellar hemispheres in group 4. The tentorial cut technique was performed for 27 of 39 CHTB veins. Twelve veins were not addressed because they did not present any obstacles during approaches. During surgery, no complications were observed due to the tentorial cut technique.

CONCLUSIONS Because there is no way to determine whether a CHTB vein can be sacrificed without complications, it is important to protect these veins in supracerebellar approaches. This new tentorial cut technique in perimedian or paramedian supracerebellar approaches makes it possible to preserve CHTB veins encountered during supracerebellar surgeries.

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Gamma Knife radiosurgery for meningiomas arising from the tentorium

Gamma Knife radiosurgery for meningiomas arising from the tentorium- a 22-year experienceJ Neurooncol (2015) 121:129–134

In order to evaluate long term clinical and imaging outcomes, the authors retrospectively reviewed our 22-year experience using stereotactic radiosurgery (SRS) for tentorial meningiomas.

Thirty-nine patients with tentorial meningiomas underwent SRS using various Gamma Knife technologies between 1988 and 2010. The most common presenting symptoms were headache, dizziness or disequilibrium, and ataxia. The median tumor volume was 4.6 cm3 (range 0.5–36.6 cm3) and the median radiation dose to the tumor margin was 14 Gy (range 8.9–18 Gy). The median follow-up period was 41 months (range 6–183 months).

At the last imaging follow-up, tumor volumes decreased in 22 patients (57 %), remained stable in 13 patients (33 %), and increased in 4 patients (10 %). The progression-free survival after SRS was 97 % at 1 year, and 92 % at 5 years. At the last clinical followup, 35 patients (90 %) showed no change in symptoms, 1 patient (2 %) showed improvement of their neurologic symptom, and 3 patients (8 %) demonstrated worsening symptoms. The rate of symptom worsening after SRS was 5 % at 1 year, and 10 % at 5 years. Asymptomatic peritumoral edema after SRS occurred in 2 patients (5 %). Symptomatic adverse radiation effect developed in 2 patients (5 %).

SRS for tentorial meningiomas provided long-term effective tumor control and a low risk of radiation related complications.

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