Surgical management of medial tentorial meningioma: falcotentorial and torcular.

Related Articles

Surgical management of medial tentorial meningioma: falcotentorial and torcular.

World Neurosurg. 2018 Apr 17;:

Authors: Talacchi A, Biroli A, Hasanbelliu A, Locatelli F

Abstract
BACKGROUND: Falcotentorial meningiomas (FTM) stand out for their rarity, inconsistent definition, and surgical complexity. It is appropriate to deal with them in the context of medial tentorial meningiomas (MTM).
METHODS: Clinical and radiological characteristics of MTM, comprising the typical features of FTM and tentorial meningioma (TM) along with surgical management, short- and long-term outcomes, are reported .
RESULTS: FTM (n=16) were typically supratentorial, large, edematous tumors that caused mainly headache and hemianopia; TM (n=12) were infratentorial, smaller not edematous tumors that caused mainly headache and gait ataxia. The most frequent venous pattern was straight sinus infiltration in one third of FTM and occlusion in one half of TM cases. Total removal (Simpson I-II) was obtained in 46.4% of cases and subtotal removal (Simpson III-IV) in 53.6%. Supra-infratentorial extension in FTM and incomplete venous invasion in TM were the factors most likely opposing complete removal. The overall acute complications rate was 32.1% (higher for FTM), transient for the vast majority of cases. Patients with supratentorial meningiomas did significantly worse preoperatively (KPS ≤70 in 75% of cases); patients with infratentorial symptoms/signs recovered worse postoperatively. Stereotactic radiosurgery with subtotal removal was used as adjuvant treatment in 8 cases. Only 2 recurrences, both atypical tumors, occurred at 57.6 months (mean) follow-up.
CONCLUSIONS: As a general rule, careful venous management, tailored surgical approach for FTM, and cautious tumor removal for TM can yield good and stable results. Total removal accounts for half the cases in both groups, while FTM was associated with worse postoperative complications.

PMID: 29678716 [PubMed - as supplied by publisher]

https://ift.tt/2K7aVUU