Minim Invasive Neurosurg 2009; 52(2): 93-97
DOI: 10.1055/s-0029-1220737
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Treatment of the Tentorial and Falco-Tentorial Junction Meningiomas

K. Majchrzak 1 , M. Tymowski 1
  • 1Department of Neurosurgery; Silesian University of Medicine in Sosnowiec, Poland
Further Information

Publication History

Publication Date:
18 May 2009 (online)

Abstract

Introduction: Tentorial meningiomas account for 3–7.7% of all meningiomas in surgically treated patients. In this group, the falco-tentorial meningiomas are considered to be the rarest.

Case Report: The paper presents three cases of the tentorial and falco-tentorial junction meningiomas. Two of the meningiomas were of major size and with an attachment at the falco-tentorial junction, while the other was attached to the inferior notch of the tentorium. The lesions manifested as headaches and disequilibrium that persisted for many years. The Parinaud syndrome and diplopia were observed in the patient with the meningioma attachment at the inferior notch of the tentorium. One of the lesions was resected completely using an occipital bitranstentorial/falcine approach. In the second case an occipito-transtentorial approach was used. However, during the surgery problems arose with resecting the lesion on the other side. The meningioma of the inferior notch of the tentorium was vascularized through the tentorial artery stemming from the meningo-hypophyseal trunk of the intracavitary section of the internal carotid artery on the right side. This meningioma required a two-stage operation. The surgical treatment was satisfactory and depended on the patient's condition at the time of the surgery.

Conclusion: The presented rare cases of tentorial and falco-tentorial junction meningiomas seem to suggest that their treatment should be surgical and launched promptly after making a diagnosis. The results of the treatment might then be favourable

References

  • 1 Bassiouni H, Hunold A, Asgari S. et al . Tentorial Meningiomas: Clinical Results in 81 Patients Treated Microsurgically.  Neurosurgery. 2004;  55 108-118
  • 2 Samii M, Carvalho GA, Tatagiba M. et al . Meningiomas of the tentorial notch: surgical anatomy and management.  J Neurosurg. 1996;  8437-8438
  • 3 Stein BM, Fetell MR. modalities for pineal region tumors.  Clin Neurosurg. 1985;  32 445-455
  • 4 Pluchino F, Broggi G, Fornari M. et al . Surgical approach to pineal tumours.  Acta Neurochir (Wien). 1989;  96 26-31
  • 5 Gokalp HZ, Artasil E, Erdogan A. et al . Tentorial meningiomas.  Neurosurg. 1995;  36 46-51
  • 6 Hostalot C, Carrasco A, Bilbao G. et al . Merningiomas de la tienda del cerebelo Revision de nuestra casuistica.  , [Tentorial meningiomas.Report of our series ] Neurocirurgia-(Astur). 2004;  15 119-127
  • 7 Bret Ph, Guyotat J, Madarassy G. et al . Tentorial Meningiomas. Report on Twenty-Seven Cases.  Acta Neurochir (Wien). 2000;  142 513-526
  • 8 Schaller C, Meyer B, Jung A. et al . Results for microsurgical removal of tentorial meningiomas.  Zentralbl –Neurochir. 2002;  63 59-64
  • 9 Lozier AP, Bruce JN. Meningiomas of the velum interpositum: Surgical considerations.  Neurosurg Focus. 2003;  15 1-9
  • 10 Matsuda Y, Inagawa T. Surgical Removal of Pineal Meningioma.  Neurol Med Chir. , (Tokyo) 1995;  35 594-597
  • 11 Malluci CL, Obukov S. Successful removal of large pineal regions meningiomas :two case reports.  Surg Neurol. 1995;  44 562-566
  • 12 De Oliveira E, Tedeschi H, Rhoton AL. et al .Microsurgical Anatomy of the internal carotid artery: intrapetrous, intracavernous, and clinoidal segments. In: Carter L Ph, Spetzler RF, Hamilton MG Neurovascular Surgery. Mac Graw-Hill ,Inc 1995: 3-10
  • 13 Konovalov AN, Spallone A, Pitzkhelauri DI. Meningioma of the pineal region: a surgical series of 10 cases.  J Neurosurg. 1996;  85 586-590
  • 14 Sagoh M, Onozuka S, Murakami H. et al . Successful removal of meningioma of the pineal region after embolization.  Neurol Med Chir. , Tokyo 1997;  37 852-855
  • 15 Nakayama K, Miyasaka Y, Ohwada T. et al . Meningioma in the pineal region – report of a case and review of the literature.  Neurol Med Chir. 1980;  20 265-271
  • 16 Kakou M, Jan M. Meningiomes de la tented u cervelet. Notre experience a propos de 20 cas.  , [ Tentorial meningioma. Surgical Experience with 20 cases ] Neurochirugie. 1999;  45 15-23
  • 17 Kawashima M, Rhoton Jr AL, Matsushima T. Comparison of Posterior Approaches to the Posterior Incisural Space: Microsurgical Anatomy and Proposal of a New Method, the Occipital Bi-transtentorial/Falcine Approach.  Neurosurg. 2002;  51 1208-1221
  • 18 Symon L, Pell M, Singh L. Surgical management of posterior cranial fossa meningiomas.  Br J Neurosurg. 1993;  7 599-609
  • 19 Sakaki S, Shiraishi T, Takeda S. et al . Occlusion of the great vein of Galen associated with huge meningioma in the pineal region.  Case report J Neurosurg. 1984;  61 1136-1140
  • 20 Saenz A, Zamorano L, Matter A. et al . Interactive image guided surgery of the pineal region.  Minim – Invasive – Neurosurg. 1998;  41 27-30
  • 21 Martin NA. Subtemporal Transtentorial Approach. In: Samii M, Cheatham ML, Becker DP Atlas of Cranial Base Surgery. W.B. Saunders Company 1995: 67-74
  • 22 Taniguchi M, Perneczky A. Subtemporal Keyhole Approach to the Suprasellar and Petroclival Region: Microanatomic Considerations and Clinical Application.  Neurosurgery. 1997;  41 592-601
  • 23 Tschabitscher M. Die Venen des menschlichen Kleinhirns.  Acta Anat. 1979;  105 344-366
  • 24 Koperna T, Tschabitscher M, Knosp E. The termination of the vein of Labbe and its microsurgical significance.  Acta Neurochir. 1992;  118 172-175

Correspondence

K. Majchrzak

Wojewódzki Szpital Specjalistyczny nr 5 im. œw. Barbary

41–200 Sosnowiec

Plac Medyków 1

Poland

Phone: +48/323 68 20 24

Fax: +48/323 68 25 50

Email: sekr_nch@wss5.pl

    >