Surgical Treatment of the Tentorial and Falco-Tentorial Junction Meningiomas

Abstract

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. 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. 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.