Summary Classification of tentorial meningiomas defines eight types of tumors according to their location on the cerebellar tentorium.
They were subsequently regrouped as follows. - Group I : Anteromedial, arising from the apex of the tentorial margin - Group II : Anterolateral, arising from the lateral aspect of the tentorial incisural margin - Group III : Intermediate, arising from the intermediate aspect of the tentorium remote from the incisura and the dural sinuses. - Group IV : Posteromedial, arising from posteromedial aspect of the tentorium close to straight sinus or venous confluence at the torcula : this group also includes the falcotentorial and torcular meningiomas. - Group V : Posterolateral, arising from the posterolateral aspect of the tentorium close to the sigmoid sinus
The most frequent benign meningomas in these locations are fibroblastic and meningothelial.
The resectability of meningiomas of the cavernous sinus depends on the degree of internal carotid artery involvement. Total excision of cavernous sinus meningiomas is possible but rarely achieved in holocavernous meningiomas. Carnial nerve morbidity is significant. Subtotal excision with or without postoperative radiotherapy is an effective short-term oncological startegy.
Tentorial meningiomas represent a heterogeneous group of tumors. Most of the published series deal with either a small number of patients or consider different locations as a whole, making indications for treatment and prognosis difficult to drawn.
* Suboccipital Approach (The approach used in this surgery) supratentorial extension are usually removed via the subtemporal approach. This approach, however, may not be practical, especially for huge tumors extending to the posterior subtemporal space.