Hydrocephalus induced psychosis associated with tentorial. Classifications of tentorial meningiomas are revised. Threedimensional understanding of the radiographic pathoanatomy of tentorial. Surgical options in the management of falcotentorial meningiomas. Visualization of tentorial branches of the internal. They involve the supra and infratentorial space and often are in close contact to the cavernous sinus, cranial nerves, and the mesencephalon. Gadolinium enhancement showing right inferior tentorial meningioma. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Different locations and sinus invasion require special surgical skills. Tentorial meningioma a, pathology showed syncytial meningioma. Meningioma research in addition to diagnosing and treating meningiomas, the experts of the johns hopkins meningioma center are leading research that is redefining the understanding of these brain tumors, their origins and directions for future treatment, including immunotherapy. The sphenoid wing meningiomas are the most common of the skull base and its location is very typical, but its extension varies widely. Unclear classification of tumor type yields poor knowledge of the characteristics of the single case, creating.
They suggested that this artery arose from the external carotid and considered ittobea pathognomonic sign of tentorial meningioma. Hemangioblastoma located in the posterior incisural space. Meningiomas are primarily benign tumors with defined borders that enables complete surgical removal, which offers the best chance for a cure. These types of meningiomas grow slowly and can cause severe visual impairment in one or both eyes. Largegiant meningiomas of posterior third ventricular region. Meningiomas do often have characteristic features on a scan however, as and when such a tumour might be operated upon, we do send tumour to the pathologist at the time of surgery to confirm the exact type of tumour. Tentorial meningioma treatment from a surgical perspective, tentorial fold tf meningiomas tfm are a unique entity of tumors. Many of the histological variants are also discussed separately. Retrosigmoid craniotomy for the removal of left sided. Multiple intracranial meningiomas are a condition where there is more than one meningioma in several intracranial locations in the same patient without signs of neurofibromatosis. Extracranial metastases from brain meningiomas is a rare, but welldocumented entity.
Clinical presentation of meningiomas clinical gate. Combined suprainfratentorial approach to tentorial. Original article surgical management of tentorial meningiomas. Meningioma brain tumors brigham and womens hospital. The tentorium cerebelli is a dural extension that separates the inferior portion of the occipital. Meningioma, also known as meningeal tumor, is typically a slowgrowing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. They involve the supratentorial and infratentorial space and often are in close contact to the cavernous sinus, cranial nerves, and the mesencephalon. Four patients were operated on, three had total excision of the tumor, the fourth, with suprasellar meningioma, had subtotal resection. To discuss the proper surgical management of tentorial meningiomas it must be based on their site of origin. Most are considered benign because they are slowgrowing with low potential to spread. Most meningiomas 8590 percent are categorized as benign tumors, while 1015 percent being atypical or malignant cancerous. Patientspecific factors presence or absence of symptoms, age, comorbidity, the location of the meningioma in relation to critical brain structures and regions, and the histopathologic characteristics who grade of the meningioma all are important factors in determining the optimal treatment.
They were not certain of the origin of the artery, but expressed doubt that it was a branch of the external carotid artery as it was not observed in a pure external carotid arteriogram in a patient in whom the artery was visualized after a common carotid arteriogram. The goal of surgery is to remove the meningioma completely, including the fibers that attach it to the. A 42year old woman presented with nonspecific headache and imbalance and magnetic resonance imaging showed ac a meningioma arising from the left tentorial membrane in the infratentorial location t4, group iii tentorial meningioma. In spite of significant advancements in imaging technology, monitoring, and microsurgical techniques, complete and safe removal of tentorial meningiomas remains a challenge for most neurosurgeons.
Falcotentorial meningioma producing irreversible midbrain damage. Tentorial meningiomas, comprising approximately 36% of all intracranial meningiomas, are complex entities with an intricate relationship to surrounding structures and require multiple surgical. Tentorial definition of tentorial by the free dictionary. A paramedian suboccipital craniotomy was performed and tumor was accessed through a.
Patient was referred from other hospital with posterior fossa mass. We report here on a patient who was treated for an atypical brain meningioma with multiple surgeries and multiple sessions of stereotactic radiosurgery with good control of his brain disease. Falcotentorial meningioma producing irreversible midbrain. Two other patients were diagnosed with tentorial meningiomas but declined surgical treatment and were followed with serial mri. Meningiomas occur either intracranially or within the spinal canal. The arachnoid is one of three protective layers, collectively known as the meninges, which surround the brain and the spinal cord. Clinical results in 81 patients treated microsurgically even during the microsurgical era, tentorial meningiomas present. Supracerebellar transtentorial approach to the tentorial incisura and. Jul 24, 2015 meningiomas are mostly benign tumours which arise from the dura mater and are usually slowgrowing. Figure 3 mri of the brain, t1weighted axial image with gadolinium enhancement showing right inferior tentorial meningioma. Due to the vascular supply and neural structures surrounding the tentorium cerebelli, surgical intervention to debulk tumors within the tentorium can be difficult.
From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and wellbeing around the world. Tentorial meningioma is a rare type of brain tumor and accounts for 3% to 6% of all intracranial meningiomas, which is very low considering the broad area of potential tumor growth. Nineteen of the tumours were in women and five werein men. Note hypercellularity and minimal whorling hematoxylineosin, original magnification x400. T3t8 meningioma displayed in preoperative sagittal contrastenhanced t1weighted magnetic resonance imaging mri in a patient presenting with gait ataxia and slight mental deficits. Occasionally seizures, dementia, trouble talking, vision problems, one sided weakness, or. By continuing to use our website, you are agreeing to our use of cookies. Surgical management of anterolateral and posteromedial. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment.
Aswell as confirming a tumour is a meningioma, the pathologist will also grade the meningioma on the basis of its appearance under the. There has been some controversy concerning the definition of falcotentorial meningiomas. Tentorial meningiomas account for 2% to 3% of all intracranial meningiomas 25. Tentorial convexity subfrontal cerebellopontine angle. Although the artery was thereafter named the artery ofbernasconi and. Eight of the tumours were seen to extendboth supratentorially and infratentorially. This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary to a tentorial meningioma with associated hydrocephalus. Falco tentorial meningioma producing irreversible midbrain damage amit agrawal professor of neurosurgery, department of neurosurgery, narayna medical college hospital, chinthareddypalem, nellore, andhra pradesh india abstract meningiomas arising from the falcotentorial junction are the rarest subgroup of tentorial menigiomas.
Meningiomas usually form wellcircumscribed lesions but, rarely, can be more diffuse eg, when they grow next to the sphenoid ridge and are called meningioma en plaque. Osama almefty, paulo abdo do seixo kadri, in craniopharyngiomas, 2015. Dose any one know what is a anteromedial tentorial meningioma is. The authors report their experience and longterm results in the surgical treatment of 61 tentorial meningiomas. Meningiomas are the most common benign intracranial tumor.
We report the clinical features, radiological studies, operative management, and followup data in a series of 27 patients with tentorial meningiomas we use cookies to enhance your experience on our website. Tms arising from the posterolateral aspect of tentorium close to the sigmoid sinus 4 cases. The neurosurgeon opens the skull through a craniotomy to enable full access to the meningioma. Types of meningiomas meningioma types mount sinai new york.
Some of them are very invasive and its extension should be specified facing the neurosurgical approach figure 19. These psychotic symptoms subsequently abated with placement of a ventriculoperitoneal shunt. Combined suprainfratentorial approach to tentorial meningiomas. Pdf tentorial meningiomas with special aspect to the.
A meningioma is a tumor that arises from a layer of tissue the meninges that covers the brain and spine. Metastases occur mostly in the lungs, pleura and liver, but may also affect lymph nodes and bones. C, twodimensional planning for stereotactic radiosurgery. A meningioma is a tumor that arises from the meninges the membranes that surround your brain and spinal cord. Treatment of meningioma typically consists of surgery alone, but radiation therapy can be used in cases of surgically inaccessible, residual, or recurrent tumors, as well as in patients with an unacceptably high surgical risk. The first report of a tentorial meningioma was in 1833 by andraal, who discovered a lesion incidentally attached to the tentorium 1. Nov 23, 2015 tentorial meningioma giuseppe ambrosio. This type of meningioma causes different clinical syndromes. Meningiomas grow on the surface of the brain or spinal cord, and therefore push the brain away rather than growing from within it.
From a surgical perspective, tentorial fold tf meningiomas tfm are a unique entity of tumors. Tentorial meningiomas comprise 3%of the total number of meningiomas seen at the new york neurological institute during the period analysed. Complete resection is challenging and can be hazardous. A meningioma is a type of tumor that develops from the meninges, the membrane that covers the brain and spinal cord. Definition a meningioma is a tumor that arises from a layer of tissue that covers the brain and spine arise from the arachnoid cap cells of the arachnoid villi in the meninges usually benign 3. The combined suprainfratentorial approach to resects tentorial meningioma is discussed. This approach provides a wider exposure of the suprainfratentorial region with less brain retraction. Cshowed left facial nerve was compressed by the va. These tumors most commonly grow inward causing pressure on the brain or spinal cord, but they may also grow. Although not technically a brain tumor, it is included in this category because it may compress or squeeze the adjacent brain, nerves and vessels. Posterior fossa meningioma surgical experiences 37.
Tentorial and falcotentorial meningiomas clinical gate. Brain tumorposterior fossa meningiomas treatmentimages. Diverse imaging appearances and locations of meningioma. Jul 29, 2010 tentorial meningiomas are a rare and heterogeneous group of tumors. Pdf surgical options in the management of falcotentorial. Falcotentorial, giant meningiomas, occipital transtentorial approach. The abducens nerve is often the first affected cranial nerve, leading to diplopia with lateral gaze. Tentorial meningiomas tm are relatively uncommon tumors.
The extent of tumor resection was scored according to the simpsons grading for tumor removal. B, mri performed 4 years after the first operation reveals a recurrence over the posterior tentorium. The most common type of vascularized tumor located in the posterior incisural space in older patients is the falcotentorial meningioma. However, it is generally accepted that falcotentorial meningiomas arise from the dura of the tentorium cerebelli and posterior part of the falx. They originate from arachnoid cap cells, which are cells within the thin, spider weblike membrane that covers the brain and spinal cord. Tentorial meningiomas represent about 5% of intracranial meningiomas. These cases were operated on between 1951 and 1985 and represented 4. Castellano and ruggiero first understood that posterior fossa meningioma could have different prognostic evolution, thanks to extensive postmortem examinations. Tentorial meningiomas are rare tumors located along the surface of the tentorium cerebella in the brain. This article is a general discussion of meningioma focusing on typical primary intradural meningiomas and the imaging findings of intracranial disease. The first report of a tentorial meningioma was in 1833 by andraal, who discovered a lesion incidentally attached to the tentorium1.
Tentorial detachment technique in the combined petrosal. A meningioma is a tumor that forms on membranes that cover the brain and spinal cord just inside the skull specifically, the tumor forms on the three layers of membranes that are called meninges. Multiple technical modifications have been reported to increase the surgical corridor, including the method of dural and tentorial opening. Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. The fifth patient a 42 years woman with tentorial meningioma refused surgery and was lost to follow up. Also joining the straight sinus are the internal cerebral veins and basal veins from both sides. Magnetic resonance imaging showed ac a meningioma at the falcotentorial junction t8, group ii tentorial meningioma in the supratentorial location. Meningiomas arise from arachnoidal cells, most of which are near the vicinity of the venous sinuses, and this is the site of greatest prevalence for meningioma formation they most frequently are attached to the dura over the superior parasagittal surface of frontal and parietal lobes, along the sphenoid ridge, in the olfactory grooves, the sylvian region, superior cerebellum along the falx. Note the patency of the straight sinus and accompanying obstructive hydrocephalus due to occlusion of the aqueduct. Various innovative surgical approaches for giant ptv meningiomas include combining the two approaches, a transsinus approach. Meningiomas classifications, risk factors, diagnosis and. Globoid type meningiomas may extend intracranially, so they may lead to seizure disorders or impairment of neurologic functions such as motor weakness. Meningioma is the most common type of tumor that forms in the head. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue.
We report our experience with and longterm results of 37 patients with tentorial meningiomas who underwent surgery between 1972 and 1993. Meningioma introduction although meningiomas are considered a type of primary brain tumor, they do not grow from brain tissue itself, but instead arise from the meninges, three thin layers of tissue covering the brain and spinal cord. Tentorial meningiomas comprise 35% of the intracranial meningiomas. Report our experience with 27 tentorial meningiomas tm surgically treated between 1985 and 1998. Tentorial medical definition merriamwebster medical dictionary. These types of posterior fossa meningiomas can cause headaches, seizures, and difficulty walking.
Tentorial meningioma brain tumor mayo clinic connect. An occipital interhemispheric approach was used and a gross total excision was achieved postoperative magnetic resonance imaging, d f. Meningiomas of the posterior cranial fossa account for about 9% of all intracranial meningiomas. The great cerebral vein of galen and the straight sinus merge with the. In the cushing and eisenhards series of 295 intracranal meningiomas, 11 tumors 3. Gokalp hz1, arasil e, erdogan a, egemen n, deda h, cerci a. In our retrospective study of 81 patients harboring a tentorial meningioma and who. Sectioning the tentorium and opening the arachnoid. Yasargils classification of tentorial meningiomas tms defines eight types of tumors according to their location on the cerebellar tentorium. Regardless of the surgical approach to the posterior incisural space. Meningioma of the pineal region romanian neurosurgery. Tentorial meningiomas account for 26% of all intracranial meningiomas. For spinal and primary extradural tumors refer to spinal meningioma and primary extradural meningioma articles respectively. Vakilnejad, roxana popa neurosurgery clinic of the national institute of neurology and neurovascular diseases, bucharest abstract meningiomas rarely occur in the pineal region, but they can reach huge diameters.
912 698 476 1556 710 79 664 429 1107 1404 733 479 234 570 1499 222 1078 1143 764 1375 1398 1313 1372 414 630 1082 384 1119 1247 812 1282