The surgical treatment of tentorial and transverse sinus meningiomas

Background. The growth zone of tentorial and transverse sinus meningiomas (TTSM) are located on the wall of the transverse sinus and tentorium cerebelli, and tumors often extend into the lumen of the sinus, causing its complete or partial occlusion.

Aim. To evaluate the clinical manifestations, relationships with venous sinuses, and results of surgical treatment of TTSM.

Materials and methods. The study includes 46 patients with TTSM who underwent surgical treatment (7 men and 39 women aged 37 to 75 years old). In 35 cases a subtentorial approach was performed, and in 11 cases a supratentorial approach was used. In 16 cases, a paramedian suboccipital craniotomy was performed for medial tumor location, and a median suboccipital craniotomy was used in 7 cases. A retrosigmoid craniotomy was done in 13 cases for lateral tumor location, and an occipital craniotomy was performed in 9 patients for isolated supratentorial growth (5 cases) and for sub- and supratentorial growth (4 cases). In 1 case, a posterior temporal craniotomy was used for supra- and subtentorial tumor spread. Tentoriotomy was performed in 15 cases to resect the growth zone on the tentorium cerebelli.

Results. The average tumor size was 37.6 (11–79) mm, and occlusive hydrocephalus was detected in 5 patients. In 27 cases, the tumor extended subtentorially, in 7 cases – supratentorially, and in 12 cases – both supra- and subtentorially. The typical neurological manifestation was ataxic syndrome, observed in 36 cases. The cranial nerve involvement was noted in 4 cases, which were represented by impaired function of the V nerve (hypoesthesia) in 1 patient and dysfunction of the VIII nerve in 3 patients. Homonymous hemianopsia was observed in 1 patient, and decreased visual acuity was detected in 7 cases. Total resection, corresponding to the Simpson grade II, was performed in 42 patients, and in 4 cases the tumor was subtotally removed (the Simpson grade III). The onset or increase of ataxic disorders was detected in 6 patients, and 1 patient with pronounced supratentorial growth experienced transient homonymous hemianopsia, which regressed after 2–3 weeks. Two patients developed venous infarction of the cerebellar hemisphere.

Conclusion. The goal of surgical interventions for TTSM is maximal resection of tumor tissue while preserving venous outflow through the sinuses and collateral veins, which ensures the preservation of cerebral structures and minimizes the risk of neurological complications.

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