Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, Kiel, Germany.
Acta Neurochir (Wien). 2010 May;152(5):827-34. doi: 10.1007/s00701-009-0591-z. Epub 2010 Feb 11.
From a surgical perspective, tentorial fold (TF) meningiomas (TFM) are a unique entity of tumors. They involve the supra- and infratentorial space and often are in close contact to the cavernous sinus, cranial nerves, and the mesencephalon. Complete resection is challenging and can be hazardous. We present our experience with this rare tumor entity and demonstrate the surgical outcome related to a topographical classification.
A retrospective analysis on 21 consecutive patients (female/male ratio 17/4) with meningiomas originating from the TF, who underwent surgery between 1992 and 2005 in our clinic, was performed. The follow-up period ranged from 6 to 93 months. The cases were classified according to tumor extension in three different types: type I, TF meningiomas with compression of the brain stem; type II, with extension into the anterior portion of middle fossa; and type III, a combination of type I and II. Depending on tumor location, surgical approaches consisted of pterional (nine cases), subtemporal (nine cases), or combined subtemporal-pterional craniotomies (three cases). We defined transient and persistent operative complications in relation to Simpson grade and TF classification.
Tumor size ranged from 1 to 6 cm in diameter, with a median at 2.5 cm. The presenting symptoms of the patients were anisocoria (six cases), diplopia (six cases), ptosis (five cases), hemianopia (four cases), and ataxia (two cases). Extent of tumor resection was Simpson grade II in 19 patients, grade III in one patient, and grade IV in one patient. There was no operative mortality (first 30 days after surgery). The rate of postoperative transient new neurological deficits was found at 9.5%, the rate of permanent at 33%. The neurological deficits at admission recovered in two patients.
In the majority of patients with TF meningiomas, total resection can be achieved through a pterional, subtemporal, or combined approaches but at a substantial toll in terms of permanent morbidity. Radiotherapy after volume reductive surgery in TFM type II and III and decompression of eloquent anatomical structures with low tolerance of radiation should be considered.
从外科角度来看，天幕褶皱（TF）脑膜瘤（TFM）是一种独特的肿瘤实体。它们涉及颅顶和颅底之间的空间，并且经常与海绵窦、颅神经和中脑紧密接触。完全切除具有挑战性，并且可能有危险。我们介绍了我们在这种罕见肿瘤实体方面的经验，并展示了与拓扑分类相关的手术结果。
对 1992 年至 2005 年间在我们诊所接受手术的 21 例起源于 TF 的脑膜瘤患者（女性/男性比例为 17/4）进行了回顾性分析。随访时间为 6 至 93 个月。根据肿瘤的扩展情况将病例分为三种不同类型：I 型，TF 脑膜瘤伴有脑干压迫；II 型，向中颅窝前部延伸；III 型，I 型和 II 型的组合。根据肿瘤位置，手术入路包括翼点入路（9 例）、颞下入路（9 例）或颞下入路联合翼点入路（3 例）。我们根据 Simpson 分级和 TF 分类定义了暂时性和永久性手术并发症。
肿瘤大小直径为 1 至 6 厘米，中位数为 2.5 厘米。患者的主要症状为瞳孔不等大（6 例）、复视（6 例）、上睑下垂（5 例）、偏盲（4 例）和共济失调（2 例）。肿瘤切除程度为 Simpson 分级 II 级的有 19 例，III 级的有 1 例，IV 级的有 1 例。术后无手术死亡（术后 30 天内）。术后暂时性新的神经功能缺损发生率为 9.5%，永久性发生率为 33%。入院时的神经功能缺损在 2 例患者中得到恢复。
在大多数 TF 脑膜瘤患者中，通过翼点、颞下或联合入路可以实现肿瘤的全切除，但会导致永久性发病率显著增加。对于 TFM 型 II 型和 III 型，应考虑在体积减少性手术后进行放疗，以及对辐射耐受度低的功能区进行减压。
