Rostomily R C, Eskridge J M, Winn H R
University of Washington School of Medicine, Seattle.
Neurosurg Clin N Am. 1994 Apr;5(2):331-48.
Tentorial meningiomas are encountered relatively infrequently, but it is nonetheless important to be aware of their variable clinical presentations and the need for individualized preoperative assessment and surgical management. The challenges presented by these lesions are due in large part to the complexity and variety of neurovascular structures associated with the tentorium. As is true for all meningiomas, the goal of operation is complete resection with limited morbidity and mortality. Preoperative assessment with CT or MR imaging or both and angiography with embolization, when possible, is advocated for all patients. The choice of surgical approach is dictated by the location of the lesion, dural origin, and involvement of major neurovascular structures. With extended surgical approaches, combining infratentorial and supratentorial exposure, one can attempt complete tumor resection even in patients with extensive skull base involvement. However, if complete resection presents an unacceptable risk of neurologic morbidity, one must consider adjuvant therapy. Radiotherapy (conventional external beam or stereotactic) has been shown to be of some benefit in stabilizing residual disease or delaying recurrence; adjuvant chemotherapy with antiprogesterone agents is still undergoing clinical evaluation.
小脑幕脑膜瘤相对少见，但了解其多样的临床表现以及进行个体化术前评估和手术治疗的必要性仍然很重要。这些病变带来的挑战很大程度上源于与小脑幕相关的神经血管结构的复杂性和多样性。与所有脑膜瘤一样，手术目标是在降低发病率和死亡率的前提下实现完整切除。对于所有患者，提倡进行CT或MR成像或两者联合的术前评估，并在可能的情况下进行血管造影和栓塞。手术入路的选择取决于病变的位置、硬脑膜起源以及主要神经血管结构的受累情况。采用扩大手术入路，结合幕下和幕上暴露，即使对于广泛累及颅底的患者，也可以尝试完整切除肿瘤。然而，如果完整切除会带来不可接受的神经功能损伤风险，则必须考虑辅助治疗。放射治疗（传统外照射或立体定向放疗）已被证明在稳定残留病灶或延迟复发方面有一定益处；抗孕激素药物辅助化疗仍在进行临床评估。
