Transtentorial Approach for a Tentorial Meningioma with Superior Extension: 3-Dimensional Operative Video

Abstract

Tentorial meningiomas comprise about 5% of all intracranial meningiomas. This tumor grow pattern can be classified in superior, inferior, or both extensions. The classical surgical approaches for microsurgical resection of superior extended tumor are subtemporal or posterior interhemispheric which consists in a challenge for neurosurgeon due an important brain retraction necessary an access the lesion dural tail and elevated risk of vascular structures like vein of Labb é and superior sagittal sinus damage. The transtentorial approach is an interesting alternative which permits early access to tumor dural tail and vascularization control without great brain manipulation. We present a 56-year-old patient with a tentorial meningioma with superior extension. The patient had a history of progressive loss of vision started about 3 months after admission associated with occipital headache. The neurologic investigation was performed by magnetic resonance imaging that revealed a meningioma located in the intermediate left side of tentorium, posterior to forth nerve entry point in tentorial edge. The patient underwent resection of the lesion through a transtentorial approach with lesion successfully resected. The patient presented the maintenance of initial evocated potentials and previous vision alterations in the post operatory. The pathology exam reveals a grade I meningioma. In this video, authors present step by step the microsurgical technique to perform a transtentorial meningioma resection. The patient consented to the procedure and publication of his images. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any medical publications in conferences and/or scientific article.