Management of tentorial meningiomas: clinical features, treatment strategies, and long-term outcomes.

Background

Management of tentorial meningiomas (TMs) is complicated by their proximity to critical neurovascular anatomy. Microsurgery and upfront Gamma Knife radiosurgery (GKRS) offer complementary options for distinct clinical indications, but evidence regarding their long-term outcomes remains limited.

Methods

We retrospectively reviewed 118 patients with primary TMs at West China Hospital (2008-2020); 67 underwent microsurgery and 51 received upfront GKRS. Tumor control, treatment-related complications, and longitudinal Karnofsky Performance Status (KPS) were assessed for each management pathway.

Results

Median follow-up was 101 months in both groups. In the microsurgery group, gross-total resection was achieved in 85.1% of patients (57/67); 5-year and 10-year progression-free survival (PFS) rates were 92.5% and 81.6%, respectively, with an overall complication rate of 22.4% and no perioperative mortality. In the upfront GKRS group, 5-year and 10-year PFS rates were 94.1% and 79.5%, respectively; symptomatic adverse radiation effects occurred in one patient (2.0%). Mean KPS score improved significantly from baseline to last follow-up in both the microsurgery group (78.06 ± 11.85 to 94.52 ± 10.82; P < 0.001) and the GKRS group (85.62 ± 10.90 to 97.71 ± 5.55; P < 0.001).

Conclusions

Microsurgery and upfront GKRS provide complementary, durable tumor control for tentorial meningiomas across distinct clinical indications. Microsurgical resection remains the primary approach for large or symptomatic lesions, whereas upfront GKRS is safe and effective for selected small-volume tumors. Treatment decisions should be individualized based on tumor burden, anatomical complexity, and baseline neurological status.