Objective Tentorial notch meningiomas (TNMs), located at the tentorial incisura, represent a subgroup of tentorial meningiomas. Gross total excision remains a challenge because these tumours tend to encase blood vessels and cranial nerves. We present our institutional experience with 26 patients harbouring tentorial notch meningiomas and discuss their surgical management. Methods We retrospectively reviewed 26 patients who underwent microsurgical excision of TNMs between January 2015 and December 2023 at our institution. Variables analysed included patient demographics, clinical features, radiological characteristics, and surgical approaches. TNMs were classified according to Samii's system into lateral and posteromedial groups. Functional outcome was assessed using the modified Rankin Scale (mRS). Results The mean age was 58.72 years with a female preponderance (M:F = 5:21). Predominant presenting features were raised intracranial pressure and fifth and sixth cranial nerve involvement. Thirteen lateral and 13 posteromedial TNMs were identified. Lateral tumours with epicentre medial to the incisura were approached via a fronto-temporal route ( n = 7); those located laterally were approached sub-temporally ( n = 6). Posteromedial tumours with epicentre below the tentorium were approached via a supra-cerebellar route ( n = 9); those above were managed through an occipital trans-tentorial route ( n = 4). Simpson Grade I resection was achieved in 2/26 cases (8%), Grade II in 4/26 (15%), Grade III in 17/26 (65%), and Grade IV in 3/26 (12%). Four patients had recurrence; two underwent Gamma Knife radiosurgery with stable disease, and two were lost to follow-up. No perioperative mortality was recorded. The majority had residual symptomatology referable to the fourth, fifth, and seventh cranial nerves. Conclusion A simplified anatomy-based TNM classification with reference to the tentorial incisura can guide surgical approach selection. While gross total resection is not always achievable, satisfactory disease control and functional preservation can be attained by combining meticulous microsurgery with adjuvant stereotactic radiosurgery where appropriate. This practical approach, grounded in institutional experience, offers a rational framework for managing these demanding lesions.
Sundar et al. (Mon,) studied this question.