Tentorial Meningioma
Meningiomas of the tentorium, which can grow above it, below it, or both, and whose treatment turns on the major draining veins nearby.
Quick Answer
A tentorial meningioma arises from the tentorium, the tent-shaped sheet of meningeal tissue that separates the upper part of the brain from the cerebellum below. Because the tentorium is a broad structure, these tumors vary widely: some grow upward, some downward, and some grow through it into both compartments. Symptoms vary accordingly and may include headache, unsteadiness, visual changes, or the effects of raised pressure in the skull. The major veins draining the brain run within and along the tentorium, and their position is what determines which surgical approach is used and how much can safely be removed.
Key Takeaways
- These tumors arise from the tentorium, the sheet separating the upper brain from the cerebellum.
- They may grow above it, below it, or through it into both compartments.
- Symptoms vary widely with the direction of growth and may include headache, unsteadiness, or visual changes.
- Major draining veins run within and along the tentorium and are the central surgical consideration.
- The surgical approach is chosen according to which compartment the tumor occupies and where the veins run.
- Tumors obstructing the flow of spinal fluid can raise pressure inside the skull and may need that addressed as well.
At a Glance
| Where it arises | From the tentorium — at its free edge, along its outer attachment, or near the junction with the falx |
|---|---|
| Typical first symptom | Headache, unsteadiness, or visual field loss, depending on direction of growth |
| Key structures at risk | The transverse and straight sinuses, the vein of Labbé, the deep venous system, and the brainstem |
| Imaging emphasis | MRI with venography to map the sinuses and major draining veins |
| Usual approach | Chosen by compartment — supracerebellar, occipital transtentorial, subtemporal, or retrosigmoid |
| Extent of removal | Complete where veins allow; partial where major venous structures are involved |
| Role of radiation | Focused radiation to residual tumor near venous structures |
| Outlook | Generally good, with the approach decision carrying most of the risk |
This page focuses specifically on Tentorial Meningioma. For a broader look at meningiomas—including grades, symptoms, diagnosis and treatment options—visit our Meningioma overview
Symptoms
Because the tentorium is a large structure and these tumors can grow in either direction from it, the presentation is more variable than for most meningiomas. What a patient notices depends less on the tumor itself than on which compartment it has grown into.
Tumors extending above the tentorium press on the occipital or temporal lobe, and may cause loss of part of the visual field on the opposite side, seizures, or difficulty with visual recognition. Visual field loss frequently goes unnoticed until it is detected on testing.
Tumors extending below press on the cerebellum, causing unsteadiness, difficulty coordinating one side, and a tendency to veer when walking. Where the tumor reaches the brainstem, double vision or facial numbness may occur.
Tumors near the free edge of the tentorium, or large enough to obstruct the flow of spinal fluid, cause headache that is often worse in the morning, nausea, and visual blurring from raised pressure inside the skull. This can develop relatively quickly compared with the slow course of the tumor itself.
Common Reasons for Evaluation
- Loss of part of the visual field or other progressive visual changes
- New seizures
- Increasing unsteadiness or difficulty coordinating one side
- Double vision or facial numbness
- Morning headaches with nausea or visual blurring
Symptoms That Need Prompt Evaluation
- A first-time seizure or a seizure lasting several minutes
- Sudden or rapidly worsening vision loss or double vision
- New severe difficulty walking or coordinating movement
- Severe worsening headache with vomiting, confusion, or reduced alertness
Diagnosis
MRI with contrast defines the tumor and, importantly, which compartments it occupies. A tumor growing through the tentorium into both compartments is approached quite differently from one confined to a single side, and that determination is made before surgery. Venous imaging is essential at this location. The transverse sinus runs along the outer attachment of the tentorium, the straight sinus along its junction with the falx, and the vein of Labbé — a large and unforgiving vein draining the temporal lobe — enters the transverse sinus nearby. Injuring any of these can cause a venous stroke. Their course relative to the tumor is mapped in detail, and it is often the single factor that decides which approach is used.
WHY LOCATION MATTERS
Why Location Matters in Tentorial Meningioma
Tentorial meningiomas can grow above the tentorium, below it, or through both compartments, so symptoms and surgical access vary substantially from one patient to another.
Where it sits
Along the tentorium, the dural fold separating the cerebral hemispheres from the cerebellum.
What it can affect
Vision, seizures, balance, coordination, facial sensation, or eye movement depending on the direction of growth.
Why it matters for treatment
The venous sinuses, vein of Labbé, and whether the tumor extends above or below the tentorium often determine the surgical route.
Treatment
Recovery depends chiefly on which compartment was entered and on how the brain tolerated the approach. Visual field loss present beforehand may improve partially. Unsteadiness from cerebellar compression usually improves. Follow-up imaging continues for years, particularly where tumor was left adjacent to a venous sinus.
At Atlantic Brain and Spine, these cases are reviewed by a multidisciplinary skull base and brain tumor team to determine the approach that offers the best balance of tumor control and preservation of neurological function. Our Skull Base Surgery Center has been designated a Multidisciplinary Team of Distinction by the North American Skull Base Society, recognizing an established multidisciplinary approach to skull base care.
TREATMENT PLANNING
How Treatment Is Planned for Tentorial Meningioma
The safest strategy depends on the tumor’s exact anatomy, the structures it involves, and the goals of treatment.
01
The Surgical Route Follows the Anatomy
More than for most meningiomas, treatment here begins with the choice of route, and that choice follows from the venous anatomy and the compartment involved. A supracerebellar approach comes from below and behind, beneath the tentorium. An occipital transtentorial approach comes from above and behind, working along the falx and opening the tentorium to reach beneath it. A subtemporal approach comes from the side. A retrosigmoid approach reaches tumors sitting more laterally and below. For tumors occupying both compartments, a combined approach may be used.
02
Protecting Major Venous Structures
The major venous structures are preserved during surgery. Where a tumor has grown into a vein that remains open, the involved portion is left and treated with focused radiation rather than removed, on the same principle used for midline tumors along the sagittal sinus. The vein of Labbé in particular is treated as inviolable — sacrificing it can cause a disabling temporal lobe stroke.
03
Removing the Involved Tentorium
Where the venous anatomy permits, the tumor is removed together with the involved portion of the tentorium, which is simply divided and taken with the tumor. This is one of the advantages of this location: the tentorium can often be resected generously, giving a complete removal of the attachment in a way that is not possible at the skull base.
The Diagnosis-to-Treatment Pathway
1. Define which compartments are involved
MRI with contrast shows whether the tumor lies above the tentorium, below it, or extends through both compartments.
2. Map the venous anatomy
Venous imaging defines the transverse sinus, straight sinus, vein of Labbé, and other major veins relative to the tumor.
3. Assess symptoms and neurologic function
Vision, seizures, balance, coordination, facial sensation, and eye movement are reviewed according to the tumor’s location.
4. Choose observation or treatment
Symptoms, growth, compartment involvement, and proximity to critical veins guide whether treatment is recommended.
5. Select the surgical corridor
When surgery is needed, the approach is chosen around the tumor’s compartment and venous anatomy to reduce the risk of venous injury.
6. Monitor residual disease and recovery
Visual and balance symptoms are reassessed, and MRI follow-up continues for years, especially when tumor remains near a venous sinus.
Frequently Asked Questions
A tentorial meningioma arises from the tentorium, the dural fold that separates the upper brain from the cerebellum. It may grow above the tentorium, below it, or through both compartments.
Symptoms depend on the tumor’s exact position and can include headaches, seizures, visual changes, imbalance, coordination problems, facial sensory changes, or eye-movement abnormalities.
The transverse sinus, straight sinus, vein of Labbé, and other major draining veins can lie beside or within the tumor. Preserving functional venous drainage is a major part of surgical planning.
The operative corridor is chosen according to whether the tumor is primarily above or below the tentorium, its relationship to the brainstem and cranial nerves, and the location of critical veins.
A small amount of tumor may be intentionally left to protect venous drainage. That residual can be monitored with MRI and treated with focused radiation if it later shows growth.
Specialists Who Treat Tentorial Meningiomas
Meningioma care at Atlantic Brain and Spine is provided by neurosurgeons with specialized expertise in brain and skull base tumors, with treatment tailored to the tumor’s location and nearby neurological structures.
Related Articles
View All Articles
A Future Restored: Samantha’s Pituitary Tumor Story
After years of infertility and a PCOS diagnosis, Samantha Marak learned that a pituitary tumor was disrupting her…
An Unexpected Brain Tumor Diagnosis—and a Remarkable Recovery
After an unexpected meningioma diagnosis, Jim Van Arsdale turned to Yaron A. Moshel, MD, PhD, for brain tumor…
Climbing Higher: Paula Cameron’s Glioblastoma Patient Story
Days after completing a 114-flight stair challenge, Paula Cameron learned that subtle changes in her smile, speech and…
Still Running: How Brain Surgery Got a Glioblastoma Patient Back in the Race
At 77, Tom Brand was diagnosed with glioblastoma after losing his ability to speak. Following advanced brain surgery…
