The tentorium cerebelli is a horizontal fold of dura mater forming the roof of the posterior fossa, separating the cerebellum below from the occipital lobes above. The tentorial notch (incisura) allows passage of the midbrain and third cranial nerve.
Separates the posterior fossa from the supratentorial compartment, transmits the transverse and sigmoid sinuses in its lateral attached margins, and provides the critical boundary at which transtentorial herniation occurs.
Transtentorial (uncal) herniation from supratentorial mass lesions compresses the third cranial nerve against the tentorial edge, producing the classic ipsilateral fixed dilated pupil — a neurosurgical emergency. Tentorial meningiomas arise from the tentorium and may obstruct the transverse sinus.
Ipsilateral CN III compression against the tentorial edge from uncal herniation producing a fixed dilated pupil, signalling imminent brainstem compression requiring emergency decompressive surgery.
Meningioma arising from the tentorium cerebelli compressing the cerebellum, brainstem, or transverse sinus, managed by staged resection with preoperative embolisation for vascular tumours.
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