The Tentorium Cerebelli: A Comprehensive Review Including Its Anatomy, Embryology, and Surgical Techniques

Abstract

The tentorium cerebelli functions as a partition, dispelling the burden of weight from supratentorial structures upon inferior brain matter. Clinicians and neurosurgeons, when assessing pathological findings, should have knowledge regarding the tentorium cerebelli anatomy. This work of literature is a comprehensive review of the tentorium cerebelli, including its anatomy, embryology, and clinical and surgical implications. The evolutionary pattern demonstrates sequential stages to higher mammalian lineage. An understanding of the complexity of the neurovascular structures and the anatomy of the tentorium cerebelli is crucial for surgical procedures by neurosurgeons.

Keywords: dural sinus; embryology; incisura; tentorial notch; tentorium cerebelli.

Figure 1. Right lateral view of the cranium after hemicraniectomy and removal of right cerebral hemisphere in a cadaver.

Note the tentorium cerebelli and its relationship to the medial brain structures. Also, note the olfactory tract (right arrow) and optic nerve (left arrow).

Figure 2. Left: the tentorial incisura (white arrows), straight sinus (blue arrows) and transverse sinus (yellow arrow); Right, schematic drawing of left hemicranium noting the numerous neurovascular structures just medial to the tentorial incisura e.g., basal vein of Rosenthal (blue).

The anterior half of the tentorium cerebelli is cut away at the blue arrow. Also note the straight sinus (SS).

Figure 3. Superior view of a cadaveric tentorium cerebelli with brain superior to the brainstem removed.

Note the midbrain (MB) and the optic chiasm (OC). White arrows point to the right tentorial incisura.

Figure 4. Schematic drawing of the anterior extensions of the tentorium cerebelli and the anterior petroclinoid and posterior petroclinoid folds, which make up the lateral and posterior borders of the oculomotor trigone.

Figure 5. Right subtemporal view of the tentorium cerebelli and structures along its medial border such as the trochlear nerve.

Anteriorly, note the internal carotid artery (transected) (ICA) for reference.

Figure 6. Superior view of the left tentorium cerebelli and its incisura.

Note, the left cerebral hemisphere has been removed.

Figure 7. Inferior view of the tentorial incisura (white arrows) following a skull base approach.

Note the posterior cerebral (PCA), superior cereberllar (SCA), and posterior communicating arteries (PComm).

Figure 8. Small vessels of the skull base noting the tentorial branch to the free edge of the tentorium from the meningohypophyseal trunk of the cavernous internal carotid artery.