Background: Tentorial meningiomas are uncommon entity, related to tentorium and representing 3–6% of in- Microsurgery tracranial meningiomas. Being related to surrounding vital neurovascular structures, complete surgical resec- Tentorial tion of such tumors was limited in the early stages with poor outcomes, but with the continuous improvements Meningioma P in microsurgery and the advent of new imaging modalities, the prognosis of such cases has improved signifi- Rankin scale Skull base cantly. We aimed to assess different surgical approaches, and functional outcome of patients with tentorial meningioma who underwent microsurgical resection at a single institution in a developing country. Methods: A Retrospective analysis of clinical data of tentorial meningioma patients who underwent microsurgi- cal excision at our institution between 2014 and 2021 was done. Tumour characteristics, location based on the modified Yasargil classification, different surgical approaches, operative details, extent of resection, and func- D tional postoperative outcome according to modified Rankin scale were also assessed. Results: 18 patients diagnosed with tentorial meningioma were included in our study, (66.7% females and 33.3% males) with mean age (50.1 ± 8.6) years. Headache was the most common presentation in (83.3%) of our pa- E tients and 5 patients (27.8%) had preoperative hydrocephalus. Gross total resection had been achieved in 66.7% of patients, while 16.7% of patients had subtotal resection and 16.7% had partial resection. 12 patients were considered in the (Good outcome) group and had score from 0 to 2 in the modified Rankin scale, while 6 cases T had (Poor outcome) were between 3 and 6 on the scale. Factors that might predict the functional outcome were evaluated and were statistically insignificant. Conclusion: Tentorial meningiomas are challenging, microsurgical excision results in favorable surgical and functional outcome in most cases however, when gross total resection isn’t feasible, subtotal resection followed C by adjuvant therapy is recommended.