Clinical Outcomes Following Intraventricular Meningioma Resection: A Longitudinal Single-Center Experience

Objective: Intraventricular meningiomas (IVMs) are a rare entity, and often present a surgical challenge due to their large size and blood supply emanating distal to the surgical approach. A transcortical approach offers adequate access and working space for IVMs in the lateral ventricle, but risks injury to surrounding white matter tracts. Radiographic and neurological outcomes are therefore of great interest for patients undergoing IVM resection. Postoperative shunt dependence has also not been defined within this patient population.

Methods: Patients who underwent IVM resection at one academic center (1997–2021) were retrospectively reviewed. Preoperative demographics, surgical details, and postoperative outcomes following resection were recorded. Postoperative diffusion restriction around the operative tract on diffusion weighted magnetic resonance imaging (DWI) was assessed. Correlation between surgical factors, postoperative DWI findings, and new postoperative neurological deficit was assessed using logistic regression and Chi-squared statistics.

Results: Thirty-three patients (72.7% female) who underwent IVM resection were included in the cohort. Presenting symptoms included neurological deficit (66.7%) and headache (27.3%); one patient was incidentally diagnosed. Median age at surgery was 48.3 (range: 21.1–87.9) years. Tumors were located within the lateral ventricle (97.0%) and 4th ventricle (3.0%). A transcortical approach was used in 90.9% of cases, a transcallosal approach in 6.1%, and suboccipital in 3.0% of cases. Median preoperative tumor volume was 36.2 cc (range: 1.0–126.0).

Thirty-one IVMs (93.9%) had gross total resection, while two (6.1%) had subtotal resection (STR). Five operations (15.2%) had a surgical complication within 30 days: two patients requiring a shunt, one ventricular hemorrhage, one postoperative cerebral swelling, and one epidural hematoma requiring the only recorded reoperation. A medical complication of meningitis occurred in two patients. Four patients (12.1%) required a ventriculoperitoneal shunt during postoperative follow-up. One patient had an asymptomatic pseudo-meningocele noted at postoperative day one which self-resolved, with no other cases of pseudo-meningocele or cerebrospinal fluid leak.

Pathology demonstrated World Health Organization grading of I: 58.1%; II: 35.5%; III: 6.5%. Median cell proliferation index (K_i-67 or MIB-1) was 5.6% (range: 1.0–20.0). With median radiographic follow-up of 11.9 (0.2–237.8) months, two patients had recurrence following IVM resection, one of which had STR. Seventeen patients (51.5%) had a new neurologic deficit postoperatively by discharge, with a visual field deficit in 10 patients, hemiparesis in four, aphasia in two, and paresthesia, dysphagia, and third cranial nerve palsy each in one patient.

Lesion characteristics, including initial IVM size (p = 0.93), were not predictive of postoperative neurological deficit ([Table 1]). Size of diffusion restriction around the resection cavity on postoperative DWI did not correlate with risk of neurological deficit (p = 0.40). [Fig. 1] demonstrates preoperative imaging of a large IVM (volume >100 cc, [Fig. 1A]) with significant postoperative diffusion restriction ([Fig. 1B]) compared with a smaller IVM (volume < 10 cc, [Fig. 1C]) with less postoperative diffusion restriction ([Fig. 1D]). Both patients had new neurological deficits lasting > 30 days postoperatively.

Conclusion: There is a low rate of recurrence following intraventricular meningioma resection. Shunt dependence is seen in the minority of patients, and GTR can be achieved in the majority of cases.

Fig. 1

Table 1

Publication History

Article published online:
15 February 2022