Meningiomas of the Lateral Ventricle

ABSTRACT

Intraventricular meningiomas represent less than 2% of all intracranial meningiomas. These tumors often have an indolent course, and patients can present in adulthood with severe headache, nausea and vomiting, visual disturbances, and/or seizures. These lesions typically reside in the trigone of the lateral ventricle, with a predilection for the left side and a female predominance; however, any location within the ventricular system is possible. The differential diagnosis for lateral ventricular lesions is broad, but intraventricular meningiomas have the same radiographic appearance on magnetic resonance imaging and cerebral angiography as other, more common intracranial meningiomas. The primary treatment for an intraventricular meningioma is surgery, with the goal of gross total resection. Many surgical approaches to the lateral ventricle exist, and the challenge is to develop a route to these deep lesions that will cause the least morbidity, provide adequate working space, allow the identification and control of the vascular pedicle, and achieve a complete resection. With the assistance of frameless stereotactic image guidance and preoperative cerebral angiography, primary surgical resection of these lesions can result in excellent clinical outcomes with low recurrence rates.

KEYWORDS

Meningioma - intraventricular - lateral ventricle - surgical approaches

REFERENCES

• 1 Majos C, Cucurella G, Aguilera C, Coll S, Pons L C. Intraventricular meningiomas: MR imaging and MR spectroscopic findings in two cases.  AJNR Am J Neuroradiol . 1999;  20 882-885
• 2 Caner H, Acikgoz B, Ozgen T, Colak A, Onol B. Meningiomas of the lateral ventricle. Report on six cases.  Neurosurg Rev . 1992;  15 303-306
• 3 Criscuolo G R, Symon L. Intraventricular meningioma. A review of 10 cases of the National Hospital, Queen Square (1974-1985) with reference to the literature.  Acta Neurochir (Wien) . 1986;  83 83-91
• 4 Guidetti B, Delfini R, Gagliardi F M, Vagnozzi R. Meningiomas of the lateral ventricles. Clinical, neuroradiologic, and surgical considerations in 19 cases.  Surg Neurol . 1985;  24 364-370
• 5 DeMonte F, Al-Mefty O. Management of meningiomas. In: Tindall GT, Cooper PR, Barrow DL, eds. The Practice of Neurosurgery Vol 1. Baltimore: Williams & Wilkins 1996: 708
• 6 Jelinek J, Smirniotopoulos J G, Parisi J E, Kanzer M. Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings.  AJR Am J Roentgenol . 1990;  155 365-372
• 7 Mani R L, Hedgcock M W, Mass S I, Gilmor R L, Enzmann D R, Eisenberg R L. Radiographic diagnosis of meningioma of the lateral ventricle. Review of 22 cases.  J Neurosurg . 1978;  49 249-255
• 8 Delfini R, Acqui M, Oppido P A, Capone R, Santoro A, Ferrante L. Tumors of the lateral ventricles.  Neurosurg Rev . 1991;  14 127-133
• 9 McDermott M W, Wilson C B. Meningiomas. In: Youmans JR, ed. Neurological Surgery Vol 4. 4th ed. Philadelphia: WB Saunders 1996: 2814-2815
• 10 Kotwica Z, Jagodzinski Z, Polis L. Meningiomas of the lateral ventricle.  Neurochirurgia (Stuttg) . 1985;  28 199-201
• 11 Timurkaynak E, Rhoton Jr L A, Barry M. Microsurgical anatomy and operative approaches to the lateral ventricles.  Neurosurgery . 1986;  19 685-723
• 12 Pendl G, Ozturk E, Haselsberger K. Surgery of tumours of the lateral ventricle.  Acta Neurochir (Wien) . 1992;  116 128-136
• 13 Arseni C, Ionescu S, Maretsis M. Meningiomas of the lateral ventricle.  Psychiatr Neurol Neurochir . 1968;  71 319-336
• 14 Guidetti B, Delfini J. Lateral and fourth ventricle meningiomas. In: Al-Mefty O, ed. Meningiomas New York: Raven Press 1991: 569-581
• 15 Tien R D. Intraventricular mass lesions of the brain: CT and MR findings.  AJR . 1991;  157 1283-1290
• 16 McConachie N S, Worthington B S, Cornford E J, Balsitis M, Kerslake R W, Jaspan T. Review article: computed tomography and magnetic resonance in the diagnosis of intraventricular cerebral masses.  Br J Radiol . 1994;  67 223-243
• 17 Kendall B, Reider-Grosswasser I, Valentine A. Diagnosis of masses presenting within the ventricles on computed tomography.  Neuroradiology . 1983;  25 11-22
• 18 Ellenbogen R G. Transcortical surgery for lateral ventricular tumors.  Neurosurg Focus . 2001;  10 1-13
• 19 Ross B, Michaelis T. Clinical applications of magnetic resonance spectroscopy.  Magn Reson Q . 1994;  10 191-247
• 20 Ott D, Hennig J, Ernst T. Human brain tumors: assessment with in vivo proton MR spectroscopy.  Radiology . 1993;  186 745-752
• 21 Usenius J P, Kauppinen R A, Vainio P A. et al . Quantitative metabolite patterns of human brain tumors: detection by 1H NMR spectroscopy in vivo and in vitro.  J Comput Assist Tomogr . 1994;  18 705-713
• 22 Rand S D, Prost R, Haughton V. et al . Accuracy of single-voxel proton MR spectroscopy in distinguishing neoplastic from nonneoplastic brain lesions.  AJNR Am J Neuroradiol . 1997;  18 1695-1704
• 23 Yoshida K, Onozuka S, Kawase T, Ikeda E. Lateral ventricular meningioma encapsulated by the dura-like membrane.  Neuropathology . 2000;  20 56-59
• 24 Alafaci C, Salpietro F M, Grasso G. et al . Osteoblastic meningioma of the lateral ventricle. Case illustration.  J Neurosurg . 1999;  91 1058
• 25 Gokalp H Z, Yuceer N, Arasil E. et al . Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970-1997.  Neurosurg Rev . 1998;  21 126-137
• 26 Apuzzo M L, Chikovani O K, Gott P S. et al . Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences.  Neurosurgery . 1982;  10 547-554
• 27 Shucart W A, Stein B M. Transcallosal approach to the anterior ventricular system.  Neurosurgery . 1978;  3 339-343
• 28 Woiciechowsky C, Vogel S, Lehmann R, Staudt J. Transcallosal removal of lesions affecting the third ventricle: an anatomic and clinical study.  Neurosurgery . 1995;  36 117-122
• 29 Geffen G, Walsh A, Simpson D, Jeeves M. Comparison of the effects of transcortical and transcallosal removal of intraventricular tumours.  Brain . 1980;  103 773-788
• 30 Santoro A, Salvati M, Frati A, Polli F M, Delfini R, Cantore G. Surgical approaches to tumours of the lateral ventricles in the dominant hemisphere.  J Neurosurg Sci . 2002;  46 60-65
• 31 Barrow D L, Dawson R. Surgical management of arteriovenous malformations in the region of the ventricular trigone.  Neurosurgery . 1994;  35 1046-1054
• 32 Batjer H, Samson D. Surgical approaches to trigonal arteriovenous malformations.  J Neurosurg . 1987;  67 511-517
• 33 Rhoton Jr L A, Fujii K, Fradd B. Microsurgical anatomy of the anterior choroidal artery.  Surg Neurol . 1979;  12 171-187
• 34 Levin H S, Rose J E. Alexia without agraphia in a musician after transcallosal removal of a left intraventricular meningioma.  Neurosurgery . 1979;  4 168-174
• 35 Fornari M, Savoiardo M, Morello G, Solero C L. Meningiomas of the lateral ventricles. Neuroradiological and surgical considerations in 18 cases.  J Neurosurg . 1981;  54 64-74
• 36 Vinas F C, Zamorano L, Lis-Planells M, Buciuc R, Diaz F G. Interactive intraoperative localization during the resection of intraventricular lesions.  Minim Invasive Neurosurg . 1996;  39 65-70
• 37 Morita A, Kelly P J. Resection of intraventricular tumors via a computer-assisted volumetric stereotactic approach.  Neurosurgery . 1993;  32 920-927
• 38 Giorgi C, Riva D. Stereotactically guided transfrontal removal of intraventricular midline tumors in children. Neurosurgical and neuropsychological considerations.  J Neurosurg . 1994;  81 374-380
• 39 Terada T, Yokote H, Tsuura M. et al . Presumed intraventricular meningioma treated by embolisation and the gamma knife.  Neuroradiology . 1999;  41 334-337
• 40 Ojemann R. Meningiomas. In: Winn RH, Matyberg M, eds. The Role of Surgery in Brain Tumor Management Vol 1. Philadelphia: WB Saunders 1990: 192-193