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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Intraventricular meningiomas: a surgical challenge
Bernard T Lyngdoh1, Pramod J Giri, Sanjay Behari
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Summary
Surgical management of intraventricular meningiomas (IVMs) is challenging due to their size and location. Early detection and monitoring for hydrocephalus are crucial for better outcomes in patients with these brain tumors.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Primary intraventricular meningiomas (IVMs) present significant surgical challenges.
- These tumors often grow large before detection, nearing critical brain structures.
- Their blood supply is typically encountered late in the surgical process.
Purpose of the Study:
- To discuss the surgical management of intraventricular meningiomas.
- To analyze surgical approaches and outcomes for IVMs.
Main Methods:
- Retrospective analysis of nine patients with IVMs (lateral and fourth ventricular) operated between 1989 and 2003.
- Surgical approaches included posterior middle temporal gyrus, superior parietal lobule, and midline suboccipital craniectomy.
- Tumor size averaged over 5.3 cm, with presentations including hydrocephalus and ventricular sequestration.
Main Results:
- Complete tumor excision was achieved in eight patients; partial excision in one.
- Postoperative external ventricular drainage was necessary for lateral ventricular tumors.
- Morbidity included visual field defects, hemiparesis, seizures, and meningitis. One patient with partial excision died due to complications.
Conclusions:
- IVMs often reach large sizes asymptomatically before diagnosis.
- Devascularization typically occurs after substantial tumor debulking.
- Postoperative monitoring for hydrocephalus and ventricular sequestration is vital, potentially managed with external ventricular drainage.
