Microsurgical management of lateral ventricular meningiomas: a report of 51 cases

Lateral ventricular meningiomas are notably rare and the optimal surgical management for them remains a challenge. We made a retrospective study of patients with these lesions and analyzed the clinical findings, radiological features and especially the surgical treatment on the basis of surgical approaches and techniques.

A total of 51 patients with lateral ventricular meningiomas were operated on between 1996 and 2006 in our institution. The mean patient age was 44 years (range: 14-75 years). The most common presenting symptoms were related to the gradually increasing high cranial pressure (82.4%) rather than the location of the tumor. The transcortical parieto-occipital approach was used in 38 patients, the temporal approach was used in 9 patients and the transcallosal approach was used in 4 patients.

The total surgical excision was complete in 48 patients (94.1%), and 3 patients with subtotal excision received radiotherapy after the operation. The previous visual fields deficits in two patients worsened and a new visual disturbance or sensory aphasia appeared in two patients. One patient died of postoperative hypothalamus complications. Thirty-eight patients underwent follow-up (range: 6 months-10 years). The conditions of 35 of these were excellent or good. No recurrence has been seen in any patient.

Understanding the features of lateral ventricular meningiomas will help one to select an appropriate surgical approach. An individualized approach is needed, and the transcortical parieto-occipital approach or transtemporal approach is advantageous for most cases in our opinion. Also, it is possible to achieve a good surgical outcome with little neurological morbidity if we take wise strategies and techniques during excision.