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Surgical approaches to meningiomas of the lateral ventricles
Vikram V Nayar1, Franco DeMonte, Daniel Yoshor
1Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden Rd, Suite 750, Houston, TX 77030, United States. vnayar@bcm.edu
Background:
Intraventricular meningiomas account for 0.5-3% of all intracranial meningiomas. The majority occur in the atrium of the lateral ventricle. Surgical experience with intraventricular meningiomas is rare in the literature, and several surgical approaches exist.
Methods:
Between 1987 and 2007, 13 patients underwent resection of intraventricular meningiomas. All patients had tumors of the lateral ventricles. These patients were retrospectively identified and their records reviewed.
Results:
Eleven tumors were found in the atrium, one in the frontal horn, and one in the body of the lateral ventricle. In 9 of 13 cases, the tumor occurred in the left lateral ventricle. Patients commonly presented with headache and cognitive difficulties. A visual field deficit was noted preoperatively in one patient. Four patients underwent preoperative angiography, but no patients underwent embolization. Gross total resection was achieved in all cases: 6 via a middle temporal gyrus approach, 5 via a superior parietal lobule approach, and 2 via a transcallosal approach. Image-guided stereotaxis was used in 6 cases. Pathology was benign in 12 of 13 cases; atypical features were identified in one case. There was no operative mortality, and no patients showed evidence of recurrence. Postoperatively, 3 patients developed new cognitive-linguistic deficits that subsequently resolved. One of these patients developed a new visual field deficit after surgery.
Conclusions:
Several approaches are available for the surgical treatment of intraventricular meningiomas. Tumor location, extension, and laterality drive the selection algorithm for these approaches. Preoperative angiography is rarely useful, and surgical cure is the rule.
Insights
Surgical resection of intraventricular meningiomas is effective, with gross total resection achieved in all patients. Tumor location and extension guide surgical approach selection for these rare brain tumors.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Intraventricular meningiomas are rare, comprising 0.5-3% of intracranial meningiomas.
- Most intraventricular meningiomas occur in the lateral ventricle atrium.
- Limited surgical experience is documented for these tumors.
Purpose of the Study:
- To review surgical approaches and outcomes for intraventricular meningiomas.
- To evaluate the effectiveness of different surgical techniques.
- To identify factors influencing surgical strategy.
Main Methods:
- Retrospective review of 13 patients with lateral ventricle intraventricular meningiomas (1987-2007).
- Analysis of tumor location, presenting symptoms, surgical approach, and outcomes.
- Utilized image-guided stereotaxis in 6 cases.
Main Results:
- Tumors predominantly located in the left lateral ventricle atrium (9/13).
- Gross total resection was achieved in all 13 patients.
- No operative mortality or recurrence; temporary cognitive deficits occurred in 3 patients.
Conclusions:
- Multiple surgical approaches exist for intraventricular meningiomas.
- Tumor characteristics (location, extension, laterality) dictate surgical strategy.
- Surgical cure is the typical outcome, with preoperative angiography rarely proving useful.
