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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Published on: October 20, 2017

Intraventricular atypical meningiomas.

Hyun-Doo Kim¹, Chan-Young Choi, Dong-Joon Lee

¹Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea.

Journal of Korean Neurosurgical Society

|July 1, 2011

Summary

This case study details a rare intraventricular meningioma that transformed into an aggressive, atypical form. The tumor recurred and metastasized despite treatment, highlighting challenges in managing these rare brain tumors.

Keywords:

Atypical Intraventricular Meningioma Transformation

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Area of Science:

Neuro-oncology
Neurosurgery
Pathology

Background:

Intraventricular meningiomas are rare tumors originating from arachnoid cap cells within the brain's ventricles.
Meningiomas are typically benign, but atypical and anaplastic variants can exhibit aggressive behavior.

Observation:

A 51-year-old woman presented with a rare intraventricular meningioma in the left lateral ventricle atrium.
Initial histopathology revealed a meningothelial meningioma with a focal atypical area (Ki-67 LI 8%).
Recurrence occurred 41 months post-surgery, showing atypical meningioma features (Ki-67 LI 20%) with spread to the quadrigeminal cistern and occipital lobe.

Findings:

The recurrent tumor demonstrated increased proliferation (Ki-67 LI 20%) without anaplastic features.
Despite fractionated stereotactic radiotherapy, multiple metastases appeared in the occipital and cerebellar cortex 24 months after the second resection.
Cerebrospinal fluid dissemination was suspected as the route for metastasis.

Implications:

This case highlights the potential for intraventricular meningiomas to undergo malignant transformation and aggressive progression.
The findings underscore the importance of vigilant follow-up for atypical meningiomas, even after gross total resection and radiotherapy.
Management strategies for aggressive intraventricular meningiomas may require further refinement to address recurrence and leptomeningeal spread.