Intraventricular Meningioma: Technical Nuances in Surgical Management

Intraventricular meningiomas (IVMs) are rare tumors compared with intracranial meningiomas. Optimal surgical management of IVMs is controversial. The objective of this article was to review the outcomes and complications of meningiomas treated with various surgical approaches.

We performed a retrospective review of 18 patients with IVMs who received different treatment strategies during the period 2000-2014. Of 18 patients, 17 underwent microsurgical resection, and 1 patient received Gamma Knife radiosurgery. The literature was reviewed to compare the present cohort with previously published series.

In our series, 12 (70%) patients underwent parieto-occipital craniotomy and a superior parietal gyrus approach, which was similar to procedures used in various series (74.4%) in the existing literature. Preoperatively, patients commonly presented with headache (65%) and neurologic deficits (70%). After surgical management, there was a significant reduction in symptoms, including headache (preoperative 65% vs. postoperative 6%, P = 0.0001), and neurologic deficits (preoperative 70% vs. postoperative 5.5%). Preoperatively, 2 patients experienced visual impairment, which was completely resolved after surgery. The Karnofsky performance scale was significantly improved after resection compared with before treatment (89 vs. 76, P = 0.003). In 4 patients with World Health Organization grade II tumor, redo surgery was required because of recurrence of tumor.

Based on a literature review and our experience, surgical approaches for patients with IVM vary according to size, location, and laterality of the meningioma. In addition, the growth pattern of the tumor (transependymal extension), vascular supply of the tumor, and brain function (particularly visual function) can affect surgical treatment and should be identified preoperatively.