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Cystic lesions in giant intraventricular meningioma: Two case reports
Hai Yu1,2, Junhua He2, Min Yang3
1Department of Neurosurgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
Rationale:
Giant meningioma stemming from the intraventricular zone has been reported to be extremely few. Two cases of supersize (>8 cm) intraventricular meningiomas presenting with cystic lesions and their clinical characteristics were collected in our study.
Patient Concerns:
One patient was a 56-year-old man who was hospitalized for blunt headache and weakness of the right lower limb along with a defect of the right visual field for 12 months. The other patient is a 22-year-old lady who presented with a slight headache accompanied by right facial numbness for 1 week. None of them had a significant past medical history.
Diagnoses:
Computed tomography and magnetic resonance imaging of both patients revealed a giant heterogeneous, enhancing tumor mainly in the left trigonum with low-density or hypointense cystic lesions located within or around the tumor. The pathological and immunohistochemical staining indicated fibroblastic meningioma (case 1) and atypical meningioma (case 2) respectively, thus the patients' diagnoses were confirmed.
Interventions:
Total microsurgical resection, including the cystic wall, was performed via a transcortical (transtemporoparietal occipital) approach in both patients, and a ventricular drainage tube was placed for 24 to 48 hours routinely after removed the tumor.
Outcomes:
Postoperatively, both patients recovered free from episodes of symptoms, and imaging examinations confirmed no evidence of regrowth of the meningioma during an average 24 months follow-up.
Lessons:
Cystic lesions may indicate the histopathologic malignancy of intraventricular meningioma. Transcortical approach through the posterior temporal lobe or the parieto-occipital lobe is an effective technology for giant intraventricular meningiomas.
Insights
Giant intraventricular meningiomas are rare tumors. This study highlights two cases with cystic lesions, emphasizing the transcortical approach for effective surgical resection and favorable outcomes in managing these large brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Neuropathology
Background:
- Giant intraventricular meningiomas (>8 cm) are exceptionally rare.
- This study investigates two cases of supersize intraventricular meningiomas with cystic components.
Observation:
- Patients presented with varied neurological deficits including headache, visual field defects, and facial numbness.
- Imaging revealed large, heterogeneous, enhancing intraventricular tumors with associated cystic lesions.
Findings:
- Pathological analysis confirmed fibroblastic meningioma in one case and atypical meningioma in the other.
- Both patients underwent successful total microsurgical resection via a transcortical approach.
- Postoperative recovery was uneventful with no tumor recurrence at 24-month follow-up.
Implications:
- Cystic lesions in intraventricular meningiomas may suggest malignancy.
- The transcortical approach is an effective surgical strategy for giant intraventricular meningiomas.
- Early diagnosis and surgical intervention are crucial for favorable outcomes.
