Skip to main content

Advertisement

SpringerLink
Log in

Intraventricular meningiomas: a consecutive series of 22 patients and literature review

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Intraventricular meningiomas (IVMs) are rare tumors of which the majority is located in the lateral ventricles. Most published series on the subject includes only a few patients. We analyzed our series of IVMs with a special interest in clinical features, outcome, and complications related to surgery. Twenty-two patients underwent resection of IVMs from 1990 to 2010 at Oslo University Hospital. Surgical and medical records were retrospectively analyzed. The IVMs were located in the trigonum of the lateral ventricles (20/22), in the third ventricle (1/22), and in the fourth ventricle (1/22). The most common symptoms and signs were headache, vertigo, nausea/vomiting, mental disturbances, balance impairment, and corticospinal tract signs. Visual field deficit was present preoperatively in two patients. Tumors of the lateral ventricles were resected via a transcortical parieto-occipital approach; the tumors in the third and fourth ventricle via a frontal transcortical and suboccipital route, respectively. Complete tumor resection was achieved in all but one case. Histology was WHO grade I in 20/22 and grade II in 2/22. Surgical mortality was 0 %. Most symptoms and signs resolved after surgery. The most common complication was visual field defect: four patients developed new-onset contralateral homonymous quadrant anopia and one patient developed hemianopia. Symptomatic IVMs should be resected, and most symptoms and signs resolve after surgery. The main challenge is to avoid damaging the geniculucalcarine tract when resecting IVMs in the trigonum. Preoperative diffusion tensor imaging-based tractography to map the geniculocalcarine tract could be a useful adjunct in the preoperative planning before selecting the surgical approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bertalanffy A, Roessler K, Koperek O, Gelpi E, Prayer D, Neuner M, Knosp E (2006) Intraventricular meningiomas: a report of 16 cases. Neurosurg Rev 29(1):30–35. doi:10.1007/s10143-005-0414-5

    Article  PubMed  Google Scholar 

  2. Bhatoe HS, Singh P, Dutta V (2006) Intraventricular meningiomas: a clinicopathological study and review. Neurosurg Focus 20(3):E9

    Article  PubMed  Google Scholar 

  3. Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM (2005) Epidemiology of intracranial meningioma. Neurosurgery 57(6):1088–1095, discussion 1088-1095

    Article  PubMed  Google Scholar 

  4. Criscuolo GR, Symon L (1986) Intraventricular meningioma. A review of 10 cases of the National Hospital, Queen Square (1974–1985) with reference to the literature. Acta Neurochir (Wien) 83(3–4):83–91

    Article  CAS  Google Scholar 

  5. Cushing HL, Eisenhardt L (1938) Meningiomas: their classification, regional behavior, life history and surgical end results. Charles C. Thomas, Springfield

    Google Scholar 

  6. Delandsheer JM (1965) Meningiomas of the lateral ventricle. Neurochirurgie 11:3–83

    PubMed  CAS  Google Scholar 

  7. Delfini R, Acqui M, Oppido PA, Capone R, Santoro A, Ferrante L (1991) Tumors of the lateral ventricles. Neurosurg Rev 14(2):127–133

    Article  PubMed  CAS  Google Scholar 

  8. Ellenbogen RG (2001) Transcortical surgery for lateral ventricular tumors. Neurosurg Focus 10(6):E2

    Article  PubMed  CAS  Google Scholar 

  9. Fornari M, Savoiardo M, Morello G, Solero CL (1981) Meningiomas of the lateral ventricles. Neuroradiological and surgical considerations in 18 cases. J Neurosurg 54(1):64–74. doi:10.3171/jns.1981.54.1.0064

    Article  PubMed  CAS  Google Scholar 

  10. Gassel MM, Davies H (1961) Meningiomas in the lateral ventricles. Brain 84:605–627

    Article  PubMed  CAS  Google Scholar 

  11. Gelabert-Gonzalez M, Garcia-Allut A, Bandin-Dieguez J, Serramito-Garcia R, Martinez-Rumbo R (2008) Meningiomas of the lateral ventricles. A review of 10 cases. Neurocirugia (Astur) 19(5):427–433

    CAS  Google Scholar 

  12. Guidetti B, Delfini R, Gagliardi FM, Vagnozzi R (1985) Meningiomas of the lateral ventricles. Clinical, neuroradiologic, and surgical considerations in 19 cases. Surg Neurol 24(4):364–370

    Article  PubMed  CAS  Google Scholar 

  13. Hasseleid F, Meling TR, Rønning P, Scheie D, Helseth E (2012) Convexity meningiomas: Simpson grade I resection should still be the goal. J Neurosurg (in press)

  14. Imielinski BL, Kloc W (1997) Meningiomas of the lateral ventricles of the brain. Zentralbl Neurochir 58(4):177–182

    PubMed  CAS  Google Scholar 

  15. Jun CL, Nutik SL (1985) Surgical approaches to intraventricular meningiomas of the trigone. Neurosurgery 16(3):416–420

    Article  PubMed  CAS  Google Scholar 

  16. Kamada K, Todo T, Morita A, Masutani Y, Aoki S, Ino K, Kawai K, Kirino T (2005) Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography. Neurosurgery 57(1):121–127, discussion 121-127

    Article  PubMed  Google Scholar 

  17. Karnofsky DA (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. p 196

  18. Kawashima M, Li X, Rhoton AL Jr, Ulm AJ, Oka H, Fujii K (2006) Surgical approaches to the atrium of the lateral ventricle: microsurgical anatomy. Surg Neurol 65(5):436–445. doi:10.1016/j.surneu.2005.09.033

    Article  PubMed  Google Scholar 

  19. Kendall B, Reider-Grosswasser I, Valentine A (1983) Diagnosis of masses presenting within the ventricles on computed tomography. Neuroradiology 25(1):11–22

    Article  PubMed  CAS  Google Scholar 

  20. Kim EY, Kim ST, Kim HJ, Jeon P, Kim KH, Byun HS (2009) Intraventricular meningiomas: radiological findings and clinical features in 12 patients. Clin Imaging 33(3):175–180. doi:10.1016/j.clinimag.2008.09.005

    Article  PubMed  Google Scholar 

  21. Kloc W, Imielinski BL, Wasilewski W, Stempniewicz M, Jende P, Karwacki Z (1998) Meningiomas of the lateral ventricles of the brain in children. Childs Nerv Syst 14(8):350–353

    Article  PubMed  CAS  Google Scholar 

  22. Kurland LT, Schoenberg BS, Annegers JF, Okazaki H, Molgaard CA (1982) The incidence of primary intracranial neoplasms in Rochester, Minnesota, 1935–1977. Ann N Y Acad Sci 381:6–16

    Article  PubMed  CAS  Google Scholar 

  23. Lang I, Jackson A, Strang FA (1995) Intraventricular hemorrhage caused by intraventricular meningioma: CT appearance. AJNR Am J Neuroradiol 16(6):1378–1381

    PubMed  CAS  Google Scholar 

  24. Liu M, Wei Y, Liu Y, Zhu S, Li X (2006) Intraventricular meninigiomas: a report of 25 cases. Neurosurg Rev 29(1):36–40. doi:10.1007/s10143-005-0418-1

    Article  PubMed  CAS  Google Scholar 

  25. Lyngdoh BT, Giri PJ, Behari S, Banerji D, Chhabra DK, Jain VK (2007) Intraventricular meningiomas: a surgical challenge. J Clin Neurosci 14(5):442–448. doi:10.1016/j.jocn.2006.01.005

    Article  PubMed  Google Scholar 

  26. Mani RL, Hedgcock MW, Mass SI, Gilmor RL, Enzmann DR, Eisenberg RL (1978) Radiographic diagnosis of meningioma of the lateral ventricle. Review of 22 cases. J Neurosurg 49(2):249–255. doi:10.3171/jns.1978.49.2.0249

    Article  PubMed  CAS  Google Scholar 

  27. McDermott MW (2003) Intraventricular meningiomas. Neurosurg Clin N Am 14(4):559–569

    Article  PubMed  Google Scholar 

  28. Menon G, Nair S, Sudhir J, Rao R, Easwer HV, Krishnakumar K (2009) Meningiomas of the lateral ventricle—a report of 15 cases. Br J Neurosurg 23(3):297–303. doi:10.1080/02688690902721862

    Article  PubMed  CAS  Google Scholar 

  29. Nakamura M, Roser F, Bundschuh O, Vorkapic P, Samii M (2003) Intraventricular meningiomas: a review of 16 cases with reference to the literature. Surg Neurol 59(6):491–503, discussion 503-494

    Article  PubMed  Google Scholar 

  30. Nayar VV, DeMonte F, Yoshor D, Blacklock JB, Sawaya R (2010) Surgical approaches to meningiomas of the lateral ventricles. Clin Neurol Neurosurg 112(5):400–405. doi:10.1016/j.clineuro.2010.02.005

    Article  PubMed  Google Scholar 

  31. Rubino PA, Rhoton AL Jr, Tong X, Oliveira E (2005) Three-dimensional relationships of the optic radiation. Neurosurgery 57(4):219–227, discussion 219-227

    Article  PubMed  Google Scholar 

  32. Staneczek W, Janisch W (1992) Epidemiologic data on meningiomas in East Germany 1961–1986: incidence, localization, age and sex distribution. Clin Neuropathol 11(3):135–141

    PubMed  CAS  Google Scholar 

  33. Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, Davis FG (1999) Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990–1994. Neurosurg Oncol 1(1):14–25

    CAS  Google Scholar 

  34. Wang X, Cai BW, You C, He M (2007) Microsurgical management of lateral ventricular meningiomas: a report of 51 cases. Minim Invasive Neurosurg 50(6):346–349. doi:10.1055/s-2007-993205

    Article  PubMed  CAS  Google Scholar 

  35. Winkler PA, Buhl R, Tonn JC (2009) Intraventricular meningiomas. In: Lee JH (ed) Meningiomas: diagnosis, treatment and outcome. Springer, London, pp 491–514

    Google Scholar 

Download references

Acknowledgments

We thank Elisabeth Elgesem and Hanne Vebenstad for excellent secretarial assistance. We thank Dr. Ane Konglund, medical student; Filip Hasseleid, medical student; Andreas Mathiesen, medical student; and Andreas Schei Hessen for help with data collection.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Oslo, Oslo, Norway

    Kristina M. Ødegaard & Eirik Helseth

  2. Department of Neurosurgery, Oslo University Hospital, Ullevål, Oslo, Norway

    Eirik Helseth

  3. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Torstein R. Meling

  4. Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, 0027, Oslo, Norway

    Torstein R. Meling

Authors
  1. Kristina M. Ødegaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eirik Helseth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Torstein R. Meling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Torstein R. Meling.

Additional information

Comments

Makoto Nakamura, Hannover, Germany

The authors present a well written and interesting surgical series of 22 patients with intraventricular meningiomas operated between 1990 and 2010. A retrospective analysis of the clinical, radiological and surgical data was conducted.

Among intraventricular meningiomas, the trigonum is the most common location. The superior parieto-occipital transcortical approach is the most favorable approach for microsurgical resection of these tumors. The authors accomplished to treat their patients with very low morbidity using this approach. However, postoperative new onset visual field deficit is a well-known problem, which can be associated with the surgical treatment of trigonal meningiomas. Modern imaging studies using DTI of the optic radiation may help in detailed surgical planning and hopefully in further reduction of damage to the optic radiation.

The authors present a well-written manuscript with an up to date review of previously published series. The discussion deals with several aspects of the epidemiology, clinical presentation, and surgical treatment options of this rare entity.

Karl Schaller, Geneva, Switzerland

The authors report on their institutional series of n = 22 intraventricular meningiomas, which had been treated over a period of time of 20 years. Twenty of the meningiomas were located in the trigonum on either side; and n = 20 were WHO I, and two WHO II. Five patients who had been operated via the parietooccipital transparenchymal approach developed new visual deficits, whereas pre-existing nonspecific symptoms (headache etc.) resolved in all. None of the deaths during follow-up was tumor related. The authors conclude that these tumors should be removed, as mostly feasible, and that DTI should be included in surgical planning in order to help avoid new onset of visual field deficits.

Although not very original by nature, this study is a relevant retrospective analysis of a rare clinical entity. The neurosurgical difficulties with these particular tumors relate to the determination of adequate surgical accessibility of those mainly, which are located in the ventricular trigonum on the dominant, and on the nondominant side. Those located in the third and fourth ventricles may be accessed by less controversial approaches, except for the never-ending debate of interhemispheric interforniceal vs. the transparenchymal approach. The authors provide a credible work-up of their series. As with such a long period of observation, it is not possible to judge inasmuch DTI-based neuronavigation might have influenced the visual outcome of their series (25 % deterioration) for the better. Since early 1990s, our technical armamentarium and the ways for intra-operative surveillance have changed considerably, and the lesson what can be learnt from the important experience of the authors is that careful planning, including functional imaging and fiber tracking, both integrated in neuronavigation, and intra-operative monitoring of visually evoked potentials should be part of appropriate contemporary management of these trigonal lesions. During the observational period of time of the reported series, the possibilities for intra-operative surveillance have gone beyond the sole monitoring of the motor tract, and the value of detailed neuroposychological testing, before and after abording trigonal lesions in the dominant lobe, cannot be overestimated according to this reviewer’s experience. Having not seen as many trigonal meningiomas as the authors as I must admit, I do still remember a few—most of which had been calcified. As with other possible incidentalomas I would, if the tumor remains asymptomatic, rather vote for continuing MRI surveillance of calcified ventricular lesions, and reserve surgery for those only which become symptomatic or which exhibit growth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ødegaard, K.M., Helseth, E. & Meling, T.R. Intraventricular meningiomas: a consecutive series of 22 patients and literature review. Neurosurg Rev 36, 57–64 (2013). https://doi.org/10.1007/s10143-012-0410-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-012-0410-5

Keywords

Search

Navigation