File 14: INTRAVENTRICULAR MENINGIOMA
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G. OJEMANN, M.D.
© Congress of Neurological Surgeons Honored
Originally Published Clinical Neurosurgery, Volume 40, Chapter
17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.
HTML Editor: Stephen
B. Tatter, M.D., Ph.D.
The information and reference materials contained herein are intended
solely to provide background information. They were written for an
audience of physicians. They are in no way intended to constitute
medical advise. For medical advise a physician must, of course, be
| FIG. 17.23. Intraventricular
meningioma. This 16-year-old female presented with headache
and a left visual field defect. Full recovery followed removal
using a middle temporal gurus approach. The CT scan shows a
large right intraventiicular tumor. Angiography was indicated
to define the vascular supply.
(Meningioma Management, File 14)
Intraventiicular meningiomas usually
are located in the trigone of the lateral ventricle but may occur
rarely in the third or fourth ventricle (24, 34, 56).
In patients with medium-sized tumors,
angiography is probably not needed since the blood supply from the
choroidal arteries can be found after internal decompression of
the tumor. However, when the tumor is large the study may provide
useful information on the location of the feeding arteries (Fig.
Surgery is indicated in patients with
neurological symptoms. Radiation therapy has not been used.
| FIG. 17.24. Intraventricular
meningioma. The surgical approaches to consider are through
the middle temporal gyrus or the posterior parietal-occipital
The advantages and disadvantages of
several different approaches to intraventricular tumors have been
summarized (FIG. 17.24) (24, 70). The posterior parietal-occipital
incision for better overall access to the tumor, particularly in
the dominant hemisphere, is preferred by some (16, 24). Others have
used a middle temporal gurus approach (12, 26, 34, 47). This has
the advantage of allowing early occlusion of the anterior choroidalartery
branches. A combined approach has also been used (70).
The key considerations in the operation
- Careful planning of the cortical
- Internal decompression of the tumor,
when necessary, to minimize brain retraction.
- Occlusion of the choroidal artery
branches as early as possible.
|TABLE 17.13 Intraventricular
aT, total removal
RST, radical subtotal removal
ST, subtotal removal
bGood, free of major
and able to return to previous activity level
Fair, independent but not able
to return to full activity
because of new neurological deficit or significant
preoperative deficit that did not fully recover
In this series there were three men
and two women, ranging in age from 16 to 58 years. All five patients
had total removal of the tumor (Table 17.13). Three had a good result,
one fair, and one poor. The patient with a poor result had a very
large tumor that had been treated with subtotal removal and radiation
therapy before we saw her, and she was already bedridden with hemiparesis
and dysphasia. However, she was worse because of occlusion of a
posterior cerebral artery branch.
Postoperative visual field deficits
usually recover rapidly (24). Konovalov et al. (34) reported one
death in 18 patients treated between 1980 and 1989.
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