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Management of Meningiomas
File 14: INTRAVENTRICULAR MENINGIOMA

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by ROBERT G. OJEMANN, M.D.
Congress of Neurological Surgeons Honored Guest Presentation
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.
Disclaimer: 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 consulted.
External carotid angiogram
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.

Contents


INTRAVENTRICULAR MENINGIOMAS

(Meningioma Management, File 14)

Management

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. 17.23).

Line drawing of Meningioma
FIG. 17.24. Intraventricular meningioma. The surgical approaches to consider are through the middle temporal gyrus or the posterior parietal-occipital region.
Surgery is indicated in patients with neurological symptoms. Radiation therapy has not been used.

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 include:

  1. Careful planning of the cortical incision.
  2. Internal decompression of the tumor, when necessary, to minimize brain retraction.
  3. Occlusion of the choroidal artery branches as early as possible.
TABLE 17.13 Intraventricular Meningiomas
aRemoval bOutcome Complications Recurrence
T 5 Good 3 Permanent
deficit
2 None
RST 0 Fair 1
ST 0 Poor 1
aT, total removal
RST, radical subtotal removal
ST, subtotal removal
bGood, free of major neurological deficit
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
Poor, dependent.

Results

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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