Tumors of the lateral ventricles

Resection of the tumor in the trigone of the lateral ventricle via the contralateral posterior interhemispheric transfalcine transprecuneus approach with multi-modern neurosurgery technology: a case report

Choroid plexus papilloma (CPP) is a rare benign intracranial tumor origin that predominantly manifests in the lateral ventricle in children, accounting for 0.3%-0.6% of all primary intracranial tumors. It is extremely rare to have the CPP in the trigone of the lateral ventricle through the contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA). Herein, we report this rare case. A 7-year-old girl presented with headache. Magnetic resonance imaging of the brain showed periatrial lesions, and histopathological examination confirmed CPP (WHO grade I). The contralateral PITTA is a safe, effective, reasonable, and appropriate for some lesions in the trigone of the lateral ventricle. It provides a wider surgical angle (especially for the lateral extension) and reduces the risk of disturbance of the optic radiation compared with the conventional approaches. The use of multiple modern neurosurgical techniques, including interventional embolization, intraoperative navigation, microscope, and electrophysiological monitoring, make the procedure much easier and more accurate, and the neuroendoscope adds to the visualization of the microscope and can reduce surgical complications.

Clinical outcomes after microsurgical resection of giant lateral ventricular meningiomas

Giant lateral ventricular meningiomas (LVMs), with the largest diameter of at least 5 cm, form a distinct subset. The incidence of giant LVMs is considered to be relatively low. Here, we evaluated clinical characteristics, and clinical outcomes after microsurgical resection, especially functional outcomes and morbidity of giant LVMs. We retrospectively reviewed 49 patients with LVMs, including 18 giant LVMs from 2012 to 2020. And we analyzed clinical, histopathological, surgical, and outcome data at our institution. Giant LVMs were most commonly present in the fourth decade of patients with the male-to-female ratio of 1:2. The most common subtypes were transitional and fibrous. Most lesions were resected via the temporal or parieto-occipital approach in our series. The median volume of blood loss was higher in the giant group (900 vs. 600 ml, p = 0.02). Meanwhile, the median length of hospital stay was prolonged for giant LVMs (20.5 vs. 16.0 days, p < 0.01). The proportion of discharged functional deterioration was higher in giant LVMs (38.9% vs. 6.5%, p = 0.02). However, there was no statistical significance between functional deterioration and tumor size at long-term follow-up (p = 0.28). Giant LVMs patients suffered from neurological and regional complications more commonly, particularly from a postoperative hematoma (4/18 vs. 1/31), and hydrocephalus (2/18 vs. 0/31). Patients with giant LVMs had a high incidence of immediate functional deterioration after microsurgery, and there was no difference in functional deterioration between the giant and non-giant LVMS during long-term follow-up. Microsurgery entails a higher complication rate in giant LVMs. We need to pay special attention to preventing postoperative hematoma and hydrocephalus.

Transcortical approaches to large intraventricular tumors: a prospective case series of 20 patients

Background

Large intraventricular tumors (IVTs) impose technical and surgical challenges, due to their enormous sizes, mass effect, vast extensions, and vascularity.

Objective

The authors aim at presenting their results, clinical outcomes, and the surgical strategies in the management of large IVTs through transcortical approaches.

Methods

A prospective trial was conducted at the Main Hospital of Alexandria University, Egypt, between August 2018 and October 2020 on 20 patients harboring IVTs larger than 5 cm or bilaterally represented. The variables evaluated included the extent of resection, postoperative neurological deficits, blood loss, surgical approaches, intraoperative challenges, complications, adjuvant therapies, Glasgow Outcome Scale, hydrocephalus, and cerebrospinal fluid (CSF) diversion.

Results

The study included 20 cases (9 males and 11 females). Mean age at diagnosis was 16.1 years (range 1–45). Mean follow-up was 12 months (range 9–26). Primary tumor locations were ventricular body, atrium, temporal horn, and frontal horn in 11, 5, 3, and 1 cases, respectively. Main pathologies were central neurocytomas (7 patients/35%), ependymomas (3 patients/15%), and subependymal giant cell astrocytoma (SEGA) (3 patients/15%). Excision was gross total (n = 19) and near-total (n = 1). Significant intraoperative bleeding (n = 6). Postoperative minor intraventricular hemorrhage (n = 6), subdural collections (n = 8), hydrocephalus (n = 9), memory affection (n = 4), and motor deficits (n = 4). Postoperative Glasgow Outcome Scale of 5/5 (n = 20), no mortalities were recorded. preoperative seizures (n = 7), new onset postoperative seizures (n = 2).

Conclusion

Surgical approaches to large tumors of the lateral ventricles should be tailored to the variability of tumor locations, dimensions, extensions, and the individual morbid anatomy, in addition to the surgeon’s experience and preferences. Trans-cortical approaches can provide safe surgical corridors to tackle these challenging subtypes of IVTs with good clinical outcomes, tumor resectability rates, and seizure control.

MICROSURGICAL MANAGEMENT OF A RARE INCIDENTAL INTRAVENTRICULAR MENINGIOMA: A CASE REPORT AND RELEVANT LITERATURE REVIEW

Intraventricular meningiomas are rare and make up between 0.5% and 3% of all intracranial meningiomas, representing one of the most challenging tumors in neurosurgery due to their difficult location. Being initially asymptomatic, such tumors usually attain large size before clinical presentation and diagnostic detection. Available literature concerned with their surgical management remains scarce. Herein, we present a case of microsurgical resection of incidental intraventricular meningioma in a 32-year-old female patient who was admitted to the hospital due to the sudden loss of consciousness, retrograde amnesia, and nausea following a head trauma. Routine brain magnetic resonance imaging revealed an irregular expansive formation located in the occipital horn of the right lateral ventricle showing heterogeneous contrast enhancement. The patient underwent right-side temporal osteoplastic craniotomy with total tumor microsurgical resection followed by external ventricular drainage, and recovered fully afterwards. Histopathologic analysis of tumor tissue samples confirmed the tumor as meningioma WHO grade I. Postoperative brain computed tomography confirmed complete tumor resection. In conclusion, intraventricular meningiomas are rather rare extra-axial tumors and may present with various symptoms depending on their size and difficult location. The development of most modern neuroimaging methods offers the opportunity of their precise and accurate diagnosis, better surgical planning, and favorable outcome. Microsurgical gross resection utilizing intraoperative neuromonitoring and cutting-edge neurosurgical armamentarium remains the treatment of choice for these location-challenging and surgically demanding, predominantly benign intracranial tumors.

Massive intracranial hemorrhage caused by intraventricular meningioma: case report

Background

Meningiomas are the most common benign intracranial tumors, and commonly comprise high-vascularizing but slow-growing tumors. On the other hand, meningiomas arising from the ventricular system are of rare occurrence, and spontaneous hemorrhage is an infrequent event.

Case presentation

We describe here the rare clinical manifestations of a 28-year-old female with acute intracranial hemorrhage located in the trigone of the lateral ventricle who was initially thought to have suffered an acute cerebrovascular accident, but was subsequently confirmed to have a benign intraventricular meningioma. To clarify the clinical features of such a rare course of meningioma, we also present a short literature review of acute intracranial hemorrhage caused by intraventricular meningioma.

Conclusions

Ventricular meningioma presenting with hemorrhage such as acute stroke is a rare event, but recognition of such a pathogenesis is important. Although further accumulation of clinical data is needed, we suggest that early surgery should be undertaken in patients with lateral ventricular meningioma, even if it is not so large or asymptomatic.

Differential Diagnosis of Central Neurocytoma: Two Cases

Central neurocytoma are rare primary brain tumors of the young and middle-aged adult, typically located in the lateral ventricles. Diagnosis has historically been difficult due to histomorphologic similarities to oligodendroglioma and ependymal tumors and remains a challenge even today. We present two cases of intraventricular central neurocytoma in which careful consideration of the clinical and radiological findings led to reevaluation of the preliminary histological interpretation, highlighting the importance of a meticulous differential diagnosis.

Rapidly Expanding Lateral Ventricular Meningioma Presenting with Intraventricular Hemorrhage following Remote Whole Brain Radiation and Stereotactic Radiosurgery

Intraventricular meningiomas are uncommon intracranial tumors and infrequently present with hemorrhage. With only 10 reported cases in the literature, it is exceedingly rare for meningiomas of the ventricular system to present with hemorrhage. To our knowledge, this is the first report of a patient presenting with an acute intraventricular hemorrhage in relation to a ventricular meningioma suspected to be radiation induced. In addition, we review the current literature on hemorrhagic intraventricular meningiomas and review the natural history of radiation-induced meningiomas.

Microsurgical resection of tumors of the lateral and third ventricles: operative corridors for difficult-to-reach lesions

Tumors of the lateral and third ventricles are cradled on all sides by vital vascular and eloquent neural structures. Microsurgical resection, which always requires attentive planning, plays a critical role in the contemporary management of these lesions. This article provides an overview of the open microsurgical approaches to the region highlighting key clinical perspectives.

Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes

OBJECT

Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route.

METHODS

Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed.

RESULTS

The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5.

CONCLUSIONS

Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

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

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.

[Surgical anatomy of the lateral ventricles]

The lateral ventricle is a deep-seated cavity, overlayed by a cortical mantle which contains eloquent areas, especially on the dominant hemisphere, and surrounded by the optic radiations. The surgical approach requires a thorough preoperative reflexion based on magnetic resonance imaging, in order to understand the site of origin and the vascular pedicles of the tumor. Surgical approaches to the frontal horn, temporal horn and atrium are successively described.

Intraventricular trigonal meningioma: Neuronavigation? No, thanks!

Background:

Most of the time meningiomas are benign brain tumors and surgical removal ensures cure in the vast majority of the cases. Thus, whenever possible, complete surgical resection should be the goal of the treatment.

Methods:

This is a report of our surgical technique for the operative resection of a trigonal meningioma in a resource-limited setting. The necessity of accurate and deep knowledge of the regional anatomy is outlined.

Results:

A 44-year-old male presented to our outpatient clinic complaining of cephalalgia increasing in frequency and intensity over the last month. His neurological exam was normal, yet a brain computed tomography scan revealed a lesion in the right trigone of the ventricular system. The diagnosis of possible meningioma was set. After thoroughly informing the patient, tumor resection was decided. An intraparietal sulcus approach was favored without the use of any modern technological aids such as intraoperative magnetic resonance imaging or neuronavigation. The postoperative course was uneventful and a postoperative computed tomography scan demonstrated the complete resection of the tumor. The patient was discharged two days later with no neurological deficits. In a two-year-follow-up he remains recurrence-free.

Conclusion:

In the current cost-effective era it is still possible to safely remove an intraventricular trigonal meningioma without the convenience of neuronavigation. Since the best neuronavigator is the profound neuroanatomical knowledge, no technological advancement could replace a well-educated and trained neurosurgeon.

Lateral ventricular meningioma presenting with intraventricular hemorrhage: a case report and literature review

Lateral ventricular meningiomas presenting with primary intraventricular hemorrhage are extremely uncommon. We report here a case of primary intraventricular hemorrhage attributable to a lateral ventricular meningioma. This case concerns a 46-year-old female patient who presented with sudden onset of headache. Computed tomography (CT), computed tomography angiography (CTA) and magnetic resonance imaging (MRI) examinations showed hemorrhage from a ruptured tumor mass, which was pathologically confirmed as a transitional meningioma. The patient underwent surgical treatment and had a good prognosis. A retrospective review of eight previous cases of hemorrhage from ruptured lateral ventricular meningiomas revealed that hemorrhage of lateral ventricular meningiomas and hemorrhage of meningiomas at other intracranial sites have similar causes. The clinical and pathological features of ruptured lateral ventricular meningiomas are consistent with those of unruptured lateral ventricular meningiomas. As this clinical entity is extremely rare, attention is called for while performing differential diagnosis.

Atypical choroid plexus papilloma in an adult

We present an extremely rare case of the atypical choroid plexus papilloma in an adult which developed at the trigone of right lateral ventricle. A 62-year-old woman presented with the history of intermittent and gradually progressive headache and left side hemiparesis for 6 months. The brain magnetic resonance image showed highly enhanced and well demarcated mass at the trigone of lateral ventricle attached to the choroid plexus. Gross total resection was performed by transcortical approach via the middle temporal gyrus. The tumor was diagnosed as an atypical choroid plexus papilloma. She had no neurologic deficit after the surgery. We report a case of atypical choroid plexus papilloma in adult and introduce newly classified pathologic characteristics of this tumor.

Surgical anatomy and surgical approaches to the lateral ventricles

This study focuses on the surgical approaches to intraventricular tumors which have developed within the cavity of the lateral ventricle. The first section is dedicated to embryology and describes the wrapping of the telencephalic vesicles around the thalamus and the morphogenesis of basal nuclei and commissures. In the second section, the anatomy of the lateral ventricles is described, along with their arterial and venous vasculature, their relationship with the eloquent cortical areas and cortical sulci, and their relationship with white matter fascicles, especially the optic radiations. In the third part, the main surgical approaches to the frontal horn, to the ventricular atrium and to the temporal horn are detailed.

Meningiomas of the lateral ventricles. A review of 10 cases

BACKGROUND

Intraventricular meningiomas are rare tumours that represent about 2% of all intracranial meningiomas, and represent one of the most challenging problems in neurosurgery. They are located deep within the brain and often are sizable and highly vascular. We report on a series of 10 meningiomas of the lateral ventricles treated at our institution during the last 28 years.

PATIENTS

Ten patients (6 women, 4 men; mean age 41.6 yrs) were admitted to our medical center between 1978-2005 with meningioma of the lateral ventricles. Headache was the first symptom in 8 cases and ocular signs were present in 5 patients.

RESULTS

Seven tumours were located in the right ventricle (70%) ranging in size from 2-8 cm, with 7 tumours larger than 3 cm in diameter. Nine patients underwent surgery with total excision in 8 cases and subtotal in the other; the remaining patient only received radiosurgery.

CONCLUSIONS

Total resection is the gold standard for treatment which was possible in all but one of the cases undergoing surgery.

Intraventricular meningiomas: A surgical challenge

BACKGROUND

Primary intraventricular meningiomas (IVM) pose a surgical challenge as they often remain asymptomatic until they become very large; have close proximity to vital intraventricular structures; and, their vascular supply is often encountered only after significant tumor debulking. In this study, the surgical management of IVM is discussed.

METHODS

Between 1989 and 2003, nine patients (7 with lateral and 2 with fourth ventricular) IVM, were operated upon. Raised intracranial pressure, gait ataxia, memory impairment, seizures (motor and sensory) were the main presentations. Four had hydrocephalus while five had either a sequestered temporal or occipital horn. All were large tumors with an average size more than 5.3 cm. The lateral ventricular IVM were accessed by the posterior middle temporal gyrus (n=5) or the superior parietal lobule (n=2) approach. A midline suboccipital craniectomy was used for the fourth ventricular IVM.

RESULTS

Total excision was achieved in eight and partial excision in one. Patients with lateral ventricular tumors required a postoperative intraventricular drain for a minimum period of 48 hours. The main morbidity included visual field defects and transient hemiparesis, seizure and meningitis. The one patient with partial excision died 6 weeks later due to transtentorial herniation as a result of intratumoral bleed and lateral ventricular sequestration.

CONCLUSIONS

An IVM, being initially asymptomatic, usually attains a large size before detection. During surgery, its devascularisation is usually achieved only after significant tumor debulking. Development of hydrocephalus or ventricular sequestration should be constantly monitored and may be avoided in the postoperative period by continuous external ventricular drainage.

Intraventricular meninigiomas: a report of 25 cases

In order to study the clinical characteristics of intraventricular meningiomas, we analyzed retrospectively 25 patients and reviewed the literature with regard to incidence, clinical manifestation, imaging features, preoperative diagnosis, surgical findings, and histopathological results. Intraventricular meningiomas are quite rare, but they represent an important differential diagnosis of intraventricular neoplasms. Computed tomography or magnetic resonance imaging enable a correct diagnosis of intraventricular meningiomas in most of the cases. The tumors often grow slowly to a substantial size before they become symptomatic. The operative route should be selected according to the tumor's location. Out of the 24 lateral ventricular meningiomas in our series, 20 were resected via a posterior parieto-occipital transcortical approach, two were resected via a transcallosal approach, and another two tumors, located in the frontal horn and body of the lateral ventricle, were resected via a frontal approach. A median suboccipital craniotomy was performed for the fourth ventricular meningioma. The parieto-occipital route for lateral ventricular meningiomas is a safe surgical approach, which is not necessarily associated with postoperative visual deficits. Piecemeal removal of the tumor can be safely and easily performed and special attention should be paid to the choroidal vessels intraoperatively.

Surgical approaches to tumors of the lateral ventricle

Lateral ventricular tumors are rare lesions of the central nervous system, and because most tumors are benign or low grade, permanent cure can be achieved with complete removal. After adequate preoperative imaging discloses a lateral ventricular mass, the neurosurgeon has several options to choose from when determining the ideal surgical approach to the tumor. The surgical approach cannot be standardized, because the specific location, size, and vascularization of these deep-seated tumors are fundamental elements influencing the choice of surgical approach. Although access to the lateral ventricles may require additional preoperative considerations and planning, the combination of proper knowledge of the cortical and intraventricular anatomy with the familiarity and selection of an appropriate surgical approach will optimize the surgical outcome.

Intraventricular meningiomas: a review of 16 cases with reference to the literature

BACKGROUND

Primary intraventricular meningiomas are notably rare with an incidence of 0.5 to 3% among all intracranial meningiomas. We present a series of 16 patients with histologically verified intraventricular meningiomas, the clinical and neuroradiological findings, and surgical results.

METHODS

The charts of the patients including surgical records, discharge letters, histologic records, follow up records and imaging studies were analyzed retrospectively from 1978 to 2001.

RESULTS

Collectively, 110 primary intraventricular tumors were surgically resected in our neurosurgical department from 1983 through 2001. There were 16 patients with primary intraventricular meningiomas. Thirteen (81.3%) of these tumors were located in the lateral ventricles, one (6.2%) in the third and two (12.5%) in the forth ventricle. Mean age was 47.1 years and there was no difference in incidence between the sexes. The most common presenting symptoms and signs were headache, mental change, and hemianopia. Other symptoms included gait ataxia, vertigo, hemiparesis, double vision, aphasia, and alexia/agraphia. On CT and MR studies most of the lateral ventricular meningiomas were located in the trigone (11 cases), two tumors originated at the level of foramen of Monro or in the frontal horn. The tumors were approached via a transcortical parieto-occipital (11 cases), transcallosal (3 cases), or median suboccipital (2 cases) route. Total removal was achieved in 15 out of 16 cases. There was no operative mortality. Clinical improvement was seen in symptoms like headaches, paresis, cerebellar signs and visual disturbances, whereas mental change showed less improvement.

CONCLUSIONS

Although intraventricular meningiomas are quite rare, they represent an important differential diagnosis of intraventricular neoplasms. They can reach a substantial size by the time of diagnosis, yet total removal can be achieved in most cases.

Lateral ventricular meningioma encapsulated by the dura-like membrane

The first case of a ventricular meningioma that was encapsulated by the dura-like membrane is reported. Magnetic resonance imaging (MRI) showed a heterogeneous mass with a low intensity rim in the trigone of the right lateral ventricle of a 63-year-old male. Histological examination revealed that the tumor was a transitional meningioma encapsulated by a thick dura-like membrane. Moreover, abundant clusters of the dura-like connective tissue existed in the tumor, indicating that both the dura-like capsule and the dura-like clusters in the tumor were created by the tumor cells.

Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970-1997

Between the years 1970 and 1997, 112 patients with tumors of the lateral ventricle were operated on at the University of Ankara, School of Medicine, Department of Neurosurgery. Seventy-one patients (63.4%) were male and 41 patients (36.6%) female. Headache (35.7%), nausea and vomiting (22.3%) were the most common presenting complaints. Papilloedema (42.9%), motor and sensory loss (25%) were the most common findings at neurological examination. Complete tumor removal was accomplished in 38.4% of the patients. Histopathologically, the most commonly seen types of the tumor were ependymoma (25%) and astrocytoma (21.4%). Among the various approach, the anterior transcortical (53.6%) and the posterior transcortical (16%) were the most commonly used. Eleven patients were reoperated for tumor recurrence. After surgery, radiation therapy was also performed on fourty-two patients. The morbidity and mortality rates were considerably higher before 1976 when the use of microneurosurgical techniques was introduced. After this, our morbidity and mortality rates decreased dramatically. The overall surgical mortality rate was 7.1% before 1976; during the last 10 years (n:46), it was 6.5%. In this report, our choice of operative approaches and the results will be discussed.

Choroid plexus papillomas: consideration of a surgical series of 33 cases

With the aim of understanding better the behaviour of an uncommon lesion such as the choroid plexus papilloma, we have analysed a surgical series of 33 cases operated on at the Neurosurgical Department, University of Rome "La Sapienza", between 1955 and 1992 and have reviewed the relevant literature. Our results support the view that a radical resection of these lesions, which if removed entirely, carry a very good prognosis. The hydrocephalus should be treated only if persistent. Adjuvant treatment such as radiotherapy and chemotherapy should be reserved for specific cases.

Microsurgical removal of an intraventricular meningioma with ultrasound guidance, and balloon dilation of operative corridors: case report and technical note

The case of a 26-year-old woman with an intraventricular meningioma presenting with visual symptoms is discussed. Preoperative imaging included magnetic resonance angiography, with a high correlation with conventional angiography. The patient underwent microsurgical removal of the lesion by combined transtemporal and transparietal approaches, with intraoperative ultrasound and balloon dilation of operative corridors. There was postoperative improvement of the visual fields. The operative technique will be discussed and compared with the other methods published.

Solitary metastasis to the choroid plexus of the lateral ventricle. Report of three cases and a review of the literature

Three cases of cancer metastasis to the choroid plexus of the lateral ventricle are reported. The metastases were from sigmoid colon cancer, renal cell carcinoma and pulmonary cancer, and were located in the trigone in two cases and the right inferior horn in one. Total removal was accomplished in all cases without any complications. In addition, eight reported cases of single brain metastasis to the choroid plexus of the lateral ventricle, including clinical and radiological features, are discussed. Peritumoral edema on computed tomographic (CT) scan or magnetic resonance (MR) imagining was found to be an important feature of metastasis developing at this site.

Case report: intraventricular meningioma with cerebellopontine angle and drop metastases

A 34-year-old Chinese woman underwent successful gross total excision of a benign fibroblastic meningioma, pre-operatively diagnosed by computed tomography (CT), arising from the left lateral ventricle of the brain. After a quiescent period of 5 years, CT and magnetic resonance imaging (MRI) demonstrated tumour recurrence at the same site. Despite two further excisions of progressively malignant intraventricular meningiomas and treatment with radiotherapy, the patient rapidly developed bilateral cerebellopontine angle and spinal drop metastases. CT and MRI were useful in demonstrating the location and extent of recurrent intraventricular meningiomas, as well as metastatic spread via the cerebrospinal fluid.