Fourth ventricular meningioma in an adult--case report

[Fourth ventricle meningiomas. A case report and literature review]

Intraventricular meningiomas are rare and account for approximately 0.5 to 3% of all meningiomas and 9.8 to 14% of all intraventricular tumors. Most rarely, intraventricular meningomas occur in the third and fourth ventricles. The article reviews the literature devoted to meningiomas of a rare localization, in the fourth ventricle. On the basis of published surgical procedures and neuroimaging data, we divided posterior cranial fossa meningiomas into tumors completely located in the fourth ventricle cavity and those with a partial intraventricular component, which are not associated with any structures outside the ventricle. The reason for this study was our own clinical observation.

Fourth Ventricular Meningiomas

OBJECTIVE

Fourth ventricular meningiomas (FVMs) are extremely rare. Here, we report a series of 11 patients at a single institution. A comprehensive literature analysis is conducted.

METHODS

Information about 11 patient was extracted from the patient data. Reports of cases in English were obtained from the literature. Including our 11 patients, 71 patients were analyzed in this study.

RESULTS

The most common age of onset was from the third decade to sixth decade of life. The female/male ratio was about 1.16:1. The most frequent subtype of meningioma was fibrous meningioma. FVMs had specific imaging features, such as calcification (20%), peritumoral edema (30.3%), heterogeneous enhancement (22.5%), cystic formation (4.3%), and hydrocephalus (52.8%). The proportion of total tumor resection was about 94.9%, with 15.3% of postoperative complications. During follow-up, the recurrent rate of FVMs was about 6.8%. There was no significant difference in the analysis of correlation between hydrocephalus and the maximum diameter of tumors, correlation between hydrocephalus and the volume of tumor, or correlation between peritumoral edema and the volume of tumor, as well as correlation between heterogeneous enhancement and the grade of meningiomas.

CONCLUSIONS

FVMs have their own characteristics in age of onset, gender ratio, histologic types, and imaging features. The recommended treatment is surgical treatment via the telovelar approach with suboccipital craniotomy/craniectomy. Adjuvant therapy is needed in some high-grade meningiomas and in patients undergoing partial resection. The prognosis is relatively good, with fewer postoperative complications and a higher rate of total resection.

Primary fourth ventricular meningioma: a case report of an adult male

Primary fourth ventricular meningiomas are extremely rare and often misdiagnosed as other tumors. They have no characteristic imaging appearance on computed tomography and magnetic resonance imaging. Therefore, differentiating the lesion from common lesions in the fourth ventricle can be diagnostically challenging. In this report, we present a 25-year-old man with fourth ventricular meningioma and refer to the usefulness of diffusion-weighted imaging and apparent diffusion coefficient measurements for the differential diagnosis of fourth ventricular tumors.

Fourth ventricular meningioma: a case report and literature review

A 60-year-old man was admitted with slowly progressive dizziness. Cranial nerve evaluation found no abnormalities. Magnetic resonance imaging revealed a well-circumscribed mass with homogeneous enhancement located in the fourth ventricle. The patient underwent surgery for the removal of the tumor via the bilateral suboccipital approach. Subtotal removal of the tumor was achieved in a piecemeal fashion. Histological diagnosis was meningothelial meningioma. Fourth ventricular meningiomas are extremely rare. We reviewed the literature and discussed the features of fourth ventricular meningiomas.

Meningioma in the Lateral Cerebellomedullary Cistern without Dural Attachment

A 59-year-old female presented with headache and dizziness for one year. Magnetic resonance imaging revealed a 52 x 28 mm, well-circumscribed, homogenously enhancing mass lesion without dural attachment located in the left lateral cerebellomedullary cistern. The tumor was excised, and a histological diagnosis was a mixed pattern meningioma of meningothelial and fibroblastic type. A meningioma in the posterior fossa without dural attachment is quite rare. We report a rare case of lateral cerebellomedullary cistern meningioma without dural attachment with literature review.

Intraventricular meningiomas: radiological findings and clinical features in 12 patients

PURPOSE

To characterize the computed tomography (CT) and magnetic resonance (MR) imaging findings and clinical features of intraventricular (IV) meningiomas.

MATERIALS AND METHODS

CT (n=8) and MR (n=12) images and medical records of 12 patients (five men and seven women; mean age, 36 years; range, 14-68 years) with pathologically proven IV meningiomas were retrospectively reviewed. Particular attention was put on the size and shape of the mass; internal architecture such as necrosis or calcification within the tumor; peritumoral edema; associated hydrocephalus and clinical features such as symptoms, treatment, and prognosis.

RESULTS

There were five of benign, three of atypical, and four of malignant subtype. All lesions were located in the lateral ventricle ranging in maximum diameters from 4.0 to 7.3 cm (mean, 5.4 cm). All tumors had lobulated shape. Five (71%, 5/7) of the atypical and malignant IV meningiomas, but just two (40%, 2/5) benign IV meningiomas, had irregular lobulation. The tumors were isointense (n=7) or hypointense (n=5) to gray matter on T1-weighted images, whereas isointense (n=9) or hyperintense (n=3) on T2-weighted images. On gadolinium-enhanced T1-weighted images, homogeneous enhancement was seen in five lesions, and heterogeneous enhancement was seen in seven lesions, Most patients (n=10) had associated localized hydrocephalus due to ventricular entrapment. Intratumoral necrosis was seen in two cases (17%, 2/12), all of these were malignant subtype. In two cases of atypical and malignant subtypes, recurrences were found during the follow-up period after surgical resection.

CONCLUSION

More than half (n=7, 58%) of the IV meningiomas were of atypical (n=3) or malignant (n=4) subtype. IV meningiomas tend to have a lobulated shape, especially irregular lobulation, and intratumoral necrosis was frequently seen in the atypical or malignant subtypes.

The term "lateral recess" and craniofacial pneumatization in old world monkeys (Mammalia, Primates, Cercopithecoidea)

The primate superfamily Cercopithecoidea (or Old World monkeys) is characterized by a widespread lack of the maxillary sinus, a paranasal pneumatic space found in most other eutherian mammals. Previous discussions of the distribution of pneumatization in the group, however, have been ambiguous and contradictory, and have been further complicated by discussion of a poorly defined structure named the "lateral recess," linked implicitly to the maxillary sinus. Computed tomography (CT) was applied to dry crania of all cercopithecoid genera to evaluate the morphological relevance of the term "lateral recess." Results suggest that the "lateral recess" is a structural consequence of changes in skull form unrelated to pneumatization. Thus, the term should be abandoned. All Old World monkeys (except the genus Macaca) are found to lack the maxillary sinus, but a previously undescribed bulla, only separated from the nasal cavity anteriorly, was discovered in the Chinese golden monkey Rhinopithecus. If this bulla is related to the paranasal sinuses, it suggests that the initial change in cercopithecoid cranial evolution was a suppression of pneumatic development, which may have been subsequently reversed twice in the history of the group, in Macaca and Rhinopithecus.

Usefulness of Thallium-201 Chloride Single Photon Emission Computed Tomography for the Preoperative Diagnosis of Fourth Ventricle Meningioma-Case Report-

A 51-year-old woman presented with a fourth ventricle meningioma manifesting as a 2-week history of dizziness and vomiting. Computed tomography (CT) and magnetic resonance (MR) imaging revealed a round mass lesion in the fourth ventricle. Thallium-201 chloride single photon emission computed tomography (201TlCl SPECT) showed high and rapid uptake on the early image and rapid washout on the delayed image. The preoperative diagnosis of meningioma could be established based on these findings. Total removal of the tumor was successfully performed. 201TlCl SPECT is useful for the preoperative diagnosis of fourth ventricle meningioma combined with CT, MR imaging, and angiography.