A third ventricular meningioma in a child

Third ventricular atypical meningioma which recurred with further malignant progression

Meningiomas in the third ventricle are rare, with only very few cases reported in the literature. We report a case of primary third ventricular anaplastic meningioma in a 49-year-old man who presented with progressive weakness of the left limbs and headache. Magnetic resonance imaging revealed a tumor which seemed to arise from the right thalamus and extending into third ventricle. The tumor was heterogeneously enhanced with gadolinium. It was totally removed by right transventricular-subchoroidal approach. The lesion was intraoperatively found to be whitish hard and embedded in right thalamus, but had attachment to choroid plexus near foramen Monroi with narrow interface. The histological diagnosis was atypical meningioma, WHO Grade II. Lesion recurred 20 months later and was resected via the same approach, which turned out to be papillary meningioma, WHO Grade III. The patient had second recurrence 23 months after second surgery which was operated and the final diagnosis was anaplastic meningioma (WHO Grade III). Literature review showed meningioma of the third ventricle is quite exceptional and more than half of the cases were aggressive subtypes (Grade II or III).

Anterior third ventricle meningiomas. Report of two cases

Third ventricle meningiomas are rare, representing approximately 0.15% of all meningiomas. The majority of third ventricular meningiomas are located posteriorly in the pineal region. Less commonly, they arise in the anterior part of the third ventricle. We report the cases of two patients with large and giant meningiomas originating in the anterior part of the third ventricle.

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.

Giant meningioma of the III ventricle in a child: case report and review of the literature

We report the case of an 11-year-old girl with a giant meningioma of the III ventricle who presented with signs and symptoms of raised intracranial pressure. The tumor was removed through a transcallosal approach. A review of current literature yielded 16 previous cases of meningiomas of the III ventricle in the pediatric age group. The usual form of presentation is that of a midline syndrome with no localizing signs. In the cases that were operated on, surgical intervention was rewarding and mortality was low. A very unusual finding in the meningioma that we report was its origin in the floor of the III ventricle, a circumstance that has only once been described previously.

Meningiomas of the lateral ventricle. Report on six cases

In this study 6 patients who had meningioma of the lateral ventricle are reviewed. The incidence is 1.8% of cases of meningiomas in our series. Microsurgical techniques were employed in all patients. There was no death and the follow-up period was between 5 months and 10 years. No recurrence was seen. Although the origin of these tumors is still not known, DUNN and KERNOHAN note that the choroid plexus has the potential for the production of meningothelial, fibrous, or mixed patterns. Our pathological results confirmed this suggestion.