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Sadashiva N, Goyal-Honavar A, Nadeem M, Phaneendra GS, Konar S, Prabhuraj AR, Shukla D, Rao MB, Vazhayil V, Beniwal M, Arimappamagan A. Surgical outcomes of trigonal intraventricular meningiomas: a single-centre study. Neurosurg Rev 2024; 47:304. [PMID: 38965148 DOI: 10.1007/s10143-024-02542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/12/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
Trigonal meningiomas are rare intraventricular tumours that present a surgical challenge. There is no consensus on the optimal surgical approach to these lesions, though the transtemporal and transparietal approaches are most frequently employed. We aimed to examine the approach-related morbidity and surgical nuances in treating trigonal meningiomas. This retrospective review assimilated data from 64 trigonal meningiomas operated over 15 years. Details of clinicoradiological presentation, surgical approach and intraoperative impression, pathology and incidence of various postoperative deficits were recorded. In our study, Trigonal meningiomas most frequently presented with headache and visual deterioration. The median volume of tumours was 63.6cc. Thirty-one meningiomas each (48.4%) were WHO Grade 1 and WHO Grade 2, while 2 were WHO Grade 3. The most frequent approach employed was transtemporal (38 patients, 59.4%), followed by transparietal (22 patients, 34.4%). After surgery features of raised ICP and altered mental status resolved in all patients, while contralateral limb weakness resolved in 80%, aphasia in 60%, seizures in 70%, and vision loss in 46.2%. Eighteen patients (28.13%) developed transient postoperative neurological deficits, with one patient (1.5%) developing permanent morbidity. Surgery for IVMs results in rapid improvement of neurological status, though visual outcomes are poorer in patients with low vision prior to surgery, longer duration of complaints and optic atrophy. The new postoperative deficits in some patients tend to improve on follow up. Transtemporal and transparietal approaches may be employed, based on multiple factors like tumour extension, loculation of temporal horn, size of lesion with no significant difference in their safety profile.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India.
| | - Abhijit Goyal-Honavar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Mohammed Nadeem
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Gugamsetti Sai Phaneendra
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Andiperumal Raj Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Malla Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India
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Menezes DR, de Lima L, Mansilla R, Conci A, Rueda F, Velarde LGC, Landeiro JA, Acioly MA. A prospective study on the usefulness of high-resolution intraoperative infrared thermography in intracranial tumors. Front Surg 2024; 11:1386722. [PMID: 38933651 PMCID: PMC11199714 DOI: 10.3389/fsurg.2024.1386722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/30/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Infrared thermography (IT) is a non-invasive real-time imaging technique with potential application in different areas of neurosurgery. Despite technological advances in the field, intraoperative IT (IIT) has been an underestimated tool with scarce reports on its usefulness during intracranial tumor resection. We aimed to evaluate the usefulness of high-resolution IIT with static and dynamic thermographic maps for transdural lesion localization, and diagnosis, to assess the extent of resection, and the occurrence of perioperative acute ischemia. Methods In a prospective study, 15 patients affected by intracranial tumors (six gliomas, four meningiomas, and five brain metastases) were examined with a high-resolution thermographic camera after craniotomy, after dural opening, and at the end of tumor resection. Results Tumors were transdurally located with 93.3% sensitivity and 100% specificity (p < 0.00001), as well as cortical arteries and veins. Gliomas were consistently hypothermic, while metastases and meningiomas exhibited highly variable thermographic maps on static (p = 0.055) and dynamic (p = 0.015) imaging. Residual tumors revealed non-specific static but characteristic dynamic thermographic maps. Ischemic injuries were significantly hypothermic (p < 0.001). Conclusions High-resolution IIT is a non-invasive alternative intraoperative imaging method for lesion localization, diagnosis, assessing the extent of tumor resection, and identifying acute ischemia changes with static and dynamic thermographic maps.
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Affiliation(s)
- Diego Rodrigues Menezes
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Lázaro de Lima
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Raíssa Mansilla
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Aura Conci
- Department of Computer Science, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Fernanda Rueda
- Division of Radiology, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | | | - Marcus André Acioly
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Li S, Liu M, Yang J, Yan X, Wu Y, Zhang L, Zeng M, Zhou D, Peng Y, Sessler DI. Intravenous tranexamic acid for intracerebral meningioma resections: A randomized, parallel-group, non-inferiority trial. J Clin Anesth 2024; 92:111285. [PMID: 37857168 DOI: 10.1016/j.jclinane.2023.111285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/14/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Tranexamic acid (TXA) is an antifibrinolytic that is widely used to reduce surgical bleeding. However, TXA occasionally causes seizures and the risk might be especially great after neurosurgery. We therefore tested the hypothesis that TXA does not meaningfully increase the risk of postoperative seizures within 7 days after intracranial tumor resections. DESIGN Randomized, double-blind, placebo-controlled, non-inferiority trial. SETTING Beijing Tiantan Hospital, Capital Medical University. PATIENTS 600 patients undergoing supratentorial meningioma resection were included from October 2020 to August 2022. INTERVENTIONS Patients were randomly assigned to a single dose of 20 mg/kg of TXA after induction (n = 300) or to the same volume of normal saline (n = 300). MEASUREMENT The primary outcome was postoperative seizures occurring within 7 days after surgery, analyzed in both the intention-to-treat and per-protocol populations. Non-inferiority was defined by an upper limit of the 95% confidence interval for the absolute difference being <5.5%. Secondary outcomes included incidence of non-epileptic complication within 7 days, changes in hemoglobin concentration, estimated intraoperative blood loss. Post hoc analyses included the types and timing of seizures, oozing assessment, and a sensitivity analysis for the primary outcome in patients with pathologic diagnosis of meningioma. MAIN RESULTS All 600 enrolled patients adhered to the protocol and completed the follow-up for the primary outcome. Postoperative seizures occurred in 11 of 300 (3.7%) of patients randomized to normal saline and 13 of 300 (4.3%) patients assigned to tranexamic acid (mean risk difference, 0.7%; 1-sided 97.5% CI, -∞ to 4.3%; P = 0.001 for noninferiority). No significant differences were observed in any secondary outcome. Post hoc analysis indicated similar amounts of oozing, calculated blood loss, recurrent seizures, and timing of seizures. CONCLUSION Among patients having supratentorial meningioma resection, a single intraoperative dose of TXA did not significantly reduce bleeding and was non-inferior with respect to postoperative seizures after surgery. REGISTRY INFORMATION This trial was registered at clinicaltrials.gov (NCT04595786) on October 22, 2020, by Dr.Yuming Peng.
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Affiliation(s)
- Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
| | - Minying Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Jingchao Yang
- Department of Anesthesiology, Cancer Hospital, Chinses Academy of Medical Sciences, Beijing, PR China
| | - Xiang Yan
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Yaru Wu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Liyong Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
| | - Dabiao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Outcome Research Consortium, Cleveland, OH, USA.
| | - Daniel I Sessler
- Outcome Research Consortium, Cleveland, OH, USA; Department of Outcome Research, Cleveland Clinic, Cleveland, OH, USA.
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Zheng D, Lin Z, Lin F, Ren X, Lin Y, Jiang Z. Trapped temporal horn: an underestimated complication after surgical removal of lesion within or adjacent to the lateral ventricular trigone. Neurosurg Rev 2023; 46:285. [PMID: 37882853 DOI: 10.1007/s10143-023-02195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Dao Zheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Road of the South 4th Ring, No. 119, Fengtai District, Beijing, 100160, China
| | - Zhiqin Lin
- Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fuxin Lin
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Road of the South 4th Ring, No. 119, Fengtai District, Beijing, 100160, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Road of the South 4th Ring, No. 119, Fengtai District, Beijing, 100160, China.
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Bamimore MA, Marenco-Hillembrand L, Ravindran K, Agyapong D, Greco E, Middlebrooks EH, Chaichana KL. Management of Intraventricular Meningiomas. Neurosurg Clin N Am 2023; 34:403-415. [PMID: 37210129 DOI: 10.1016/j.nec.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Intraventricular meningiomas (IVM) are intracranial tumors that originate from collections of arachnoid cells within the choroid plexus. The incidence of meningiomas is estimated to be about 97.5 per 100,000 individuals in the United States with IVMs constituting 0.7% to 3%. Positive outcomes have been observed with surgical treatment of intraventricular meningiomas. This review explores elements of surgical care and management of patients with IVM, highlighting nuances in surgical approaches, their indications, and considerations.
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Affiliation(s)
- Michael A Bamimore
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Neurological Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Lina Marenco-Hillembrand
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Krishnan Ravindran
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - David Agyapong
- School of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elena Greco
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Herlin B, Uszynski I, Chauvel M, Poupon C, Dupont S. Cross-subject variability of the optic radiation anatomy in a cohort of 1065 healthy subjects. Surg Radiol Anat 2023:10.1007/s00276-023-03161-4. [PMID: 37195302 DOI: 10.1007/s00276-023-03161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Optic radiations are tracts of particular interest for neurosurgery, especially for temporal lobe resection, because their lesion is responsible for visual field defects. However, histological and MRI studies found a high inter-subject variability of the optic radiation anatomy, especially for their most rostral extent inside the Meyer's temporal loop. We aimed to better assess inter-subject anatomical variability of the optic radiations, in order to help to reduce the risk of postoperative visual field deficiencies. METHODS Using an advanced analysis pipeline relying on a whole-brain probabilistic tractography and fiber clustering, we processed the diffusion MRI data of the 1065 subjects of the HCP cohort. After registration in a common space, a cross-subject clustering on the whole cohort was performed to reconstruct the reference optic radiation bundle, from which all optic radiations were segmented on an individual scale. RESULTS We found a median distance between the rostral tip of the temporal pole and the rostral tip of the optic radiation of 29.2 mm (standard deviation: 2.1 mm) for the right side and 28.8 mm (standard deviation: 2.3 mm) for the left side. The difference between both hemispheres was statistically significant (p = 1.10-8). CONCLUSION We demonstrated inter-individual variability of the anatomy of the optic radiations on a large-scale study, especially their rostral extension. In order to better guide neurosurgical procedures, we built a MNI-based reference atlas of the optic radiations that can be used for fast optic radiation reconstruction from any individual diffusion MRI tractography.
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Affiliation(s)
- B Herlin
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France.
- AP-HP, Epilepsy Unit, GH Pitié-Salpêtrière-Charles Foix, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- Sorbonne Université, Paris, France.
| | - I Uszynski
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France
| | - M Chauvel
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France
| | - C Poupon
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France
| | - S Dupont
- AP-HP, Epilepsy Unit, GH Pitié-Salpêtrière-Charles Foix, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Sorbonne Université, Paris, France
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Yu H, He J, Yang M. Cystic lesions in giant intraventricular meningioma: Two case reports. Medicine (Baltimore) 2023; 102:e32494. [PMID: 36827076 PMCID: PMC11309697 DOI: 10.1097/md.0000000000032494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 02/25/2023] Open
Abstract
RATIONALE Giant meningioma stemming from the intraventricular zone has been reported to be extremely few. Two cases of supersize (>8 cm) intraventricular meningiomas presenting with cystic lesions and their clinical characteristics were collected in our study. PATIENT CONCERNS One patient was a 56-year-old man who was hospitalized for blunt headache and weakness of the right lower limb along with a defect of the right visual field for 12 months. The other patient is a 22-year-old lady who presented with a slight headache accompanied by right facial numbness for 1 week. None of them had a significant past medical history. DIAGNOSES Computed tomography and magnetic resonance imaging of both patients revealed a giant heterogeneous, enhancing tumor mainly in the left trigonum with low-density or hypointense cystic lesions located within or around the tumor. The pathological and immunohistochemical staining indicated fibroblastic meningioma (case 1) and atypical meningioma (case 2) respectively, thus the patients' diagnoses were confirmed. INTERVENTIONS Total microsurgical resection, including the cystic wall, was performed via a transcortical (transtemporoparietal occipital) approach in both patients, and a ventricular drainage tube was placed for 24 to 48 hours routinely after removed the tumor. OUTCOMES Postoperatively, both patients recovered free from episodes of symptoms, and imaging examinations confirmed no evidence of regrowth of the meningioma during an average 24 months follow-up. LESSONS Cystic lesions may indicate the histopathologic malignancy of intraventricular meningioma. Transcortical approach through the posterior temporal lobe or the parieto-occipital lobe is an effective technology for giant intraventricular meningiomas.
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Affiliation(s)
- Hai Yu
- Department of Neurosurgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Junhua He
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Min Yang
- Department of Ophthalmology, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Umekawa M, Shinya Y, Hasegawa H, Katano A, Saito N. Primary Stereotactic Radiosurgery Provides Favorable Tumor Control for Intraventricular Meningioma: A Retrospective Analysis. J Clin Med 2023; 12:jcm12031068. [PMID: 36769714 PMCID: PMC9918074 DOI: 10.3390/jcm12031068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The surgical resection of intraventricular meningiomas (IVMs) remains challenging because of their anatomically deep locations and proximity to vital structures, resulting in non-negligible morbidity and mortality rates. Stereotactic radiosurgery (SRS) is a safe and effective treatment option, providing durable tumor control for benign brain tumors, but its outcomes for IVMs have rarely been reported. Therefore, the goal of the present study was to evaluate the SRS outcomes for IVMs at our institution. This retrospective observational study included 11 patients with 12 IVMs with a median follow-up period of 52 months (range, 3-353 months) treated with SRS using the Leksell Gamma Knife. Nine (75%) tumors were located in the trigone of the lateral ventricle, two (17%) in the body of the lateral ventricle, and one (8%) in the third ventricle. Tumor control was achieved in all cases, and seven (55%) decreased in size. Post-SRS perifocal edema was observed in four (37%; three asymptomatic and one symptomatic but transient) patients, all of which were resolved by the last follow-up. SRS appears to provide safe and excellent tumor control for IVMs. A longer follow-up with a larger number of cases is desired for a more solid conclusion.
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Affiliation(s)
- Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Correspondence: ; Tel.: +81-3-5800-8853
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
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Cao D, Ou Y, Chen X, Guo Z, Chen Y, Chen J. Clinical outcomes after microsurgical resection of giant lateral ventricular meningiomas. Neurosurg Rev 2023; 46:33. [PMID: 36607461 DOI: 10.1007/s10143-022-01932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Dan Cao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yibo Ou
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xu Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhengqian Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yong Chen
- Department of Neurosurgery Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jian Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Toyooka T, Takeuchi S, Otani N, Kumagai K, Tomiyama A, Wada K, Mori K. Prophylactic intraventricular piping method prevents entrapped temporal horn after removal of ventricle trigone meningioma: technical note. World Neurosurg 2022; 168:13-18. [PMID: 36115563 DOI: 10.1016/j.wneu.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Entrapped temporal horn (ETH) is one of the critical complications after tumor removal in the lateral ventricle trigone that sometimes becomes life-threatening. OBJECTIVE To develop a novel intraoperative method of prophylactic intraventricular piping (PIP) just after tumor removal to prevent ETH. METHODS Three patients with meningiomas in the lateral ventricle trigone were treated by a novel intraoperative method of PIP just after tumor removal to prevent ETH. Silicone catheters normally used as ventricular drainage catheters were cut to 5-6 cm length and inserted into the tumor cavity to ensure communication between the temporal horn and the atrium or the body of the lateral ventricle through the piping straddling the trigone. RESULTS None of our patients developed ETH during the follow-up period without complications caused by the tube placement. CONCLUSIONS PIP might be beneficial to prevent ETH because constant osmotic pressure and constant cerebrospinal fluid pulse wave transmission are maintained between each compartment of the lateral ventricle.
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Affiliation(s)
- Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan.
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Naoki Otani
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kosuke Kumagai
- Department of Neurosurgery, Social Medical Corporation Shijinkai Ken-o-Tokorozawa Hospital
| | - Arata Tomiyama
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan
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11
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Zhang C, Ge L, Li Z, Zhang T, Chen J. Single-Center Retrospective Analysis of Risk Factors for Hydrocephalus After Lateral Ventricular Tumor Resection. Front Surg 2022; 9:886472. [PMID: 35784941 PMCID: PMC9243456 DOI: 10.3389/fsurg.2022.886472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThere is no general consensus on the placement of preoperative and intraoperative external ventricular drainage (EVD) in patients with lateral ventricular tumors (LVTs). The aim of this study was to identify the predictors of postoperative acute and persistent hydrocephalus need for postoperative cerebrospinal fluid (CSF) drainage and guide the management of postoperative EVD in patients with LVTs.MethodsWe performed a single-institution, retrospective analysis of patients who underwent resection of LVTs in our Department between January 2011 and March 2021. Patients were divided between one group that required CSF drainage and another group without the need for CSF drainage. We analyzed the two groups by univariate and multivariate analyses to identify the predictors of the requirement for postoperative CSF drainage due to symptomatic intracranial hypertension caused by hydrocephalus.ResultsA total of 97 patients met the inclusion criteria, of which 31 patients received preoperative or intraoperative EVD. Ten patients without prophylactic EVD received postoperative EVD for postoperative acute hydrocephalus. Eleven patients received postoperative ventriculoperitoneal(VP) shunt subsequently. Logistic regression analysis showed that tumor invasion of the anterior ventricle (OR = 7.66), transependymal edema (OR = 8.76), and a large volume of postoperative intraventricular hemorrhage (IVH) (OR = 6.51) were independent risk factors for postoperative acute hydrocephalus. Perilesional edema (OR = 33.95) was an independent risk factor for postoperative VP shunt due to persistent hydrocephalus.ConclusionPostoperative hydrocephalus is a common complication in patients with LVTs. These findings might help to determine whether to conduct earlier interventions.
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Affiliation(s)
- Chengda Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Neurosurgery, The Affiliated Hospital of Hubei University of Medicine, The First People’s Hospital of Xiangyang, Xiangyang, China
| | - Lingli Ge
- Department of Paediatrics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, The Central Hospital of Xiangyang, Xiangyang, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Tingbao Zhang
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Tingbao Zhang
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Li S, An N, Chen N, Wang Y, Yang L, Wang Y, Yao Z, Hu B. The impact of Alzheimer's disease susceptibility loci on lateral ventricular surface morphology in older adults. Brain Struct Funct 2022; 227:913-924. [PMID: 35028746 DOI: 10.1007/s00429-021-02429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Abstract
The enlargement of ventricular volume is a general trend in the elderly, especially in patients with Alzheimer's disease (AD). Multiple susceptibility loci have been reported to have an increased risk for AD and the morphology of brain structures are affected by the variations in the risk loci. Therefore, we hypothesized that genes contributed significantly to the ventricular surface, and the changes of ventricular surface were associated with the impairment of cognitive functions. After the quality controls (QC) and genotyping, a lateral ventricular segmentation method was employed to obtain the surface features of lateral ventricle. We evaluated the influence of 18 selected AD susceptibility loci on both volume and surface morphology across 410 subjects from Alzheimer's Disease Neuroimaging Initiative (ADNI). Correlations were conducted between radial distance (RD) and Montreal Cognitive Assessment (MoCA) subscales. Only the C allele at the rs744373 loci in BIN1 gene significantly accelerated the atrophy of lateral ventricle, including the anterior horn, body, and temporal horn of left lateral ventricle. No significant effect on lateral ventricle was found at other loci. Our results revealed that most regions of the bilateral ventricular surface were significantly negatively correlated with cognitive scores, particularly in delayed recall. Besides, small areas of surface were negatively correlated with language, orientation, and visuospatial scores. Together, our results indicated that the genetic variation affected the localized areas of lateral ventricular surface, and supported that lateral ventricle was an important brain structure associated with cognition in the elderly.
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Affiliation(s)
- Shan Li
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China
| | - Na An
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China
| | - Nan Chen
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China
| | - Yin Wang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China
| | - Lin Yang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China.
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou, 730000, Gansu Province, People's Republic of China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, ShangHai, China.
- Joint Research Center for Cognitive Neurosensor Technology of Lanzhou University and Institute of Semiconductors, Chinese Academy of Sciences, LanZhou, China.
- Engineering Research Center of Open Source Software and Real-Time System, Ministry of Education, Lanzhou University, Lanzhou, China.
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Preoperative Embolization of Lateral Ventricular Tumors. World Neurosurg 2022; 161:123-124. [PMID: 35217227 DOI: 10.1016/j.wneu.2022.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cao D, Chen Y, Guo Z, Ou Y, Chen J. Clinical Outcome After Microsurgical Resection of Central Neurocytoma: A Single-Centre Analysis of 15 Years. Front Neurol 2022; 12:790641. [PMID: 35002932 PMCID: PMC8727338 DOI: 10.3389/fneur.2021.790641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: This study aimed to explore the immediate postoperative and long-term outcomes of central neurocytoma (CN) based on 15 years of experience in our institution. Methods: This single-institution study collected data of 43 patients with CN who underwent surgery between 2005 and 2020. We reviewed data of clinical, immediate postoperative outcome, and long-term outcome of patients. More specifically, we divided complications into neurological and regional complications groups. Results: Among the 43 patients with CN who underwent surgery, the transcortical (72.1%) or transcallosal (25.6%) approach was used. There were 18 patients (41.9%) who complained about postoperative neurological complications, including motor weakness (25.6%), memory deficit (18.6%), aphasia (7.0%), and seizure (4.7%). In addition, 18 patients suffered postoperative regional complications such as hydrocephalus (2.3%), hematoma (34.9%), infection (4.7%), and subcutaneous hydrops (2.3%). Only one-quarter of patients had suffered permanent surgical complications. The majority of patients recovered from the deficit and could turn back to normal life. There were no significant differences in the clinical outcomes between transcortical and transcallosal approaches. At a median follow-up of 61.8 months, the 5-year overall survival and progression-free survival were 87.0 and 74.0%, respectively. A multivariate Cox model analysis showed that the extent of resection was not related to progression-free survival. However, the extent of resection was significantly associated with overall survival, and gross total resection decreased the risk of death. Conclusions: Patients with CN show favorable outcomes after surgery. The transcortical and transcallosal approaches have similar postoperative complication rates and long-term follow-up outcomes. In terms of long-term prognosis, maximal safety resection should be the first choice of CN.
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Affiliation(s)
- Dan Cao
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Chen
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengqian Guo
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yibo Ou
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Chen
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Agarwal P, Gupta N, Srivastava A, Kumar M, Kumar S, Srivastava C. Anaplastic Intraventricular Meningioma with Rhabdoid Features: An Unusual Tumor with Usual Clinical Presentation. CLINICAL PATHOLOGY 2022; 15:2632010X221115157. [PMID: 35923857 PMCID: PMC9340328 DOI: 10.1177/2632010x221115157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 12/07/2022]
Abstract
Meningiomas are tumors arising from leptomeninges. Malignant counterpart of them is known
as anaplastic meningioma which are WHO grade III tumors. Intraventricular location of
these tumors is rare and is clinic-radiologically challenging. Histopathology and
immunohistochemistry are confirmatory. We present case of a 27-year-old girl, who
presented with usual symptoms of intraventricular mass in emergency. After shunt surgery,
clinical diagnosis of ependymoma was formed with differential of high-grade glioma. Squash
tissue was difficult to crush displaying tight clusters of spindle cells with necrosis in
background. Definitive histology revealed high grade spindle cell neoplasm disposed in
sheets with brisk and atypical mitosis. Only focal whorling pattern was seen. Large cells
with eccentric cytoplasm, reminiscent of rhabdoid cells were also seen.
Immunohistochemistry was positive for vimentin and EMA, negative for GFAP. Final diagnosis
of Anaplastic meningioma was dispatched. The histological pattern of the present case,
young age of presentation and presence of Rhabdoid cells make it unusual. Though rare but
intraventricular meningiomas must also be kept in clinical radiological differentials
apart from the usual ependymoma at this location.
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Affiliation(s)
- Preeti Agarwal
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Nancy Gupta
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Alok Srivastava
- Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Madhu Kumar
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Suarabh Kumar
- Department of Radiodiagnosis, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Chhitij Srivastava
- Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Malignant intraventricular meningioma: literature review and case report. Neurosurg Rev 2021; 45:151-166. [PMID: 34159472 DOI: 10.1007/s10143-021-01585-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/19/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
Malignant intraventricular meningiomas (IVMs) are very rare with only a few reported cases. A midline search up to December 2020 selected 40 articles for a total of 65 patients. The inclusion criteria were series and case reports in English language, as well as papers written in other languages, but with abstracts written in English. Malignant IVMs at the first diagnosis (group A, 50 patients) and those with anaplastic transformation from previous WHO grades I and II tumors (group B, 15 patients) were separately analyzed. The unique personal case among 1285 meningiomas (0.078%) is also added. Malignant IVMs mainly occur in women (61%) with a median age of 45 years and are mainly located in the lateral ventricle (93%) and trigonal region (74%), with no cases in the fourth ventricle. Irregular borders (80%), heterogeneous enhancement (83%), and perilesional edema (76%) are the most frequent radiological findings. The histology was mainly pure anaplastic (85%), whereas papillary (7%), rhabdoid (5%), and mixed forms (3%) are very rare. The CSF spread was found in 60% of the cases. The prognosis is very dismal, with an overall median survival of 17.5 months after surgery for the anaplastic forms. Malignant IVMs at initial diagnosis (group A) show better overall survival (25 months) than those occurring from anaplastic transformation of lower grade tumors (group B) (10.1 months).
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Preoperative obliteration of choroidal arteries in the treatment of large hypervascular tumors in the lateral ventricle. BMC Neurol 2021; 21:113. [PMID: 33711950 PMCID: PMC7953562 DOI: 10.1186/s12883-021-02129-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Removal of large hypervascular tumors in the lateral ventricle still poses a surgical challenge. These tumors are usually fed from choroidal arteries, and vascular control is typically performed late during the removal. We aimed to evaluate the clinical efficacy of our strategy for persistent preoperative obliteration of feeders from the choroidal arteries to manage large hypervascular tumors in the lateral ventricle. Methods We retrospectively analyzed six patients with hypervascular tumors in the lateral ventricle. We first attempted to obstruct feeders using endovascular treatment, and, if unavailable, performed initial microsurgical occlusion through the temporal horn for the staged tumor removal. Results In all patients, feeder obliteration was successfully performed; the anterior choroidal arteries were occluded by the endovascular treatment and microsurgical occlusion in one and five patients, respectively, while the lateral posterior choroidal arteries were occluded via endovascular treatment in four patients. No patients had permanent symptoms due to feeder obliteration, and tumor devascularization was achieved at the mean rate of 69.9%. During the tumor removal, the mean blood loss volume was 253 ml. No postoperative hemorrhage had occurred, and all patients scored ≤ 2 on the modified Rankin Scale at six months post-removal. Conclusions Although further studies are warranted, persistent feeder obliteration of choroidal arteries could be an effective treatment strategy against large hypervascular tumors in the lateral ventricle.
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Clinical outcome after microsurgical resection of intraventricular trigone meningiomas: a single-centre analysis of 20 years and literature overview. Acta Neurochir (Wien) 2021; 163:677-687. [PMID: 32772161 DOI: 10.1007/s00701-020-04520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Outcome and treatment-associated morbidity analysis of trigone meningioma surgery. METHODS We retrospectively assessed 27 neurosurgically treated patients (median age 63 years, range 15-84) between 1999 and 2019. The median preoperative Karnofsky Performance Scale (KPS) was 80 (range 20-100), and the majority (78%) suffered from tumour-specific symptoms. The most frequent symptoms were aphasia (n = 6), visual field deficits (n = 5), and increased intracranial pressure (n = 5). The median tumour volume was 11.2 cm3 (range 3.9-220.5). The most common approaches were the transtemporal (n = 17) and transparietal routes (n = 5). RESULTS At last follow-up (median follow-up 35 months, range 3-127), the median KPS was 90 (range 30-100); eleven (42%) patients had improved, nine (35%) were unchanged, six (23%) had worsened, and one was lost to follow-up. One year after surgery, 18/21 (86%) patients had retained an activity level similar or improved compared with preoperatively. No surgery-related mortality was recorded. Postoperative new neurological deficits were seen in 13 (48%) patients; eight suffered from permanent, most commonly motor deficits (n = 4), and five of transient deficits. Permanent new motor deficits improved in the majority of affected patients (3/4) over time. New deficits were more often seen for transtemporal (8/17) than transparietal approaches (1/5). Patients with postoperative permanent new deficits had a significantly worse KPS at last follow-up (p < 0.001). CONCLUSIONS The transtemporal and transparietal approaches provide good access, but the latter might provide for a better risk profile. Patients show favourable outcome, but there is a considerable risk for new neurological deficits. This must be taken into consideration for oligosymptomatic patients.
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Sumi K, Suma T, Yoshida R, Kajimoto R, Kobayashi M, Katsuhara T, Hirayama K, Tang X, Otani N, Yoshino A. Massive intracranial hemorrhage caused by intraventricular meningioma: case report. BMC Neurol 2021; 21:25. [PMID: 33451289 PMCID: PMC7811261 DOI: 10.1186/s12883-021-02056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Koichiro Sumi
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takeshi Suma
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Reona Yoshida
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ryuta Kajimoto
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masato Kobayashi
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takamichi Katsuhara
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koki Hirayama
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Xiaoyan Tang
- Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoki Otani
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
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Lin Z, Zhang X, Shen S, Gao Z, Guan C, Liu T, Guo D, Qi X, Ren X, Jiang Z. Postoperative delayed trapped temporal horn in patients with lateral ventricular trigone meningioma: Risk factors, surgical management, and literature review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:2324-2330. [PMID: 32371042 DOI: 10.1016/j.ejso.2020.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/15/2020] [Accepted: 04/16/2020] [Indexed: 02/09/2023]
Abstract
OBJECT To assess the risk factors for and surgical treatment of delayed trapped temporal horn (dTTH) in patients who had undergone removal of lateral ventricular trigone meningioma. METHOD Patients with lateral ventricular trigone meningioma treated at our institution from 2011 to 2015 were identified. Predictors for dTTH were determined using logistic regression. Literature review and pooled analysis were also conducted to evaluate the comparative effectiveness of surgical treatment for dTTH. RESULTS A total of 110 cases were included in the analysis. Thirteen (11.8%) cases developed dTTH following surgery. Multivariable logistic regression demonstrated an association of longer operative duration with higher incidence of dTTH (OR, 1.34; 95% CI, 1.00-1.80; p = 0.049). As surgical duration prolonged from less than 3 hours to 5 hours or more, the incidence of dTTH increased in a consistent, linear fashion from 7.7% to 13.9% (p = 0.03). Six cases (46.2%, 6/13) of dTTH underwent surgical treatment for their life-threatening symptoms. Seven studies including 13 cases of dTTH in the literature were identified. Literature data, including the current series, revealed a total of 24 procedures were performed in 19 cases. Endoscopic fenestration trended toward fewer complications than shunt (7.7% vs 25.0%, p = 0.530). There were no significant differences in failure rates between the two groups (23.1% vs 25.0%, p = 1.000). CONCLUSION Patients with prolonged operative duration may be at higher risk of dTTH. Endoscopic fenestration is considered in preference to shunt placement, since it possesses equivalent success rates with fewer complications and avoids the need for a permanent implant.
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Affiliation(s)
- Zhiqin Lin
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China
| | - Xiaohui Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shaoshan Shen
- Department of Neurosurgery, Zhangzhou Hospital, Fujian Medical University, Fujian, China
| | - Zhenwen Gao
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China
| | - Celin Guan
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China
| | - Tianqing Liu
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China
| | - Dongbin Guo
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China
| | - Xiaolong Qi
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Abstract
Intraventricular meningiomas are rare tumors that are generally located in the trigone of the lateral ventricle. This area is deep inside the cerebral hemisphere, adjacent to important eloquent cortical areas. Hence, it is difficult to achieve total tumor resection without any complications or new neurologic morbidity. To improve surgical outcome, selection of proper surgical approach is important; however, the use of modern neurosurgical techniques may be equally, if not more, consequential. Recently, radiosurgery has been gaining some attention as an alternative treatment modality. This chapter reviews some of the clinical characteristics and technical considerations for surgical modalities in treating intraventricular meningiomas. In addition, brief introduction of radiosurgery is presented.
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Affiliation(s)
- Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Won Jung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Lin M, Bakhsheshian J, Strickland B, Rennert RC, Chu RM, Chaichana KL, Zada G. Exoscopic resection of atrial intraventricular meningiomas using a navigation-assisted channel-based trans-sulcal approach: Case series and literature review. J Clin Neurosci 2020; 71:58-65. [DOI: 10.1016/j.jocn.2019.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/24/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
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Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome. J Neurooncol 2019; 145:469-477. [DOI: 10.1007/s11060-019-03312-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/05/2019] [Indexed: 12/19/2022]
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Wang DP, He W, Shen XL, Hai J. Microsurgical resection of trigone ventricular meningiomas using the parieto-occipital approach: a retrospective analysis of 47 cases and literature review. J Neurosurg Sci 2019; 65:518-523. [PMID: 31599559 DOI: 10.23736/s0390-5616.19.04759-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To investigate the risk factors of preoperative and postoperative treatment for trigone ventricular meningioma and the clinical efficacy of microsurgical resection of the neoplasm using the parieto-occipital approach. METHODS Forty-seven trigone ventricular meningiomas were resected using the parieto-occipital approach in one institute from January 2015 to January 2019. Patients were postoperative followed up for 3 months to 3 years. Karnofsky performance status (KPS) and Glasgow Coma Scale (GCS) were used to assess patient's performance status and consciousness. Clinical data including patients' characteristics, surgical procedure, and postoperative management were retrospectively analyzed. RESULTS Microsurgery achieved total removal of the tumor in 46 cases with no obvious residue (97.9%), and subtotal removal in 1 case (2.1%). No deaths occurred. Preoperative symptoms of neurology were significantly improved. There was a significant difference in preoperative KPS and postoperative KPS (P<0.05). No difference was found in GCS. Compared to patients with peritumoral brain edema (PTBE), KPS of patients without PTBE was significantly increased (P<0.05). CONCLUSIONS PTBE may be a risk factor for preoperative neurological symptoms. Furthermore, the parieto-occipital approach is a safe and effective surgical approach in resecting trigone ventricular meningioma.
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Affiliation(s)
- Da-Peng Wang
- Department of Neurosurgery, Tong Ji Hospital, Tong Ji University School of Medicine, Shanghai, China -
| | - Wei He
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao-Li Shen
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Hai
- Department of Neurosurgery, Tong Ji Hospital, Tong Ji University School of Medicine, Shanghai, China
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Liu J, Long SR, Li GY. Entrapment of the temporal horn secondary to postoperative gamma-knife radiosurgery in intraventricular meningioma: A case report. World J Clin Cases 2019; 7:2894-2898. [PMID: 31616708 PMCID: PMC6789398 DOI: 10.12998/wjcc.v7.i18.2894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Entrapment of the temporal horn (ETH) is a rare pathologic condition. It is a kind of focal hydrocephalus caused by obstruction of flow pathway of cerebrospinal fluid. It is caused by various conditions, but ETH secondary to postoperative gamma-knife radiosurgery (GKS) is extremely rare.
CASE SUMMARY A 52-year old previously healthy woman underwent resection of a large intraventricular meningioma. A small fragment of residual tumor with no obvious enlargement of the temporal horn was observed 3 mo after surgery, and she was referred for GKS. Two months after GKS, she complained of headache and progressive paralysis of the left limb. Magnetic resonance imaging revealed enlargement of the temporal horn. There was a second procedure to resect the residual tumor 8 mo after GKS. After the second procedure, she recovered smoothly. As of the date of this writing, she has remained in good condition.
CONCLUSION This case reminds us that ETH should be considered in the treatment of intraventricular meningiomas, especially before GKS.
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Affiliation(s)
- Jia Liu
- Department of Neurosurgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Sheng-Rong Long
- Department of Neurosurgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Guang-Yu Li
- Department of Neurosurgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Güngör A, Danyeli AE, Akbaş A, Ekşi MŞ, Güdük M, Özduman K, Pamir MN. Ventricular Meningiomas: Surgical Strategies and a New Finding That Suggest an Origin From the Choroid Plexus Epithelium. World Neurosurg 2019; 129:e177-e190. [DOI: 10.1016/j.wneu.2019.05.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/01/2023]
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Capilla-Guasch P, Quilis-Quesada V, Regin-Neto M, Holanda VM, González-Darder JM, de Oliveira E. White Matter Relationships Examined by Transillumination Technique Using a Lateral Transcortical Parietal Approach to the Atrium: Three-Dimensional Images and Surgical Considerations. World Neurosurg 2019; 132:e783-e794. [PMID: 31415888 DOI: 10.1016/j.wneu.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous lesions are found in the ventricular atrium (VA). Access is gained through many white matter tracts with great relevance and specific neurologic functions. It is important to understand the configuration of the most relevant structures surrounding this zone and, thus, select the safest entry zone on the lateral cerebral surface. OBJECTIVE We studied the white matter layers traversed in the lateral transcortical parietal approach through the intraparietal sulcus (IPS), adding a transillumination technique. With this knowledge, we selected the safest highway to improve this particular approach. METHODS An in-depth study of the white matter tracts was performed on 24 cerebral hemispheres (12 human whole brains). The Klingler technique and microsurgical dissection techniques were used under ×6 to ×40 magnification. The transillumination technique (torch illuminating the ventricular cavity) was used to expose the layers surrounding the VA and, thus, guide the dissection. RESULTS Taking the IPS on the cerebral surface as a reference, we identified the following white matter layers ordered from the surface to the ependyma: U fibers, superior longitudinal fascicle, arcuate fascicle, vertical occipital fascicle, sagittal stratum with the optic radiations, and tapetum fibers. The transillumination technique allowed for the easier identification of the white matter deep periventricular layers. CONCLUSIONS Knowledge of the main fascicles in the path and neighborhood of the VA allowed us to understand how certain neurologic functions can be affected by lesions at this level and to select the most appropriate way to avoid damaging relevant fascicles.
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Affiliation(s)
- Pau Capilla-Guasch
- Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain; Department of Anatomy and Human Embriology, Microneurosurgery Laboratory, University of Valencia, Valencia, Spain.
| | - Vicent Quilis-Quesada
- Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain; Department of Anatomy and Human Embriology, Microneurosurgery Laboratory, University of Valencia, Valencia, Spain; Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Mateus Regin-Neto
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Hospital Beneficieência Portuguesa, São Paulo, Brazil
| | - Vanessa M Holanda
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Hospital Beneficieência Portuguesa, São Paulo, Brazil
| | - José M González-Darder
- Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain; Department of Anatomy and Human Embriology, Microneurosurgery Laboratory, University of Valencia, Valencia, Spain
| | - Evandro de Oliveira
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Hospital Beneficieência Portuguesa, São Paulo, Brazil
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Yu Q, Lin K, Liu Y, Li X. Clinical Uses of Diffusion Tensor Imaging Fiber Tracking Merged Neuronavigation with Lesions Adjacent to Corticospinal Tract : A Retrospective Cohort Study. J Korean Neurosurg Soc 2019; 63:248-260. [PMID: 31295976 PMCID: PMC7054117 DOI: 10.3340/jkns.2019.0046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the efficiency of diffusion tensor imaging (DTI) fiber-tracking based neuronavigation and assess its usefulness in the preoperative surgical planning, prognostic prediction, intraoperative course and outcome improvement. METHODS Seventeen patients with cerebral masses adjacent to corticospinal tract (CST) were given standard magnetic resonance imaging and DTI examination. By incorporation of DTI data, the relation between tumor and adjacent white matter tracts was reconstructed and assessed in the neuronavigation system. Distance from tumor border to CST was measured. RESULTS The sub-portion of CST in closest proximity to tumor was found displaced in all patients. The chief disruptive changes were classified as follows : complete interruption, partial interruption, or simple displacement. Partial interruption was evident in seven patients (41.2%) whose lesions were close to cortex. In the other 10 patients (58.8%), delineated CSTs were intact but distorted. No complete CST interruption was identified. Overall, the mean distance from resection border to CST was 6.12 mm (range, 0-21), as opposed to 8.18 mm (range, 2-21) with simple displacement and 2.33 mm (range, 0-5) with partial interruption. The clinical outcomes were analyzed in groups stratified by intervening distances (close, <5 mm; moderated, 5-10 mm; far, >10 mm). For the primary brain tumor patients, the proportion of completely resected tumors increased progressively from close to far grouping (42.9%, 50%, and 100%, respectively). Five patients out of seven (71.4%) experienced new neurologic deficits postoperatively in the close group. At meantime, motor deterioration was found in six cases in the close group. All patients in the far and moderate groups received excellent (modified Rankin Scale [mRS] score, 0-1) or good (mRS score, 2-3) rankings, but only 57.1% of patients in the close group earned good outcome scores. CONCLUSION DTI fiber tracking based neuronavigation has merit in assessing the relation between lesions and adjacent white matter tracts, allowing prediction of patient outcomes based on lesion-CST distance. It has also proven beneficial in formulating surgical strategies.
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Affiliation(s)
- Qi Yu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.,Liaoning Clinical Medical Research Center in Nervous System Disease, Liaoning, China.,Liaoning Key Laboratory of Neuro-Oncology, Liaoning, China
| | - Kun Lin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.,Liaoning Clinical Medical Research Center in Nervous System Disease, Liaoning, China.,Liaoning Key Laboratory of Neuro-Oncology, Liaoning, China
| | - Xinxing Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.,Liaoning Clinical Medical Research Center in Nervous System Disease, Liaoning, China.,Liaoning Key Laboratory of Neuro-Oncology, Liaoning, China
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Attuati L, Zaed I, Morselli C, Pecchioli G, Fornari M, Picozzi P. Multimodal Management of Metastatic Malignant Meningiomas: The Role of Radiosurgery in Long-Term Local Control. World Neurosurg 2019; 128:562-572. [PMID: 31102770 DOI: 10.1016/j.wneu.2019.05.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Metastatic meningiomas (MMs) are rare (0.1 of 100 cases). Their treatment requires a multimodal approach, with surgery, radiotherapy, chemotherapy, and radiosurgery, which allows a long-term local control (LC) and an extension of free survival. In this study, the authors performed a review of the literature and reported 2 cases of patients affected by extracranial MMs, with long-term follow-up. CASE DESCRIPTION Case 1: A 48-year-old woman was admitted for resection of an extra-axial falx lesion (meningioma G1). After 2 years, the lesion got a local recurrence, resected with a histologic diagnosis of meningioma G3. During the next 9 years, the patient underwent 5 Gamma Knife radiosurgery (GKRS) procedures for local recurrence. At 56 years, she was readmitted for a surgical local recurrence (histologic definition: anaplastic meningioma G3). At the age of 62, the patient underwent a right lobectomy for a lung mass (histologic diagnosis: anaplastic meningioma G3). After that, multiple lesions at soma L5 and adrenal gland were discovered and then monitored. Case 2: A 48-year-old woman was operated for a lesion involving torcular herophili (meningioma G2). After 3 years, a local recurrence requires GKRS combined with tamoxifen. In the next 7 years, she underwent 5 GKRS procedures for local recurrence. The patient also underwent chemotherapy with octreotide. At the age of 61, she discovered multiple lesions in both lungs, liver, and kidney. A hepatic biopsy showed anaplastic meningioma G3. Also this patient does not suffer from any neurologic or clinical deficits. CONCLUSIONS LC in malignant meningioma is achievable through a multimodal approach; GKRS makes possible LC, but a novel aspect of these lesions is opened to discussion: the metastases. These reports show that multimodal treatment for MMs is an effective approach with good LC and improvement of overall survival. However, a long survival may allow systemic diffusion of the disease, in particular, when sagittal sinus is involved.
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Affiliation(s)
- Luca Attuati
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
| | - Carlotta Morselli
- Department of Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Guido Pecchioli
- Department of Neurosurgery, Azienda Ospedaliera Careggi, Florence, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Piero Picozzi
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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Chen C, Lv L, Hu Y, Yin S, Zhou P, Jiang S. Clinical features, surgical management, and long-term prognosis of intraventricular meningiomas: A large series of 89 patients at a single institution. Medicine (Baltimore) 2019; 98:e15334. [PMID: 31008991 PMCID: PMC6494377 DOI: 10.1097/md.0000000000015334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Intraventricular meningiomas are rather rare and only represent a small proportion of all intracranial meningiomas. Data are still limited toward this peculiar entity and surgical resection remains challenging for neurosurgeons. The purpose of present study is to demonstrate clinical features, surgical treatment, and potential risk factors determined long-term prognosis of intraventricular meningiomas.A total of 89 surgically treated and histopathologically confirmed intraventricular meningiomas were identified in our institution from 2008 to 2018. Clinical features, neuroimaging findings, surgical records, and prognosis data were extracted and reviewed retrospectively. Group comparison and recurrence-free survival analysis were performed.Female predominance was well established with a sex radio of 2.1:1. Raised intracranial pressure and decline of visual acuity were 2 chief symptoms that patients generally complained of. Preoperative magnetic resonance imaging (MRI) scans were performed in all patients and there was a trend toward lateral ventricular meningiomas were larger in size than others (P = .07). Superior parietal lobule and temporal approach were widely adopted and lateral/4th ventricular meningiomas were more easily to acquire total tumor resection as compared with 3rd ventricular meningiomas (P = .03). After an average follow-up of 57.3 months, 6 patients experienced recurrence of disease in our series. Individuals with subtotal resection (P < .001) and higher World Health Organization classification (P = .001) were more prone to relapse.Intraventricular meningiomas presented with a wide variety of symptoms. Surgery remained 1st treatment of choice and optimal surgical approach should be planned individually based on preoperative MRI evaluation. Patients underwent subtotal tumor resection and with malignant tumor nature should be carefully monitored during follow-up.
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Jiang Y, Lv L, Li J, Ma W, Chen C, Zhou P, Jiang S. Clinical features, radiological findings, and treatment outcomes of high-grade lateral ventricular meningiomas: a report of 26 cases. Neurosurg Rev 2019; 43:565-573. [PMID: 30649647 DOI: 10.1007/s10143-019-01078-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/25/2018] [Accepted: 01/08/2019] [Indexed: 02/05/2023]
Abstract
High-grade meningiomas in ventricles are rare, where most published series only include a few patients. A retrospective analysis was performed on the clinical features, radiological findings, and treatment outcomes of 26 patients with high-grade meningiomas in lateral ventricles who were surgically treated in our hospital between July 2008 and July 2016. A female predilection (female/male = 1.4:1) was observed with a mean age of 42.4 years. Headache and/or vomiting (65.3%) were the most common initial symptom, and with symptom duration time ranging between 7 days and 5 years (mean 8.5 months). The lateral ventricle trigone area was the most common site (80.7%). Twenty-two patients (84.6%) obtained gross total resection. The 2007 WHO classification was used to classify 22 (84.6%) meningiomas as grade II and the remaining four tumors were graded III. These tumors accounted for a recurrence rate of 38.5% (10 of 26 patients) and a mortality rate of 11.5% (3 deaths) during the follow-up periods. The recurrence rate after the gross total resection was 27.3% (6 of 22 patients). Radiotherapy was administered as an adjuvant treatment in 12 patients (46.2%) after surgery. There were 4 recurrences out of the 12 patients who received radiotherapy and 6 of the 14 patients relapsed without radiotherapy (p = 0.58). The subtotal resection was considered a risk factor for recurrence. The postoperative radiotherapy seemed to have little significance for the high-grade meningiomas in the lateral ventricles. Long-term follow-up is required, regardless of the resection grade, and reoperation is feasible for patients with recurrence.
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Affiliation(s)
- Yong Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Liang Lv
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Weichao Ma
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Cheng Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Moon JS, Cha SH, Cho WH. Lateral Ventricular Meningioma Presenting with Intraventricular Hemorrhage. Brain Tumor Res Treat 2019; 7:151-155. [PMID: 31686448 PMCID: PMC6829083 DOI: 10.14791/btrt.2019.7.e41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/01/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022] Open
Abstract
A 35-year-old female visited emergency department for a sudden onset of headache with vomiting after management for abortion at local department. Neurological examination revealed drowsy mentality without focal neurological deficits. CT showed 3.2×3.4 cm hyperdense intraventricular mass with intraventricular hemorrhage. The intraventricular hemorrhage was found in lateral, 3rd, and 4th ventricles. MRI showed well enhancing intraventricular mass abutting choroid plexus in the trigone of the right lateral ventricle. CT angiography showed tortuous prominent arteries from choroidal artery in tumor. Her neurological status deteriorated to stupor and contralateral hemiparesis during planned preoperative workup. Urgent transtemporal and transcortical approach with decompressive craniectomy for removal of intraventricular meningioma with hemorrhage was done. Grossly total removal of ventricular mass was achieved. Pathological finding was meningotheliomatous meningioma of World Health Organization (WHO) grade I. The patient recovered to alert mentality and no motor deficit after intensive care for increased intracranial pressure. However, visual field defect was developed due to posterior cerebral artery territory infarction. The visual deficit did not resolve during follow up period. Lateral ventricular meningioma with spontaneous intraventricular hemorrhage in pregnant woman is very uncommon. We report a surgical case of lateral ventricular meningioma with rapid neurological deterioration for intraventricular hemorrhage.
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Affiliation(s)
- Ji Soo Moon
- Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Heon Cha
- Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
| | - Won Ho Cho
- Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Chen H, Lai R, Tang X, Liu Z, Xu J. Lateral Intraventricular Anaplastic Meningioma: A Series of 5 Patients at a Single Institution and Literature Review. World Neurosurg 2018; 131:e1-e11. [PMID: 30500581 DOI: 10.1016/j.wneu.2018.11.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lateral intraventricular anaplastic meningiomas (LIAMs) are rare lesions. The aim of this study is to clarify clinical and radiologic characteristics and the optimal treatment strategies of LIAMs with long-term follow-up. METHODS From September 2008 to September 2017, 5 patients with LIAM were enrolled in our study. The clinical profiles, radiologic features, treatment strategies, and outcomes were retrospectively analyzed. RESULTS Five patients (all female; mean age, 48.8 years; range, 33-61 years) were included in this study. The most frequent symptoms were those related to increased intracranial pressure. Mean duration of symptoms was 6.7 months (range, 2 weeks-2 years). The average tumor size was 4.98 cm at the maximal diameter (range, 3.0-6.2 cm). All were confirmed with a diagnosis of anaplastic meningioma. Gross total resection was achieved in all 5 patients. All patients experienced improvement of symptoms. Recurrence and progression were identified in only 2 patients. At the last follow-up, the mean recurrence-free survival was 13 months (range, 7-21 months) and the mean overall survival was 16.25 months (range, 8-21 months). One patient was lost to follow-up. CONCLUSIONS Female and right trigone area predominance were found in our case series. Shorter duration of symptoms, irregular tumor shape, peritumoral edema, and heterogeneous enhancement may indicate an aggressive feature. Maximal safe resection followed by radiation therapy may be the best strategy for patients with LIAM. Long-term clinical follow-up and serial imaging are recommended.
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Affiliation(s)
- Hongxu Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Rui Lai
- Department of Anesthesiology, People's Hospital of Deyang City, Deyang, Sichuan, P.R. China
| | - Xinpu Tang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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Intracranial Meningiomas: A Systematic Analysis of Prognostic Factors for Recurrence in a Large Single Institution Surgical Series. World Neurosurg 2018; 123:e273-e279. [PMID: 30496926 DOI: 10.1016/j.wneu.2018.11.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Meningioma is the most common primary intracranial tumor. Surgical resection is the first choice of treatment, whereas the role of adjuvant radiotherapy (RT) is still unclear. Aim of the study was to evaluate prognostic factors influencing the local recurrence rate. METHODS Patients who had grade I-II meningiomas and underwent surgery were included in the present study. The extent of surgical resection was defined according to Simpson criteria, and were dichotomized as gross total and subtotal resection (STR). Adjuvant RT was considered in case of STR. Clinical outcome was evaluated by neurological examination and brain magnetic resonance imaging, which was performed every 6 months for the first year and yearly thereafter. RESULTS From January 2000 to December 2015, 296 patients were analyzed. Most were women (65.9%), with a Karnofsky performance status ≥80 (94.6%), grade I meningioma (79.4%), and symptoms at diagnosis (91.5%). STR was performed in 58%, followed by adjuvant RT in 10%. Improvement or stability of neurological status was obtained in 90.4% of patients. The median follow-up time was 79 months (range, 24-214 months). Local recurrence occurred in 87 (29.4%) patients, at a median time of 56 months (range, 6-214 months). No patients, who underwent surgery plus adjuvant RT, had local relapse. The median, 2-, 5-, 10-year progression-free survival were 172 months, 91.1%, 80.7%, and 67.2%, respectively. On univariate and multivariate analysis factors impacting on progression-free survival were grade, extent of surgical resection, and adjuvant RT in case of STR, regardless of meningioma grade. CONCLUSIONS Overall, our findings suggest that recurrence rates are influenced by grade, extent of surgical resection, and use of adjuvant RT in not completely resected meningioma, regardless of tumor grade.
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Krishnan SS, Nigam P, Anand VSS, Vasudevan MC. Case series of trigonal meningiomas. Neurol Neurochir Pol 2018; 52:606-611. [PMID: 30190212 DOI: 10.1016/j.pjnns.2018.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/25/2018] [Accepted: 08/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Trigonal meningiomas have unique clinical presentation, unlike those in other areas of brain. Situated deep in the brain, the surgical nuances of this tumour are distinctive. We present our experience with this tumour including a discussion of surgical corridors that may be employed. METHODS At our centre, 12 trigonal meningiomas were operated over past two decades. A retrospective analysis of case records of these cases was undertaken as regards age, sex clinical presentation, imaging and surgical approach. RESULTS Mean time from heralding symptom to presentation was 10.4 months. At presentation, the most commonly encountered symptoms were those of non-localising symptoms attributable to raised ICP. Majority of lesions were more than 6 cm and on left side and the preferred surgical approach was inferior temporo-parietal. Most symptoms were relieved on long-term follow-up except homonymous hemianopia. CONCLUSION The incidence of deficit is low on employing the "shortest route" approach, even in the dominant hemisphere and through eloquent area. This may be secondary to possible shift of eloquent area function due to longstanding lesion and may thus be a "workable" surgical option, especially in resource-limited centres where such resources as neuronavigation and tractography may be unavailable.
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Affiliation(s)
- Shyam Sundar Krishnan
- Post Graduate Institute of Neurological Surgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India.
| | - Pulak Nigam
- Post Graduate Institute of Neurological Surgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India
| | - Veeraraghavalu Sudhakar Sathish Anand
- Post Graduate Institute of Neurological Surgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India
| | - Madabushi Chakravarthy Vasudevan
- Post Graduate Institute of Neurological Surgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India
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Pereira BJA, de Almeida AN, Paiva WS, de Aguiar PHP, Teixeira MJ, Marie SKN. Natural history of intraventricular meningiomas: systematic review. Neurosurg Rev 2018; 43:513-523. [PMID: 30112665 DOI: 10.1007/s10143-018-1019-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
Abstract
Review the data published on the subject to create a more comprehensive natural history of intraventricular meningiomas (IVMs). A Medline search up to March 2018 using "intraventricular meningioma" returned 98 papers. As a first selection step, we adopted the following inclusion criteria: series and case reports about IVMs, as well as papers written in other languages, but abstracts written in English were evaluated. Six hundred eighty-one tumors were evaluated from 98 papers. The majority of the tumors were located in the lateral ventricles (602-88.4%), fourth ventricle (59-8.7%), and third ventricle (20-2.9%). These tumors accounted for a mortality rate of 4.0% (25 deaths) and a recurrence rate of 5.3% (26 recurrences). The majority of the tumors were grade I (89.8%) and consisted of the following subtypes: fibrous, 39.7% (n = 171); transitional, 22.0% (n = 95); meningothelial, 18.6% (n = 80); angiomatosus, 3.2% (n = 14); psammomatous, 2.6% (n = 11); and others, 13.9% (n = 60). Forty-five patients (7.4%) presented with grade II (GII) tumors, and 17 patients (2.8%) presented with grade III (GIII) tumors. These tumors follow the histopathological distribution of meningiomas in general, with the exception of the higher prevalence of the fibrous subtype, possibly due to its embryonic origin. Recurrence and mortality were lower than in other localizations likely due to a complete surgical resection rate than in the convexity and skull base, which suggests that GTR is the gold standard for the management of IVMs.
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Affiliation(s)
- Benedito Jamilson Araújo Pereira
- Departamento de Neurologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. .,699 Edifício Paulista Paradise Life, Rua Martiniano de Carvalho, Apto 1150, Bela Vista, Brazil.
| | - Antônio Nogueira de Almeida
- Divisão de Neurocirurgia Funcional IPQ, Hospital das Clínicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wellingson Silva Paiva
- Departamento de Neurologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Manoel Jacobsen Teixeira
- Departamento de Neurologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Frati A, Pesce A, D'Andrea G, Fraschetti F, Salvati M, Cimatti M, Esposito V, Raco A. A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies. J Clin Neurosci 2018; 50:252-261. [PMID: 29429789 DOI: 10.1016/j.jocn.2018.01.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY OBJECT The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard "anatomical" approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. MATERIALS AND METHODS 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. RESULTS The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. CONCLUSIONS A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and "tailored" cortico-leucotomy for an optimal exposure of the lesion.
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Affiliation(s)
- Alessandro Frati
- IRCCS "Neuromed" - Neurosurgery - "Sapienza" Univesity, Pozzilli (IS), Italy
| | - Alessandro Pesce
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | - Flavia Fraschetti
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy.
| | - Maurizio Salvati
- IRCCS "Neuromed" - Neurosurgery - "Sapienza" Univesity, Pozzilli (IS), Italy
| | - Marco Cimatti
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | - Vincenzo Esposito
- IRCCS "Neuromed" - Neurosurgery - "Sapienza" Univesity, Pozzilli (IS), Italy
| | - Antonino Raco
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy
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Wang C, Zhao M, Deng X, Wang J, Jiang Z, Zhao J. Clinical features and neurosurgical treatment of trigonal cavernous malformations. Neurosurg Rev 2017; 41:877-890. [PMID: 29280021 DOI: 10.1007/s10143-017-0938-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
The goals of this study were to analyze the incidence, clinical manifestations, neuroimaging findings, surgical treatments, and neurological outcomes of trigonal cavernous malformations (TCMs). Among 1395 cases of intracranial and intraspinal cavernous malformations (CMs) surgically treated between 2003 and 2016 at Beijing Tiantan Hospital, a series of 12 patients with TCM was chosen for analysis and their records were reviewed. We also performed an exhaustive literature search using PubMed to identify all previously reported cases in the literatures. TCMs accounted for 0.86% of the entire series of the central nervous system (CNS) CMs. The case series consisted of five male and seven female patients (ratio 1:1.4), with an average age at presentation of 32.9 years (7-53 years). In all the cases, headache was the most common initial symptom (66.7%). Complete resection without surgical mortality was achieved in all the cases. Postoperative complications included fever, lower limb weakness, sensory aphasia, and calculational capacity declination. Follow-up period after diagnosis was 15 to 74 months (mean 48.3 months); no patient was lost to follow-up. All the patients were considered to be in excellent clinical condition. TCMs are rare lesions; they can reach large size, and their symptoms and signs commonly resulted from mass effect. Surgical intervention is the treatment of choice for TCMs; patients can obtain favorable neurological outcomes after complete resection.
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Affiliation(s)
- Chengjun Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China. .,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
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39
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Nakashima T, Hatano N, Kanamori F, Muraoka S, Kawabata T, Takasu S, Watanabe T, Kojima T, Nagatani T, Seki Y. Tumor Volume Decrease via Feeder Occlusion for Treating a Large, Firm Trigone Meningioma. NMC Case Rep J 2017; 5:9-14. [PMID: 29354332 PMCID: PMC5767480 DOI: 10.2176/nmccrj.cr.2017-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/28/2017] [Indexed: 12/18/2022] Open
Abstract
Trigone meningiomas are considered a surgical challenge, as they tend to be considerably large and hypervascularized at the time of presentation. We experienced a case of a large and very hard trigone meningioma that was effectively treated using initial microsurgical feeder occlusion followed by surgery in stages. A 19-year-old woman who presented with loss of consciousness was referred to our hospital for surgical treatment of a brain tumor. Radiological findings were compatible with a left ventricular trigone meningioma extending laterally in proximity to the Sylvian fissure. At initial surgery using the transsylvian approach, main feeders originating from the anterior and lateral posterior choroidal arteries were occluded at the inferior horn; however, only a small section of the tumor could initially be removed because of its firmness. Over time, feeder occlusion resulted in tumor necrosis and a 20% decrease in its diameter; the mass effect was alleviated within 1 year. The residual meningioma was then totally excised in staged surgical procedures after resection became more feasible owing to ischemia-induced partial softening of the tumor. When a trigone meningioma is large and very hard, initial microsurgical feeder occlusion in the inferior horn can be a safe and effective option, and can lead to necrosis, volume decrease, and partial softening of the residual tumor to allow for its staged surgical excision.
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Affiliation(s)
- Takuma Nakashima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norikazu Hatano
- Department of Stroke Medicine, Kawashima Hospital, Nagoya, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Shinsuke Muraoka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Teppei Kawabata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Syuntaro Takasu
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tadashi Watanabe
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takao Kojima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yukio Seki
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
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40
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Lam Shin Cheung V, Kim A, Sahgal A, Das S. Meningioma recurrence rates following treatment: a systematic analysis. J Neurooncol 2017; 136:351-361. [DOI: 10.1007/s11060-017-2659-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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41
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Clinical features and long-term outcomes of pediatric intraventricular meningiomas: data from a single neurosurgical center. Neurosurg Rev 2017; 41:525-530. [DOI: 10.1007/s10143-017-0884-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/04/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
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42
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Risk factors for new-onset shunt-dependency after craniotomies for intracranial tumors in adult patients. Neurosurg Rev 2017; 41:465-472. [DOI: 10.1007/s10143-017-0869-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
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43
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Intraventricular Meningiomas: A Series of 42 Patients at a Single Institution and Literature Review. World Neurosurg 2017; 97:178-188. [DOI: 10.1016/j.wneu.2016.09.068] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 11/22/2022]
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44
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Güngör A, Baydin S, Middlebrooks EH, Tanriover N, Isler C, Rhoton AL. The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus. J Neurosurg 2016; 126:945-971. [PMID: 27257832 DOI: 10.3171/2016.1.jns152082] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The relationship of the white matter tracts to the lateral ventricles is important when planning surgical approaches to the ventricles and in understanding the symptoms of hydrocephalus. The authors' aim was to explore the relationship of the white matter tracts of the cerebrum to the lateral ventricles using fiber dissection technique and MR tractography and to discuss these findings in relation to approaches to ventricular lesions. METHODS Forty adult human formalin-fixed cadaveric hemispheres (20 brains) and 3 whole heads were examined using fiber dissection technique. The dissections were performed from lateral to medial, medial to lateral, superior to inferior, and inferior to superior. MR tractography showing the lateral ventricles aided in the understanding of the 3D relationships of the white matter tracts with the lateral ventricles. RESULTS The relationship between the lateral ventricles and the superior longitudinal I, II, and III, arcuate, vertical occipital, middle longitudinal, inferior longitudinal, inferior frontooccipital, uncinate, sledge runner, and lingular amygdaloidal fasciculi; and the anterior commissure fibers, optic radiations, internal capsule, corona radiata, thalamic radiations, cingulum, corpus callosum, fornix, caudate nucleus, thalamus, stria terminalis, and stria medullaris thalami were defined anatomically and radiologically. These fibers and structures have a consistent relationship to the lateral ventricles. CONCLUSIONS Knowledge of the relationship of the white matter tracts of the cerebrum to the lateral ventricles should aid in planning more accurate surgery for lesions within the lateral ventricles.
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Affiliation(s)
| | | | - Erik H Middlebrooks
- Radiology, and the.,K. Scott and E. R. Andrew Advanced Neuroimaging Lab, College of Medicine, University of Florida, Gainesville, Florida; and
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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45
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Wang Y, Lin Z, Li Z, Zhao M, Hu M, Zhang H, Chen X, Jiang Z. The Incidence and Risk Factors of Postoperative Entrapped Temporal Horn in Trigone Meningiomas. World Neurosurg 2016; 90:511-517. [PMID: 27012837 DOI: 10.1016/j.wneu.2016.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine risk factors for the occurrence of postoperative entrapped temporal horn (ETH), a specific form of isolated hydrocephalus that is a severe complication after resection of lateral ventricular trigone tumors, following trigone meningioma surgery. METHODS A retrospective review was performed of 121 cases of trigone meningiomas surgically treated between November 2011 and March 2015 in Beijing Tiantan Hospital. Patient demographics, imaging features, surgical procedures, and postoperative complications were evaluated by statistical analysis. RESULTS The median follow-up time was 24.1 months. Postoperative ETH developed in 23 patients (19.0%). Primary univariate analysis showed that young age, a longer clinical history, development of postoperative meningitis, and a longer duration of ventricular drainage were significantly associated with an increased risk of postoperative ETH. Subsequent multiple logistic regression analysis indicated that a clinical history of >3 months (odds ratio [OR], 4.8; P = 0.008), postoperative neurologic deficits (OR, 4.2; P = 0.014), duration of ventricular drainage >3 days (OR, 4.8; P = 0.012), and postoperative meningitis (OR, 9.9; P = 0.001) were independently associated with a risk of postoperative ETH. CONCLUSIONS Postoperative ETH frequently occurs in patients with trigone meningiomas. The severity of surgical injury of the surrounding brain tissue partly accounts for the risk of postoperative ETH. Clinical management of ventricular drainage and postoperative meningitis are of utmost importance. Ventricular drainage should be performed on an individual basis, and drainage tubes should be removed as early as possible.
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Affiliation(s)
- Yongzhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhiqin Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zongze Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengqing Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Nanda A, Bir SC, Maiti T, Konar S. Intraventricular Meningioma: Technical Nuances in Surgical Management. World Neurosurg 2015; 88:526-537. [PMID: 26548837 DOI: 10.1016/j.wneu.2015.10.071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intraventricular meningiomas (IVMs) are rare tumors compared with intracranial meningiomas. Optimal surgical management of IVMs is controversial. The objective of this article was to review the outcomes and complications of meningiomas treated with various surgical approaches. METHODS We performed a retrospective review of 18 patients with IVMs who received different treatment strategies during the period 2000-2014. Of 18 patients, 17 underwent microsurgical resection, and 1 patient received Gamma Knife radiosurgery. The literature was reviewed to compare the present cohort with previously published series. RESULTS In our series, 12 (70%) patients underwent parieto-occipital craniotomy and a superior parietal gyrus approach, which was similar to procedures used in various series (74.4%) in the existing literature. Preoperatively, patients commonly presented with headache (65%) and neurologic deficits (70%). After surgical management, there was a significant reduction in symptoms, including headache (preoperative 65% vs. postoperative 6%, P = 0.0001), and neurologic deficits (preoperative 70% vs. postoperative 5.5%). Preoperatively, 2 patients experienced visual impairment, which was completely resolved after surgery. The Karnofsky performance scale was significantly improved after resection compared with before treatment (89 vs. 76, P = 0.003). In 4 patients with World Health Organization grade II tumor, redo surgery was required because of recurrence of tumor. CONCLUSIONS Based on a literature review and our experience, surgical approaches for patients with IVM vary according to size, location, and laterality of the meningioma. In addition, the growth pattern of the tumor (transependymal extension), vascular supply of the tumor, and brain function (particularly visual function) can affect surgical treatment and should be identified preoperatively.
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Affiliation(s)
- Anil Nanda
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA.
| | - Shyamal C Bir
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Tanmoy Maiti
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Subhas Konar
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
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Sun GC, Chen XL, Yu XG, Zhang M, Liu G, Hou BK, Ma XD. Functional Neuronavigation-Guided Transparieto-Occipital Cortical Resection of Meningiomas in Trigone of Lateral Ventricle. World Neurosurg 2015; 84:756-65. [PMID: 25957723 DOI: 10.1016/j.wneu.2015.04.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/26/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study investigated whether functional neuronavigation can be used to remove lesions in the lateral ventricle while preserving patients' neurologic functionality. METHODS A total of 60 patients with lateral ventricular meningiomas were divided into study and control groups (n = 30 each). Diffusion tensor and blood oxygenation level-dependent functional magnetic resonance imaging were used for fiber tracking and eloquent cortex localization, respectively, in the study group. The surgical approach was based on coregistered data sets from 3-D lesion and brain structure reconstructions. Patients in the control group underwent anatomic neuronavigation-guided surgery. The patients' demographics, degree of resection, visual field, language score, movement, preoperative and postoperative Karnofsky Performance Status (KPS) scores, and surgical complications were recorded. RESULTS Tumors were completely removed in both groups. Patients in the study group had a higher rate of visual field preservation than controls (P = 0.01). The two groups had similar motor and language functions after surgery, except that fewer cases of transient aphasia were observed in the former (P < 0.05). KPS scores for the study and control groups were 80 (70-80) and 70 (60-70), respectively (P < 0.01), at 2 weeks and 90 (80-100) and 85 (70-90), respectively (P = 0.022), at 3 months after surgery. CONCLUSIONS Functional neuronavigation preserved neurologic functionality and was especially beneficial for protecting optical functionality and for the rapid recovery of patients.
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Affiliation(s)
- Guo-chen Sun
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xiao-lei Chen
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xin-guang Yu
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Meng Zhang
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Gang Liu
- Department of Ophthalmology, PLA General Hospital, Beijing, China
| | - Bao-ke Hou
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Xiao-dong Ma
- Department of Neurosurgery, PLA General Hospital, Beijing, China.
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Giulioni M, Martinoni M. Giant intraventricular meningioma. World Neurosurg 2014; 82:e657-8. [PMID: 25150206 DOI: 10.1016/j.wneu.2014.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/16/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Giulioni
- IRCCS Institute of Neurological Sciences, Section of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Matteo Martinoni
- IRCCS Institute of Neurological Sciences, Section of Neurosurgery, Bellaria Hospital, Bologna, Italy
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