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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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Darshan HR, Patel BK, Singh A, Nair P, Poyuran R, Easwer HV. Simultaneous trigonal and spinal meningioma with varied histology: A rare case report. Surg Neurol Int 2021; 12:611. [PMID: 34992927 PMCID: PMC8720455 DOI: 10.25259/sni_1051_2021] [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: 10/15/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Meningioma is one of the most common neoplasms of the central nervous system. Multiple meningiomas without neurofibromatosis are not a usual occurrence. Intraventricular meningioma with spinal meningioma is rare and not been reported in the literature. Case Description: We report a case of a 63-year-old male with the left trigonal and spinal meningioma. Both the meningiomas were resected in different settings. The histological examination of tumors revealed to be of varied histology, that is, meningothelial and atypical meningioma, respectively. Conclusion: Although various cases with multiple cranial and spinal meningiomas are described, this is the first case of an intraventricular and spinal meningioma. With varied histology, the case also reaffirms the theory of polyclonal origin of multiple meningiomas.
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Affiliation(s)
- H. R. Darshan
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Biren Khimji Patel
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ajit Singh
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - H. V. Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
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Teng H, Liu Z, Yan O, He W, Jie D, Qie Y, Xu J. Lateral Ventricular Meningiomas: Clinical Features, Radiological Findings and Long-Term Outcomes. Cancer Manag Res 2021; 13:6089-6099. [PMID: 34377027 PMCID: PMC8349535 DOI: 10.2147/cmar.s320651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Lateral ventricle meningioma (LVM) is a rare type of intracranial meningioma, which has been rarely studied. It has different clinical features, imaging features, and long-term results from other locations. This study investigated the epidemiology, clinical characteristics and prognosis of LVM and comprehensively describes its characteristics. Methods This article analyzes the LVMs that were diagnosed pathologically in West China hospital between January 1, 2009 and July 1 2020. Demographic information, imaging characteristics and prognostic factors are discussed. Data analysis was performed using SPSS 23.0 and R version 3.5.3. Results We collected 7202 meningiomas and 195 LVMs (136 females; median age, 46 years; range, 5–81 years) were included in this study. Gross total resection was completed in 189 patients. The OS rate was 93.8%, and the recurrence rate was 5.2%. Multivariate regression analysis showed that sex (P = 0.01) and tumor size (P = 0.018) were related to WHO grade. Postoperative KPS (P = 0.003) was associated with OS. WHO grade (P = 0.025), extent of tumor resection (P < 0.001), and hospital day (P=0.028) were associated with recurrence. Conclusion LVMs require long-term follow-up, individualized treatment, and follow-up strategies to be formulated according to the relevant risk factors.
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Affiliation(s)
- Haibo Teng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ouying Yan
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Wenbo He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Danyang Jie
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yuanwei Qie
- Health Management Center, West-China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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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: 1] [Impact Index Per Article: 0.3] [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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Raguž M, Rotim A, Sajko T, Jurilj M, Splavski B, Rotim K. MICROSURGICAL MANAGEMENT OF A RARE INCIDENTAL INTRAVENTRICULAR MENINGIOMA: A CASE REPORT AND RELEVANT LITERATURE REVIEW. Acta Clin Croat 2021; 60:156-160. [PMID: 34588738 PMCID: PMC8305356 DOI: 10.20471/acc.2021.60.01.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
Intraventricular meningiomas are rare and make up between 0.5% and 3% of all intracranial meningiomas, representing one of the most challenging tumors in neurosurgery due to their difficult location. Being initially asymptomatic, such tumors usually attain large size before clinical presentation and diagnostic detection. Available literature concerned with their surgical management remains scarce. Herein, we present a case of microsurgical resection of incidental intraventricular meningioma in a 32-year-old female patient who was admitted to the hospital due to the sudden loss of consciousness, retrograde amnesia, and nausea following a head trauma. Routine brain magnetic resonance imaging revealed an irregular expansive formation located in the occipital horn of the right lateral ventricle showing heterogeneous contrast enhancement. The patient underwent right-side temporal osteoplastic craniotomy with total tumor microsurgical resection followed by external ventricular drainage, and recovered fully afterwards. Histopathologic analysis of tumor tissue samples confirmed the tumor as meningioma WHO grade I. Postoperative brain computed tomography confirmed complete tumor resection. In conclusion, intraventricular meningiomas are rather rare extra-axial tumors and may present with various symptoms depending on their size and difficult location. The development of most modern neuroimaging methods offers the opportunity of their precise and accurate diagnosis, better surgical planning, and favorable outcome. Microsurgical gross resection utilizing intraoperative neuromonitoring and cutting-edge neurosurgical armamentarium remains the treatment of choice for these location-challenging and surgically demanding, predominantly benign intracranial tumors.
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Affiliation(s)
| | - Ante Rotim
- 1Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Tomislav Sajko
- 1Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Mia Jurilj
- 1Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Bruno Splavski
- 1Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Krešimir Rotim
- 1Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
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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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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. Eur J Surg Oncol 2020; 46:2324-2330. [PMID: 32371042 DOI: 10.1016/j.ejso.2020.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/15/2020] [Accepted: 04/16/2020] [Indexed: 02/09/2023] Open
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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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: 1.5] [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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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: 0.8] [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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Babichev KN, Stanishevskiy AV, Svistov DV. [Fourth ventricle meningiomas. A case report and literature review]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:77-86. [PMID: 31339500 DOI: 10.17116/neiro20198303177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraventricular meningiomas are rare and account for approximately 0.5 to 3% of all meningiomas and 9.8 to 14% of all intraventricular tumors. Most rarely, intraventricular meningomas occur in the third and fourth ventricles. The article reviews the literature devoted to meningiomas of a rare localization, in the fourth ventricle. On the basis of published surgical procedures and neuroimaging data, we divided posterior cranial fossa meningiomas into tumors completely located in the fourth ventricle cavity and those with a partial intraventricular component, which are not associated with any structures outside the ventricle. The reason for this study was our own clinical observation.
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Affiliation(s)
- K N Babichev
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | | | - D V Svistov
- Kirov Military Medical Academy, Saint Petersburg, Russia
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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: 1.8] [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: 0.8] [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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Romano A, D'Andrea G, Pesce A, Olivieri G, Rossi-Espagnet MC, Picotti V, Raco A, Bozzao A. Trigonal and Peritrigonal Lesions of the Lateral Ventricle: Presurgical Tractographic Planning and Clinic Outcome Evaluation. World Neurosurg 2018; 124:S1878-8750(18)32909-7. [PMID: 30599250 DOI: 10.1016/j.wneu.2018.12.086] [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: 08/17/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and peritrigonal lesions. METHODS Diffusion tensor imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using the Karnofsky Performance Status Scale. The corticospinal tract, optic radiation, and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography. RESULTS According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) and the posterior parietal gyrus in 7 patients (37%), leading to an a priori change in the surgical approach in 14 patients (73%). Six patients (31%) showed new postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status Scale evaluation showed an improvement or a substantial stability of symptoms in 90% of cases. In 2 patients, a worsening of 30% of clinical performance was appreciable. CONCLUSIONS The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.
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Affiliation(s)
- Andrea Romano
- Department of Odontostomatological and Maxillo-Facial Sciences, Umberto I Hospital, University Sapienza, Rome, Italy; NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy.
| | - Giancarlo D'Andrea
- Department of Neurosurgery, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - Alessandro Pesce
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Giorgia Olivieri
- Department of Clinical Pathology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy; Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Veronica Picotti
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Antonino Raco
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
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15
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Li J, Deng X, Zhang S, Wang Q, Cheng J, Li X, Ke D, Hui X. Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients. Clin Neurol Neurosurg 2018; 175:74-83. [DOI: 10.1016/j.clineuro.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
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16
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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: 0.7] [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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17
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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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18
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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: 18] [Impact Index Per Article: 3.0] [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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Kim JH, Jang WY, Duy Khuong LN, Jung TY, Moon KS, Kim IY, Park WJ, Jung S. Selection of Surgical Approach for Trigonal Meningiomas in Consideration of Visual Outcome. World Neurosurg 2018; 118:e436-e442. [PMID: 29981465 DOI: 10.1016/j.wneu.2018.06.211] [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: 05/21/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We report the surgical outcome of trigonal meningiomas through 3 different approaches with attention to visual outcomes. METHODS Between 1994 and 2017, 23 patients underwent resection of trigonal meningiomas. We performed tumor removal using 3 different surgical approaches through the superior parietal lobule, middle temporal gyrus (MTG), and modified MTG. The patients were retrospectively identified, and surgical results including visual outcome were analyzed. RESULTS Twenty-three patients with a mean age of 45 years formed the study group. The most common symptom and sign were headache (N = 14, 60.9%) and visual disturbance (N = 6, 26.1%). All patients underwent surgical resection, 6 via a translateral approach through MTG, 8 via a translateral approach through modified MTG, and 9 via a transparietal approach through the superior parietal lobule (SPL). Gross total resection was achieved in all patients. We found that visual preservation rate was 25% (1/4) in the MTG group, 62.5% (5/8) in the modified MTG group, and 100% (7/7) in the SPL group, respectively (P = 0.044). Permanent complication rate was 50% (3/6) in the MTG group, 50% (n = 4/8) in the modified MTG group, and 11.1% (n = 1/9) in the SPL group. CONCLUSIONS The superior parietal lobule approach is a safe and applicable procedure with a great visual preservation and an acceptable risk of morbidity for trigonal meningiomas when there is a chance of visual recovery or preservation.
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Affiliation(s)
- Ju-Hwi Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Le Nguyen Duy Khuong
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Won-Ju Park
- Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea.
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20
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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: 1.3] [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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21
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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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22
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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: 3.7] [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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23
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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: 0.8] [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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24
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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: 2.0] [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: 1.7] [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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Bohnstedt BN, Kulwin CG, Shah MV, Cohen-Gadol AA. Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes. J Neurosurg 2015; 123:1045-54. [PMID: 25932608 DOI: 10.3171/2015.3.jns14847] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route. METHODS Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed. RESULTS The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5. CONCLUSIONS Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.
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Affiliation(s)
- Bradley N Bohnstedt
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Charles G Kulwin
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Mitesh V Shah
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
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Zhao X, Shen X, Chen X, Zhang J, Wang X, Zhang Y, Tu Y, Zheng G. Integrated functional neuronavigation-guided resection of small meningiomas of the atrium via the paramedian parieto-occipital approach. Clin Neurol Neurosurg 2014; 128:47-52. [PMID: 25462095 DOI: 10.1016/j.clineuro.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Small meningiomas located in the atrium of the lateral ventricle remain a challenge for neurosurgeons due to the eloquent nature of the surrounding anatomy. Functional MRI (fMRI) and diffusion tensor tractography (DTT) allow for in vivo demonstrations of eloquent cortical structures and neuronal fiber tracts, respectively. Our objective is to evaluate the contribution of functional neuronavigation combined with fMRI and DTT results to surgical outcomes. MATERIALS AND METHODS we investigated 11 patients with small meningiomas located in the atrium of the lateral ventricle who underwent surgery with the aid of functional neuronavigation via the paramedian parieto-occipital approach. The patients willingly underwent assessments of neurologic deficits preoperatively and postoperatively at discharge and at three months after surgery. RESULTS Gross total resection was achieved in all patients, and no residual or recurrent tumors were observed on follow-up imaging. There was no mortality. Only one patient suffered from transient postoperative aphasia (mild to moderate) that was resolved one week after surgery. No novel neurologic deficits were present in any of the other patients, and no new-onset epileptic attacks were observed. CONCLUSIONS With the aid of the neuronavigation that incorporates fMRI and DTT results, small meningiomas located in the atrium of the lateral ventricle can be safely resected through the paramedian parieto-occipital approach.
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Affiliation(s)
- Xin Zhao
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Xuefeng Shen
- Department of Occupational and Environmental Health and The Ministry of Education Key Laboratory of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi'an 710032, China
| | - Xiaolei Chen
- Department of Neurosurgery, PLA General Hospital, Beijing 100853, China
| | - Jiashu Zhang
- Department of Neurosurgery, PLA General Hospital, Beijing 100853, China
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Yuhui Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Yanyang Tu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA; Department of Experimental Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
| | - Gang Zheng
- Department of Neurosurgery, PLA General Hospital, Beijing 100853, China; Department of Neurosurgery, Wulumuqi General Hospital of PLA, Wulumuqi 830000, China.
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Ma J, Cheng L, Wang G, Lin S. Surgical management of meningioma of the trigone area of the lateral ventricle. World Neurosurg 2014; 82:757-69. [PMID: 24878623 DOI: 10.1016/j.wneu.2014.05.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 04/15/2014] [Accepted: 05/21/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Lateral ventricular trigone meningioma is relatively rare and surgical resection is the main treatment strategy. It is a challenge to achieve total resection without any complication. We analyzed a series of cases using literature review. METHODS Retrospective data was collected on patients who underwent surgical treatment for trigone meningioma at our department from 2007 to 2012. RESULTS Forty-three patients were included (12 men, 31 women). The average age was 42.8 years old. The symptoms depended on tumor size and location; 38 had prominent symptoms. The preoperative neuroimaging help assess the entity, size, location, and blood supply of the tumor. All lesions were resected using the trans-sulcal temporal or parietal approach, with intraoperative ultrasound assistance. Total resection was achieved in all patients. Thirty-six patients had a ventricular drain, which was removed 1 to 14 days later. Of the patients having prominent symptoms, 31 had relief soon after the operation, the other 7 patients improved to some extent at long-term follow-up. Two patients developed intraoperative distant epidural hematoma, which was confirmed by ultrasound, and underwent hematoma evacuation immediately. Two patients were reoperated for extensive intracranial hypertension. Three patients developed localized hydrocephalus and 2 of those underwent ventriculoperitoneal shunt several months later and 1 patient had spontaneous relief. One patient had grade II meningioma and 2 had grade III; they underwent adjuvant radiotherapy. The follow-up period ranged from 2 to 71 months, with no recurrence. CONCLUSIONS Surgical resection, using the trans-sulcal approach with intraoperative ultrasound assistance, can achieve a high rate of total resection and a low rate of complication, promising a good prognosis. The management technique and the perioperative treatment have to be individualized.
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Affiliation(s)
- Jun Ma
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| | - Guanghua Wang
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brian Tumor, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brian Tumor, Beijing, China.
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Della Puppa A, De Pellegrin S, d'Avella E, Gioffrè G, Munari M, Saladini M, Salillas E, Scienza R, Semenza C. Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor. J Neurosurg 2013; 119:1107-11. [PMID: 23930858 DOI: 10.3171/2013.6.jns122445] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The role of parietal areas in number processing is well known. The significance of intraoperative functional mapping of these areas has been only partially explored, however, and only a few discordant data are available in the surgical literature with regard to the right parietal lobe. The purpose of this study was to evaluate the clinical impact of simple calculation in cortical electrostimulation of right-handed patients affected by a right parietal brain tumor. METHODS Calculation mapping in awake surgery was performed in 3 right-handed patients affected by high-grade gliomas located in the right parietal lobe. Preoperatively, none of the patients presented with calculation deficits. In all 3 cases, after sensorimotor and language mapping, cortical and intraparietal sulcus areas involved in single-digit multiplication and addition calculations were mapped using bipolar electrostimulation. RESULTS In all patients, different sites of the right parietal cortex, mainly in the inferior lobule, were detected as being specifically related to calculation (multiplication or addition). In 2 patients the intraparietal sulcus was functionally specific for multiplication. No functional sites for language were detected. All sites functional for calculation were spared during tumor resection, which was complete in all cases without postoperative neurological deficits. CONCLUSIONS These findings provide intraoperative data in support of an anatomofunctional organization for multiplication and addition within the right parietal area. Furthermore, the study shows the potential clinical relevance of intraoperative mapping of calculation in patients undergoing surgery in the right parietal area. Further and larger studies are needed to confirm these data and assess whether mapped areas are effectively essential for function.
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Biroli A, Chiocchetta M, Gerosa M, Talacchi A. Surgical treatment of parasagittal and falcine meningiomas of the posterior third. Acta Neurochir (Wien) 2012; 154:1987-95. [PMID: 22886053 DOI: 10.1007/s00701-012-1454-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND To the authors' knowledge, meningiomas of the posterior third of the falx and the parasagittal sinus have never been specifically described to date and correlated visual outcome remains unclear. With this retrospective study we describe the clinical characteristics of these tumours, their surgical management, and the improvement in visual disturbances after surgery. METHODS Twenty-six consecutive patients (22 females, 4 males; mean age, 54 years) operated on for parasagittal (n = 22) and falcine (n = 4) meningioma between 1990 and 2010 were analysed retrospectively. Preoperative planning included magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or angiography. Sinus invasion was classified as normal, stenotic or occluded from the imaging findings and according to the Sindou classification from the intraoperative notes. RESULTS Visual disturbances and headache (in 21 and 14 cases, respectively) were the most commonly referred symptoms; visual field deficit was present in 19 patients. Simpson grade I was obtained in four patients, grade II in 15, grade III in three, and grade IV in four. The main limiting factor for total removal was sinus involvement. No perioperative deaths or relevant postoperative complications occurred. The mean follow-up was 107 months. Visual field deficit improved or resolved in almost half of the patients during the follow-up period. Three (12%) patients relapsed, two were treated with Gamma Knife surgery (stable at current writing) and the third died of disease progression. CONCLUSIONS Outcome after surgery compares favourably with other parasagittal meningioma localisations and overall morbidity is negligible. Visual function is crucial for clinical outcome. Since an improvement of the deficit might still be possible, every effort should be undertaken to preserve the visual cortex.
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Affiliation(s)
- Antonio Biroli
- Section of Neurosurgery, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
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Intraventricular meningiomas: a consecutive series of 22 patients and literature review. Neurosurg Rev 2012; 36:57-64; discussion 64. [PMID: 22847766 DOI: 10.1007/s10143-012-0410-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/14/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
Intraventricular meningiomas (IVMs) are rare tumors of which the majority is located in the lateral ventricles. Most published series on the subject includes only a few patients. We analyzed our series of IVMs with a special interest in clinical features, outcome, and complications related to surgery. Twenty-two patients underwent resection of IVMs from 1990 to 2010 at Oslo University Hospital. Surgical and medical records were retrospectively analyzed. The IVMs were located in the trigonum of the lateral ventricles (20/22), in the third ventricle (1/22), and in the fourth ventricle (1/22). The most common symptoms and signs were headache, vertigo, nausea/vomiting, mental disturbances, balance impairment, and corticospinal tract signs. Visual field deficit was present preoperatively in two patients. Tumors of the lateral ventricles were resected via a transcortical parieto-occipital approach; the tumors in the third and fourth ventricle via a frontal transcortical and suboccipital route, respectively. Complete tumor resection was achieved in all but one case. Histology was WHO grade I in 20/22 and grade II in 2/22. Surgical mortality was 0%. Most symptoms and signs resolved after surgery. The most common complication was visual field defect: four patients developed new-onset contralateral homonymous quadrant anopia and one patient developed hemianopia. Symptomatic IVMs should be resected, and most symptoms and signs resolve after surgery. The main challenge is to avoid damaging the geniculucalcarine tract when resecting IVMs in the trigonum. Preoperative diffusion tensor imaging-based tractography to map the geniculocalcarine tract could be a useful adjunct in the preoperative planning before selecting the surgical approach.
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Lefranc M, Reyns N, Blond S. [Place of stereotactic techniques in the modern management of lateral ventricle tumors. Stereotactic biopsies and radiosurgery]. Neurochirurgie 2011; 57:199-205. [PMID: 22024609 DOI: 10.1016/j.neuchi.2011.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/11/2011] [Indexed: 12/15/2022]
Abstract
The authors make an overview about the use of stereotactic techniques in the management of lateral ventricle tumors. If stereotactic techniques are not in the foreground for the management of lateral ventricle tumors, stereotactic biopsies can be very useful in case of atypical, clinical or radiological presentation of the tumors and radiosurgery can help in case of evolution or re-evolution of tumors after resection. In these cases, stereotactic procedures are very safe. Modern technical evolutions allow the optimization of the stereotactic procedure but also to mix robotic with endoscopic techniques in order to offer new surgical perspectives.
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Affiliation(s)
- M Lefranc
- Service de neurochirurgie, hôpital Nord, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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Baroncini M, Peltier J, Le Gars D, Lejeune JP. [Meningiomas of the lateral ventricle. A series of 40 cases with analysis of the literature]. Neurochirurgie 2011; 57:220-4. [PMID: 22030166 DOI: 10.1016/j.neuchi.2011.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/12/2011] [Indexed: 10/15/2022]
Abstract
This series reports 40 cases of meningiomas of the lateral ventricle treated in France between 1995 and 2010. The mean age was 52 years. The revelation was incidental in 23% of cases. 36 patients underwent surgery with uneventful postoperative course in 75% of them. Visual field deficits were the most frequent sequelae. In six cases, recurrences occurred during the follow-up period. The relevant series of the literature were discussed in order to precise the therapeutic strategies and the outcome.
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Affiliation(s)
- M Baroncini
- Pôle des neurosciences et de l'appareil locomoteur, clinique de neurochirurgie, hôpital Salengro, CHRU de Lille, rue E.-Laine, 59037 Lille cedex, France.
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Silva DOA, Matis GK, Costa LF, Kitamura MAP, Birbilis TA, Azevedo Filho HRC. Intraventricular trigonal meningioma: Neuronavigation? No, thanks! Surg Neurol Int 2011; 2:113. [PMID: 21886886 PMCID: PMC3162803 DOI: 10.4103/2152-7806.83733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 07/22/2011] [Indexed: 11/05/2022] Open
Abstract
Background: Most of the time meningiomas are benign brain tumors and surgical removal ensures cure in the vast majority of the cases. Thus, whenever possible, complete surgical resection should be the goal of the treatment. Methods: This is a report of our surgical technique for the operative resection of a trigonal meningioma in a resource-limited setting. The necessity of accurate and deep knowledge of the regional anatomy is outlined. Results: A 44-year-old male presented to our outpatient clinic complaining of cephalalgia increasing in frequency and intensity over the last month. His neurological exam was normal, yet a brain computed tomography scan revealed a lesion in the right trigone of the ventricular system. The diagnosis of possible meningioma was set. After thoroughly informing the patient, tumor resection was decided. An intraparietal sulcus approach was favored without the use of any modern technological aids such as intraoperative magnetic resonance imaging or neuronavigation. The postoperative course was uneventful and a postoperative computed tomography scan demonstrated the complete resection of the tumor. The patient was discharged two days later with no neurological deficits. In a two-year-follow-up he remains recurrence-free. Conclusion: In the current cost-effective era it is still possible to safely remove an intraventricular trigonal meningioma without the convenience of neuronavigation. Since the best neuronavigator is the profound neuroanatomical knowledge, no technological advancement could replace a well-educated and trained neurosurgeon.
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Affiliation(s)
- Danilo O A Silva
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
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Kim HD, Choi CY, Lee DJ, Lee CH. Intraventricular atypical meningiomas. J Korean Neurosurg Soc 2011; 49:292-5. [PMID: 21716627 DOI: 10.3340/jkns.2011.49.5.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 11/09/2010] [Accepted: 04/18/2011] [Indexed: 11/27/2022] Open
Abstract
A rare case of intraventricular meningioma that arose in the atrium of the left lateral ventricle was identified in a 51-year-old woman. Gross total removal was performed by transcortical approach. Histopathological findings showed meningothelial meningioma with a focal atypical area which had 8% of Ki-67 labeling index (LI). A large recurrence extending into the ipsilateral quadrigeminal cistern and opposite medial occipital lobe developed approximately 41 months after the first operation. The specimens obtained from the second resection showed atypical meningioma with 20% of Ki-67 LI but there were no anaplastic area. The patient underwent fractionated stereotactic radiotherapy. However, multiple local distant metastases were found in the occipital and cerebellar cortex suggesting cerebrospinal fluid dissemination apparently 24 months after the second operation. This report presents chronological progression of a rare intraventricular atypical meningioma with more aggressive transformation.
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Affiliation(s)
- Hyun-Doo Kim
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
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Li F, Lin J, Zhu G, Meng H, Wu N, Hu R, Feng H. Neuroimaging and functional navigation as potential tools to reduce the incidence of surgical complications of lateral ventricular meningiomas. Clin Neurol Neurosurg 2011; 113:564-9. [PMID: 21530073 DOI: 10.1016/j.clineuro.2011.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 02/07/2011] [Accepted: 03/28/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Post-operative complications are common following treatment for meningiomas in the lateral ventricles because it is unavoidable to disrupt the integrity of the brain during surgery. This study discusses our experience with strategies for reducing these complications. METHOD Twenty-seven cases of lateral ventricular meningiomas treated surgically were summarized. The surgical corridors of 11 patients were selected according to the traditional anatomical markers. Navigation technologies including neuronavigation, ultrasonography, neuro-endoscopy, fMRI and intraoperative brain mapping were used in the other 16 patients. The post-operative Karnofsky Performance Status (KPS) of patients with or without navigation were compared at 1 week and 3, 6 and 12 months. RESULTS Except for one patient who died from postoperative intracerebral hemorrhage, most of the preoperative disorders improved after surgery. Although only 4 out of 27 cases suffered from permanent complications of visual field defect or epilepsy, novel postoperative complications were found in 8 of 11 patients without navigation but in only 5 of 16 patients with navigation. The post-operative KPS of patients with navigation were better than those without navigation at 1 week and 3 months after surgery. CONCLUSION The use of neuroimaging and functional navigation technologies may effectively lower the incidence of postoperative complications.
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Affiliation(s)
- Fei Li
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, The People's Republic of China
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