Intraventricular meningioma. A review of 10 cases of the National Hospital, Queen Square (1974-1985) with reference to the literature

Abstract

Ten patients with histologically verified intraventricular meningiomas were treated between 1974 and 1985. There were eight female and two male patients, ranging in age from 25 to 72 years with a mean age of 45.5 years. Headache and disturbed mentation were the most common presenting symptoms whereas corticospinal disturbance, altered mentation and homonymous hemianopia were the most common signs on formal neurological examination. Papilloedema was demonstrable in 50% of cases and evidence of dysphasia was apparent in 60% of patients with lesions affecting their dominant hemisphere. A single instance of drop attack occurred in a patient harbouring a third ventricular meningioma. Computed tomography, with and without contrast enhancement, and angiography were employed in all cases and proved highly sensitive and specific for tumour localisation and tissue diagnosis. In addition, angiography proved invaluable in demonstrating both vascular supply and the effects imposed upon the surrounding cerebral vasculature by tumour mass and hydrocephalus. Nine tumours occurred in the lateral ventricular trigone of which 5 were left-sided. A tenth tumour was located in the third ventricle. Twelve resections were performed in 10 patients. One patient was found to have a highly malignant cystic meningioma which recurred within 10 weeks of the original surgery and proved fatal shortly thereafter. A second patient whose initial resection was subtotal had a recurrence 3 years postoperatively which was totally resected. Lesions were approached most commonly through the posterior middle or posterior inferior temporal gyri. On 3 occasions a right posterior middle frontal gyrus approach was used and in one case a posterior parieto-occipital cortical incision was employed.(ABSTRACT TRUNCATED AT 250 WORDS)