Diagnosis And Treatment Of Microneurosurgery For Intraventricular Meningiomas

Objective: To improve the diagnosis and treatment of intraventricular meningiomas, the characteristics of epidemiology, clinical manifestation, radiological features, diagnosis and differential diagnosis, surgical skills, postoperative complications, pathological features and final outcome of patients with intraventricular meningiomas are described.Method: 32 patients with intraventricular meningiomas which were hospitalization and treatment in Department of Neurosurgery, Qilu Hospital of Shandong University between July 1999 and December 2006 were analyzed retrospectively. All the patients were diagnosed by CT (computer tomography), in 13 of them MRI (magnetic resonance imaging) was performed and 1 patient was inspected by DSA (digital subtraction angiography).Results: Patients with intraventricular meningiomas is about 4.3% of all the intracranial meningiomas. Ten patients were male and 22 female. Mean age was 41.7 years (21～67) and the average duration of presenting symptoms was 18 months. Ten patients of 32 (31.25%) with lateral venticular meningiomas were male, 22 of 32 (68.75%) were female: 19 patients with lateral venticular meningiomas and 3 with meningiomas that were in the fourth ventricle. The most common complaints at presentation were headaches (68.8%). All the meningiomas underwent microsurgery, total resection was achieved in 30 cases (93.75%) and subtotal resection was performed in 2 cases (6.25%). There was no operative mortality. Postoperatively, aphasia is improved in 1 patient and hemiopia improved in 2 cases, hemiparalysis occurred in 5 cases, aphasia in 8, hemiopia in 5, and also one intracranial infection. Postoperative complications were obsolescent or improved when they were discharge. The follow-up was available in 18 patients. They were evaluated with KPS (karnofsky performance status) six months after operation. Twelve cases were above 80 scores and 6 were below. One patient was under reoperation nine months after operation for recurrence of meningioma, and the effectiveness of recovery was satisfactory.Conclusions: 1. Incidence of intraventricular meningiomas is low, which is ofen located in the trigone of lateral cerebral ventricle and preference with young and middle-aged women. 2. Intraventricular meningiomas have no characteristic clinical manifestation, which is common in intracranial hypertension and diagnosis depends on imageology. 3. Examination by MRI (magnetic resonance imaging) can offer precise three-dimensional localization and blood-supply of tumor. 4. The effectiveness of treatment with microneurosurgery for intraventricular meningiomas is satisfactory. Microsurgical techinique, proper operative approaches together with microsurgical skills are the guarantee for increasing total removal rate of tumors and decreasing mortality and disability rate.