Trigone ventricular meningiomas: surgical approaches

Abstract

Objective: Report our experience with trigone ventricular meningiomas and review the surgical approaches to the trigone. Method: From 1989 to 2006, six patients with meningiomas of the trigone of the lateral ventricles underwent microsurgical resection. Their clinical features, image, follow up, and surgical approaches were retrospectively analyzed. Results: Five patients presented with large and one with small volume meningioma. Unspecific symptoms occurred in three patients; intracranial hypertension detected in three patients; homonymous hemianopsy in three; and motor deficit present in one patient. Three patients were operated by transparietal transcortical approach, two by middle temporal gyrus approach, and one by parieto-occipital interhemispheric precuneus approach. Total resection was achieved in all patients without additional deficits. Conclusion: Judicious preoperative plan, adequate knowledge of anatomy, and use of correct microsurgical techniques are fundamental in achieving complete resection of trigone meningioma with low morbidity. Key words: meningioma, lateral ventricle, trigone, surgical approach.Meningiomas do trígono ventricular: abordagens cirúrgicas RESUMO Objetivo: Relatar a experiência com seis meningiomas do trígono ventricular e discutir as várias vias de abordagem para o trígono descritos na literatura. Método: Seis pacientes com meningiomas do trígono ventricular operados entre 1989 e 2006 foram analisados quanto às suas características clínicas, de imagem, evolução e às vias de abordagem. Resultados: Cinco pacientes apresentaram meningiomas de grande volume e um pequeno. Sintomas inespecíficos ocorreram em três pacientes, hipertensão intracraniana em outros três pacientes; hemianopsia homônima em três e déficit motor em um paciente. Três pacientes foram operados por via transcortical transparietal, dois através do giro temporal médio, e um por abordagem interhemisférica precuneus. A ressecção total foi possível em todos os pacientes, sem défices adicionais. Conclusão: Planejamento operatório cuidadoso aliado ao uso de técnicas microcirúrgicas são fundamentais na ressecção completa dos meningiomas do trígono com baixa morbidade. Palavras-chave: meningioma, ventrículo lateral, trígono, abordagem cirúrgica.

Trigone ventricular meningiomas — clinical characteristics, histopathology and results of surgical treatment

“…In our series, no significant female predominance was observed (53% vs 47%). The mean age reported in the literature varies from 35 to 47 years [9,16]; in our study, the mean age was 52 years.…”

“…On the other hand, headaches without enlargement of the ventricular system (2/7 cases in our group) suggest that, in some cases, unrelated headaches may lead to a diagnosis of an asymptomatic tumour. In the Zanini series, as many as 3/5 tumours were diagnosed incidentally or due to non-specific symptoms [16]. In another series, a large number of IVMs were also detected incidentally [17].…”

“…In addition, our experience indicates that even permanent hemianopsia can occur with this approach. On the other hand, the interparietal, intraparietal or parieto-occipital approaches appear to be the most popular to trigonal IVMs [9,12,[14][15][16]18].…”

Lateral Ventricular Meningioma Presenting with Intraventricular Hemorrhage: A Case Report and Literature Review

“…For the meningiomas of the trigone of lateral ventricle, there are several approaches used, such as superior parietal lobe approach and parieto-occipital approach 22. In our case, we chose the temporoparietal approach instead of other approaches, because as shown by the CTA image, the lesion was supplied by anterior and posterior choroidal arteries, and maximum intensity projection clearly revealed a high-density calcification shadow at the rear of the lesion.…”

Paraventricular meningioma revealed by mental disorder

“…[23] Many approaches to the trigone have been described and the challenge is to choose the best to provide wide tumor exposure and early access to the vascular pedicle to allow complete tumor resection causing less additional lesion. [28]…”