An unusual growth of an intraventricular meningioma: a case report

Intraventricular meningiomas are rare often histologically benign tumors arising most always from the trigonal region of the lateral ventricle. We report the first described case of a rapidly growing histologically benign intraventricular meningioma in a 68-year-old woman whose magnetic resonance imaging (MRI) executed 1 year before surgical operation was negative for intracranial mass lesion.     

Parasellar Solitary Fibrous Tumor of Meninges: Magnetic Resonance Imaging Features With Pathologic Correlation

Solitary fibrous tumor (SFT) is a benign mensenchymal neoplasm of spindle-cell origin. The authors report the case of a 50-year-old man with SFT arising from the meninges of the left parasellar region with cavernous sinus involvement. The tumor was demonstrated isointense on T1-weighted and heterogeneously hypointense on T2-weighted magnetic resonance imaging (MRI) with strong contrast enhancement. The preoperative MRI diagnosis was meningioma or hemangiopericytoma. Pathological study revealed an SFT that stained positive immunohistochemically for CD34 and vimentin.     

Intracranial Rosai–Dorfman disease in a child mimicking bilateral giant petroclival meningiomas: a case report and review of literature

Objectives and importance Rosai–Dorfman disease (RDD) is a rare but distinctive entity of unknown etiology; isolated intracranial RDD is uncommon. Of 37 reported intracranial RDD cases, only three were reported in children.Clinical presentation We report an unusual case of a 15-year-old boy presenting with 4 months history of raised intracranial pressure with visual deterioration. Computed tomography and magnetic resonance imaging revealed bilateral petroclival enhancing lesions with cavernous sinus extension mimicking meningioma. However, histological examination was diagnostic of RDD.Intervention The patient underwent extended right-sided middle fossa approach and near-total tumor removal from petroclival region and cavernous sinus on both sides in two stages 6 weeks apart.Conclusion Ours is the first case of pediatric isolated intracranial RDD presenting with giant bilateral petroclival masses successfully managed with bilateral extended middle fossa approach in two stages. An optimal treatment for RDD is not established, but complete surgical resection alone seems effective.     

Intraventricular metaplastic meningioma in a child: case report and review of the literature

Childhood meningiomas are rare and display important differences from adult forms. We report the first case of an intraventricular metaplastic meningioma arising in a child. A 7‐year‐old female underwent resection of an enhancing tumor arising within the left lateral ventricle. It was composed of monomorphic cells embedded within an abundant myxoid stroma. The cells demonstrated epithelial membrane antigen and vimentin immunoreactivity. Ultrastructural analysis demonstrated intermediate filaments, complex intercellular interdigitations and desmosomes, and a diagnosis of myxoid (metaplastic) meningioma was rendered. This case reflects the higher incidence of intraventricular meningiomas in childhood and greater incidence of intraventricular meningiomas in the left lateral ventricle. Recognition of the grade I myxoid meningioma in this case is paramount since chordoid meningiomas, which share similar histologic features, are of a higher grade and worse prognosis.     

Kawase入路手术切除岩斜区脑膜瘤的疗效分析

目的 探讨Kawase入路手术切除岩斜区脑膜瘤的疗效。方法 回顾性分析2012年4月至2019年12月经Kawase入路手术治疗的57例岩斜区脑膜瘤的临床资料。结果 根据Kawase分型标准:上斜坡型15例,海绵窦型10例,小脑幕型23例,岩尖型9例。Simpson分级Ⅰ~Ⅱ级切除42例,Ⅲ~Ⅳ级15例。术后新发颅神经损伤6例,颅内感染2例,迟发性颅内血肿1例,脑脊液漏2例。57例中位随访时间为28个月;末次随访,症状明显改善19例（33.3%）,改善32例（56.1%）,无改善或恶化2例（3.5%）。Simpson分级Ⅰ~Ⅱ级42例中位随访时间为26个月,肿瘤复发2例（3.5%）;Ⅲ~Ⅳ级15例中位随访时间为31个月,8例（53.3%）复发,1例术后17个月死亡。结论 岩斜区脑膜瘤解剖结构复杂,手术难度大,采用Kawase入路,根据Kawase分型标准,应用不同的手术策略,可取得良好的疗效。     

Cystic optic nerve sheath meningioma.

A 58-year-old woman with a 35-year history of left proptosis underwent neuroimaging that revealed a large cystic lesion. Surgery revealed an optic nerve sheath meningioma associated with cyst formation. The cyst was part of the tumor, a phenomenon that is well described in intracranial meningiomas but not in optic nerve sheath meningiomas.     

Meningiomas of the cavernous sinus: the surgical resectability and complications

The optimal management for patients with cavernous sinus meningiomas is to evacuate tumor without causing mortality or morbidity. The records of 16 patients, including 11 women and 5 men ranging in age from 31 to 63 years, underwent surgical treatment for this condition were reviewed. Completeness of tumor resection, cranial nerve morbidity, complications, mortality, the internal carotid artery encasement and outcome were studied. Total removal was achieved in six patients. Of ten patients who underwent subtotal resection there was one death and four were sent to radiotherapy. Morbidity was 24% for cranial nerves controlling extraocular motor function; trigeminal nerve function did not improve after surgical treatment. Symptomatic recurrence occurred in two patients who underwent subtotal tumor resection and in one who underwent complete tumor resection. The average follow-up period was of 26 months. According to our findings, we conclude: 1) the resectability of meningiomas of cavernous sinus depends on the degree of internal carotid artery involvement; 2) total resection of meningiomas confined in cavernous sinus is rare; 3) morbidity of the cranial nerves is significant; 4) subtotal resection is an effective mean to obtain control of the disease.     

侵及颅内主要静脉系统脑膜瘤的手术治疗

目的提高侵及颅内主要静脉系统脑膜瘤手术的全切率,总结利用显微外科技术切除肿瘤和处理颅内静脉系统的经验和技巧。方法我院1991年7月至2001年7月,手术治疗300例侵及颅内主要静脉系统的脑膜瘤,包括(1)矢状窦旁脑膜瘤;(2)大脑镰旁脑膜瘤;(3)小脑幕脑膜瘤;(4)横窦和窦汇区脑膜瘤;(5)镰幕脑膜瘤;(6)海绵窦脑膜瘤;(7)乙状窦脑膜瘤;(8)颈静脉孔区脑膜瘤。视肿瘤部位采用相应的手术入路,根据静脉系统受侵及的程度做不同的处理。结果按脑膜瘤切除的Simpson's分级,其中Ⅰ、Ⅱ级为全切除,全切率为86.7%,死亡率为1.7%。结论当脑膜瘤侵及不同的硬脑膜静脉窦或重要的颅内静脉时,手术处理方法不同。采用显微神经外科技术可提高脑膜瘤的全切率,并降低死亡率。     

Sphenoid and optic nerve sheath meningioma revealed by recurrent brain infarctions

Meningioma, though benign, may invade adjacent structures such as bone, soft tissues, dural sinuses and arteries. However brain infarctions secondary to meningioma involving the cavernous sinus and encasing and narrowing the intracranial carotid artery are rare. We report the case of a young man with recurrent left carotid artery infarctions due to a left sphenoid meningioma infiltrating the posterior optic nerve sheath through the optic canal and circumscribing the intracranial carotid artery. The patient had a gradually progressive occlusion of the middle cerebral artery, the distal internal carotid artery and finally the anterior cerebral artery ipsilateral to the sphenoid meningioma.     

上矢状窦中后部脑膜瘤导致静脉窦闭塞后静脉代偿特点及意义

目的 探讨中、后部矢状窦旁脑膜瘤导致静脉窦闭塞后静脉代偿特点以及全切除肿瘤的手术要点。方法 分析15例中、后部上矢状窦完全闭塞的窦旁脑膜瘤的脑血管造影表现，探讨其静脉回流代偿的形式对手术疗效的影响。结果 静脉回流代偿的形式有三种：(1)皮层浅静脉端-端吻合，主要流向侧裂、Labbe静脉；(2)脑膜静脉流向蝶顶窦、海绵窦；(3)板障静脉流向头皮。本组肿瘤全切除12例，无手术死亡，术后发生三肢瘫1例，双下肢瘫1例，高颅压、失明1例。结论 术前仔细研究血管造影上静脉回流代偿的形式，有助于术中加强对其保护，减少全切除肿瘤手术后的严重并发症的发生。     

Bilateral sphenoorbital hyperostotic meningiomas with proptosis and visual impairment: a therapeutic challenge. Report of three patients and review of the literature

Objective

Bilateral hyperostotic sphenoorbital meningiomas are extremely uncommon. Due to extensive infiltration of the orbits and the frontotemporal skull base, often only a subtotal tumor resection is feasible. Thus far, no treatment algorithms have been suggested for this rare tumor entity. We report on the surgical management of 3 patients.

Methods

All 3 patients underwent a pterional approach for surgical resection. Surgery was performed in two stages, primarily treating the most affected side. Treatment consisted of microsurgical resection of the infiltrated sphenoid wing and orbital walls, intraorbital tumor removal and optic nerve decompression. Orbital wall reconstruction was performed using titanium mesh allografts. Radiation therapy was administered in 1 patient with residual tumor infiltration of the cavernous sinus.

Results

Our series includes 2 women (51 and 68 years old) suffering from simultaneous progressive bilateral loss of vision and proptosis and 1 woman (69 years old) who developed contralateral disease after surgical resection of a hyperostotic sphenoorbital meningioma 16 years earlier. After optic nerve decompression, vision improved in 2 cases after surgery. Initial visual deterioration was observed in 1 case but improved on longterm follow-up. The degree of proptosis was reduced in all treated eyes.

Conclusion

In bilateral hyperostotic sphenoorbital meningiomas we propose staged surgery when clinical and radiological progression is observed. Subtotal tumor resection with the aim of optic nerve decompression and subsequent orbital reconstruction provides satisfactory results. The most affected eye should be treated first. In case of additional cavernous sinus infiltration, focal radiation therapy can be considered.     

显微镜下锁孔手术治疗56例颅内小脑膜瘤的疗效分析

目的探讨小脑膜瘤的治疗策略。方法回顾性分析2012年1月至2014年12月采用显微镜下经锁孔手术治疗的56例小脑膜瘤(直径1~3 cm)患者的临床资料并随访观察疗效。结果 56例患者中,男性15例、女性41例,年龄平均(52±10)岁。肿瘤位于大脑半球凸面35例,矢状窦旁4例,大脑镰旁1例,小脑半球凸面2例,前颅底3例,鞍区6例,中颅底2例,桥小脑角3例。所有肿瘤采用锁孔手术入路,肿瘤全切除,术后出现不良反应2例(3.57%)。42例获得随访,随访时间平均30个月,均未发现肿瘤复发,无永久性神经功能障碍。结论锁孔手术治疗颅内小脑膜瘤安全有效,支持对于小脑膜瘤应该早期手术治疗的观点。     

蝶骨嵴内侧脑膜瘤术后并发症相关因素分析

目的 探讨蝶骨嵴内侧脑膜瘤（mSWM）术后并发症的相关因素。方法 回顾性分析2011年1月至2021年1月经翼点入路或扩大翼点入路手术治疗的129例mSWM的临床资料。术后并发症定义为术后6个月仍存在神经功能障碍,如肢体偏瘫,外展神经麻痹,动眼神经麻痹,复视,视力下降,脑积水,意识障碍,癫痫发作,颅骨缺损等。结果 129例中,术后6个月存在并发症20例,并发症发生率为15.50%(20/129);一侧肢体偏瘫4例,术后因颅内血肿致意识障碍2例,动眼神经损伤3例,外展神经损伤3例,因术后脑梗死行去骨瓣减压术遗留颅骨缺损2例,术后发生癫痫大发作4例,视力下降2例。多因素logistic回归分析显示,肿瘤侵犯海绵窦（OR=4.205;95%CI 1.104～16.019;P=0.035）、肿瘤包绕颈内动脉或其分支（OR=3.501;95%CI 1.054～11.631;P=0.041）是m SWM术后发生并发症的独立危险因素。结论 对于侵犯海绵窦、包绕颈内动脉或其分支的m SWM,单纯追求肿瘤的全切除,会提高并发症的发生率,适当保留少量肿瘤,术后辅以放疗,可能是更好的选择。     

Surgical management of falcine meningiomas: Experience of 95 patients

Falcine meningiomas, defined as a meningiomas arising from the falx not involving the superior sagittal sinus, account for 9% of all intracranial meningiomas. We analyzed 95 patients with falcine meningiomas who underwent surgical removal of their lesion at our institution between 2001 and 2014. Surgical management of these patients, focusing on anatomical and clinical features is described. Thus, based on our series, a surgical algorithm, classifying the falcine meningioma into four types, according to location at the falx, and using an ipsilateral interhemispheric approach in supine or prone position, is described. The median length of follow-up was 7.1 years (range 1.6–12.3 years). Approximately one-third of all patients was asymptomatic, headaches occurred in 27 patients, seizures in 14 cases, and lower-extremity weakness in 9 cases. In this series, the middle third of the falx was the most frequently involved site (55,78%), while the anterior third (26,31%) and the posterior type (17,89%) were less common. The transitional and meningothelial types occurred in 69 of patients and a high grade in only two patients. Compared with previous series in literature, there was no mortality and Gross Total Resection was obtained in 83 (87,5%) cases. Three of 95 patients experienced new or worsened neurological deficits after surgery while other complications were relatively in only 6 cases. This study presents our good results about removal of the tumor while preserving major cortical veins and the sinus using advanced microsurgical tools.     

Significance of the simultaneous combined transcranial and endoscopic endonasal approach for prevention of postoperative CSF leak after surgery for lateral skull base meningioma

Lateral skull base meningiomas, particularly sphenoorbital meningiomas, sometimes extend extremely widely into adjacent structures including the paranasal sinuses. For endonasal skull base reconstruction using a vascularized nasoseptal flap for prevention of postoperative cerebrospinal fluid (CSF) leak, the simultaneous combined transcranial and endoscopic endonasal approach was applied for resection of these extensive tumors. We performed a retrospective review of four patients treated with the simultaneous combined transcranial and endoscopic endonasal approach for resection of lateral skull base meningiomas. Preoperative characteristics, tumor extent, extent of resection, complications, and postoperative outcomes were analyzed. The tumor extended into the paranasal sinus, infratemporal fossa, and pterygopalatine fossa in all patients. Extracranial extension into the cavernous sinus or superior orbital fissure was detected in two and three patients, respectively. In one patient without extension into the cavernous sinus and superior orbital fissure, gross total resection was achieved, whereas in the other three patients, subtotal resection was performed, and small residual masses of the tumor remained in the cavernous sinus or superior orbital fissure to minimize the risk of postoperative ocular nerve damage. No patients experienced postoperative CSF leak. The simultaneous combined transcranial and endoscopic endonasal approach is useful for a subgroup of patients with lateral skull base meningiomas for prevention of postoperative CSF leak. Particularly in recurrent cases in which vascularized flaps from the transcranial side are likely unavailable due to prior tumor resection, this combined approach is worth considering depending on tumor extension into the paranasal sinus.     

Neural connections in and around the cavernous sinus in rat,with special reference to cerebrovascular innervation

There is a confluence in and around the cavernous sinus of neural pathways innervating the intracranial structures. To determine the patterns of innervation, particularly of the cerebral arteries, we stained whole-mount preparations of the cavernous sinus and adjacent regions of the rat for acetylcholinesterase. The cavernous nerve plexus, with several small ganglia, mainly occupied the lateral wall of the sinus and extended laterally above the ophthalmic and maxillary divisions of the trigeminal nerve, in relation to the oculomotor and trochlear nerves. The cavernous plexus was connected to the pterygopalatine ganglion, the trigeminal ganglion, and the abducens nerve. The elongated pterygopalatine ganglion consisted of an orbital part, from which parasympathetic fibers ran to the cerebral arteries, and a cavernous part. Nerves from the lateral extension of the cavernous plexus ran rostrally into the orbit along the oculomotor, trochlear, and ophthalmic nerves, and caudally to the pineal gland along the trochlear nerve. Several branches also ran over the dura mater. Caudal to the cavernous sinus, we found two large nerves and a number of small nerves that ran between the nerves surrounding the internal carotid artery and the abducens nerve. These nerves may represent additional parasympathetic and/or sensory pathways to the cerebral arteries. © 1996 Wiley-Liss, Inc.     

Chordoid meningioma of the foramen magnum in a child: a case report and review of the literature

We report a 3-year-6-month-old boy with chordoid meningioma in the foramen magnum. Chordoid meningioma represents between 0.5 and 1.0% of all meningiomas, and it is frequently located in the supratentorial region. The patient started with an episode of instability, falls, and headache; after which, he developed cuadriparesis, cervical pain, and neck stiffness, which slightly improved after medical treatment, so he was referred to our hospital. Physical examination revealed left hemiparesis and cervical muscle spasm with left torticollis. Magnetic resonance imaging (MRI) demonstrated an intradural–extramedullary well-circumscribed, homogeneous enhancing mass, in the anterior part of the foramen magnum with cervical extension. The operative technique was the extreme-lateral craniocervical retrocondylar approach with total removal and dural coagulation. Histopathological examination demonstrated a chordoid meningioma, with meningotelial basophilic mucoid chordoma-like component in 80% of the tissue. The immunohistochemical stains were positive to epithelial membrane antigen, vimentin, and S-100 protein. At 10 months follow-up, the patient showed improvement in his neurological deficit with physical rehabilitation, and motor response in his extremities are now normal; neck stiffness with cervical spasm disappeared postoperatively. MRI showed no residual tumor. To our knowledge, this is the first report of a chordoid meningioma on the foramen magnum in a child.     

Abducens nerve palsy due to inferior petrosal sinus thrombosis

Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello’s canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber’s ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello’s canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello’s canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.     

前颞下"锁孔"入路显微手术的临床应用

目的以"锁孔"微创的理念,改良常规颞下入路,以减少手术损伤.方法采用耳前方颧弓向上直切口4 cm,铣开2.0～2.5 cm左右直径骨窗,经颞下行海绵窦、脑干、岩斜区部位病灶的手术治疗13例.结果6例岩斜区脑膜瘤全切除4例,次全切1例,大部切除1例;脑干转移癌、颞底胶质瘤各1例均全切除,海绵窦脑膜瘤、脑桥胶质瘤各1例次全切除,脑桥病灶出血1例予AVM切除、血肿清除,海绵窦内血栓1例子全切除,大脑后动脉瘤1例予夹闭.1例术后出现脑脊液耳漏,经原入路修补后痊愈.2例岩斜区脑膜瘤切除术后遗有轻度偏瘫.结论颞下"锁孔"入路可满足岩斜区、脑桥腹、侧方及海绵窦区的手术要求,是一种行之有效的微创手术入路.     

Meningiomas of the lateral ventricles of the brain in children

Meningiomas of the lateral ventricles of the brain are rare tumours, accounting for approximately 0.5–5% of all intracranial meningiomas. Their natural history and symptomatology and the possibilities of early diagnosis are presented. The intraventricular location of the slow-growing benign mass provides a compensatory mechanism in the form of reserve space, which contributes to the delay in clinical demonstration of symptoms and signs. This makes the choice of diagnostic procedure an essential problem. CT and MRI are useful in detecting these masses, and magnetic resonance angiography (MRA) has also proved to be of great value in demonstrating the vascular supply of the tumour. This paper deals with two cases. In case 1 CT, MRI and MRA and in case 2 CT examination proved to be very useful. The tumours were removed by a transcortical approach in the posterior area. Received: 15 January 1998