Bret P, Gharbi S, Cohadon F, Remond J
Service de Neurochirurgie C, U.F.R. Lyon Nord et Alexis-Carrel, Hôpital Neurologique et Neurochirurgical Pierre-Wertheimer.
Neurochirurgie. 1989;35(1):5-12.
Three recent cases of intra-ventricular meningiomas are reported. The incidence of this tumor type is very low, since they account for only 0.2% of all intra-cranial neoplasms and 2% of all intra-cranial meningiomas in the adult. In our first 2 cases, the meningioma involved the right trigonal area. In our third patient, a 14 year-old girl, the tumor had involved the left occipital horn. It is usually assumed that their development is a result of meningothelial inclusion bodies normally present in the arachnoid of the tela choroidea. As mentioned in previous reports, their clinical presentation may be that of paroxysmal increased intra-cranial pressure and a mechanism of trapped ventricular horn has been advocated. However, under such circumstances, an intraventricular bleeding seems to be a more likely mechanism. Despite their rarety, intra-ventricular meningiomas are usually diagnosed on C.T. It typically shows a hyperdense mass, attached to the plexus and enhancing after contrast infusion. In one of our patients (obs. 2), the meningioma manifested on M.N.R. by a low signal intensity in T1 sequences and by a high signal in T2 sequences. In our third patient, the M.N.R. findings were indicative of a cystic lesion lying in the occipital horn, but not of a meningioma, the diagnosis of which was made on further microscopic examination. The angiographic evaluation remains useful to document preoperatively the arterial supply to the meningioma, which is mainly from the postero-lateral choroïdal arteries. At operation, anterior meningiomas lying near the foramen of Monro are easily exposed through a transfrontal approach and raise no technical problem.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了三例近期的脑室内脑膜瘤病例。这种肿瘤类型的发病率非常低,因为它们仅占所有颅内肿瘤的0.2%,在成人所有颅内脑膜瘤中占2%。在我们的前两例病例中,脑膜瘤累及右侧三角区。在我们的第三例患者,一名14岁女孩中,肿瘤累及左侧枕角。通常认为它们的发生是脉络丛蛛网膜中正常存在的脑膜上皮包涵体所致。如先前报告中所述,它们的临床表现可能是阵发性颅内压升高,并且有人主张存在脑室角受阻机制。然而,在这种情况下,脑室内出血似乎是更可能的机制。尽管罕见,但脑室内脑膜瘤通常通过CT诊断。它通常显示为高密度肿块,附着于脉络丛,注入造影剂后增强。在我们的一名患者(病例2)中,脑膜瘤在磁共振成像(M.N.R.)上T1序列呈低信号强度,T2序列呈高信号。在我们的第三例患者中,M.N.R.结果提示枕角有一个囊性病变,但不是脑膜瘤,其诊断是通过进一步的显微镜检查做出的。血管造影评估对于术前记录脑膜瘤的动脉供血仍然有用,其主要来自脉络膜后外侧动脉。手术时,位于室间孔附近的前部脑膜瘤通过经额入路很容易暴露,并且不存在技术问题。(摘要截短至250字)