Nanda Anil, Bir Shyamal C, Maiti Tanmoy, Konar Subhas
Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA.
Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA.
World Neurosurg. 2016 Apr;88:526-537. doi: 10.1016/j.wneu.2015.10.071. Epub 2015 Nov 5.
Intraventricular meningiomas (IVMs) are rare tumors compared with intracranial meningiomas. Optimal surgical management of IVMs is controversial. The objective of this article was to review the outcomes and complications of meningiomas treated with various surgical approaches.
We performed a retrospective review of 18 patients with IVMs who received different treatment strategies during the period 2000-2014. Of 18 patients, 17 underwent microsurgical resection, and 1 patient received Gamma Knife radiosurgery. The literature was reviewed to compare the present cohort with previously published series.
In our series, 12 (70%) patients underwent parieto-occipital craniotomy and a superior parietal gyrus approach, which was similar to procedures used in various series (74.4%) in the existing literature. Preoperatively, patients commonly presented with headache (65%) and neurologic deficits (70%). After surgical management, there was a significant reduction in symptoms, including headache (preoperative 65% vs. postoperative 6%, P = 0.0001), and neurologic deficits (preoperative 70% vs. postoperative 5.5%). Preoperatively, 2 patients experienced visual impairment, which was completely resolved after surgery. The Karnofsky performance scale was significantly improved after resection compared with before treatment (89 vs. 76, P = 0.003). In 4 patients with World Health Organization grade II tumor, redo surgery was required because of recurrence of tumor.
Based on a literature review and our experience, surgical approaches for patients with IVM vary according to size, location, and laterality of the meningioma. In addition, the growth pattern of the tumor (transependymal extension), vascular supply of the tumor, and brain function (particularly visual function) can affect surgical treatment and should be identified preoperatively.
与颅内脑膜瘤相比，脑室内脑膜瘤（IVM）较为罕见。IVM的最佳手术治疗方法存在争议。本文的目的是回顾采用各种手术方法治疗脑膜瘤的疗效和并发症。
我们对2000年至2014年期间接受不同治疗策略的18例IVM患者进行了回顾性研究。18例患者中，17例行显微手术切除，1例接受伽玛刀放射外科治疗。回顾文献以将本队列与先前发表的系列进行比较。
在我们的系列研究中，12例（70%）患者采用顶枕开颅和顶上小叶入路，这与现有文献中各系列（74.4%）所采用的手术方法相似。术前，患者常见症状为头痛（65%）和神经功能缺损（70%）。手术治疗后，症状显著减轻，包括头痛（术前65% vs.术后6%，P = 0.0001）和神经功能缺损（术前70% vs.术后5.5%）。术前，2例患者有视力障碍，术后完全缓解。与治疗前相比，切除术后卡氏功能状态评分显著改善（89 vs. 76，P = 0.003）。4例世界卫生组织II级肿瘤患者因肿瘤复发需要再次手术。
基于文献回顾和我们的经验，IVM患者的手术方法因脑膜瘤的大小、位置和侧别而异。此外，肿瘤的生长方式（经室管膜扩展）、肿瘤的血管供应和脑功能（特别是视觉功能）会影响手术治疗，应在术前明确。
