Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, 650-0017, Chuo-ku, Kobe, Japan.
Childs Nerv Syst. 2023 Dec;39(12):3595-3600. doi: 10.1007/s00381-023-06056-2. Epub 2023 Jun 27.
Intraparenchymal meningiomas in the basal ganglia are extremely rare, and to the best of our knowledge, only three case reports have been published to date. Owing to concerns regarding major vessels, gross total resection (GTR) is difficult to achieve; therefore, subtotal resection and radiation therapy are often chosen as treatment options. We present a pediatric case with an intraparenchymal meningioma in the left basal ganglia that was successfully treated with GTR. We also reviewed the relevant literature to discuss the pathogenesis, radiological findings, and treatment methods of this rare disease.
A 4-year-old girl presented with progressive right facial paralysis, aphasia, and right incomplete hemiplegia. Imaging revealed a mass lesion in the left basal ganglia and unilateral obstructive hydrocephalus. Neuroendoscopic septostomy, tumor biopsy, and cerebrospinal fluid reservoir placement were performed, and the initial pathological diagnosis was suspected glioma. Thus, craniotomy was performed to remove the tumor, which was white, elastic, and well-defined. Intraoperative rapid pathology revealed a meningioma. Postoperatively, the patient experienced transient worsening of the right incomplete hemiplegia, which subsequently improved. The final pathological diagnosis was a fibrous meningioma.
Surgery for intraparenchymal meningiomas in the basal ganglia is challenging owing to the proximity of major blood vessels; however, GTR may be preferable to subtotal resection, considering the possibility of recurrence. Even in cases of intraparenchymal tumors, it is important to consider meningioma as a differential diagnosis and to carefully plan the appropriate treatment.
基底节区脑实质内脑膜瘤极为罕见，据我们所知，迄今为止仅发表了三例病例报告。由于担心主要血管，很难实现完全切除（GTR）；因此，通常选择部分切除和放射治疗作为治疗选择。我们报告了一例成功接受 GTR 治疗的左基底节脑实质内脑膜瘤的儿科病例。我们还回顾了相关文献，讨论了这种罕见疾病的发病机制、影像学表现和治疗方法。
一名 4 岁女孩出现进行性右侧面瘫、失语和右侧不完全偏瘫。影像学显示左基底节区有肿块病变和单侧梗阻性脑积水。进行了神经内镜室间隔切开术、肿瘤活检和脑积水分流术，最初的病理诊断疑似为胶质瘤。因此，进行了开颅手术切除肿瘤，肿瘤呈白色、有弹性且边界清晰。术中快速病理显示为脑膜瘤。术后患者出现右侧不完全偏瘫一过性加重，随后改善。最终的病理诊断为纤维型脑膜瘤。
由于靠近大血管，基底节脑实质内脑膜瘤的手术具有挑战性；然而，考虑到复发的可能性，GTR 可能优于部分切除。即使在脑实质内肿瘤的情况下，也应将脑膜瘤作为鉴别诊断，并仔细计划适当的治疗方案。
