Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, Karnataka, India.
Neurosurg Rev. 2024 Jul 5;47(1):304. doi: 10.1007/s10143-024-02542-6.
Trigonal meningiomas are rare intraventricular tumours that present a surgical challenge. There is no consensus on the optimal surgical approach to these lesions, though the transtemporal and transparietal approaches are most frequently employed. We aimed to examine the approach-related morbidity and surgical nuances in treating trigonal meningiomas. This retrospective review assimilated data from 64 trigonal meningiomas operated over 15 years. Details of clinicoradiological presentation, surgical approach and intraoperative impression, pathology and incidence of various postoperative deficits were recorded. In our study, Trigonal meningiomas most frequently presented with headache and visual deterioration. The median volume of tumours was 63.6cc. Thirty-one meningiomas each (48.4%) were WHO Grade 1 and WHO Grade 2, while 2 were WHO Grade 3. The most frequent approach employed was transtemporal (38 patients, 59.4%), followed by transparietal (22 patients, 34.4%). After surgery features of raised ICP and altered mental status resolved in all patients, while contralateral limb weakness resolved in 80%, aphasia in 60%, seizures in 70%, and vision loss in 46.2%. Eighteen patients (28.13%) developed transient postoperative neurological deficits, with one patient (1.5%) developing permanent morbidity. Surgery for IVMs results in rapid improvement of neurological status, though visual outcomes are poorer in patients with low vision prior to surgery, longer duration of complaints and optic atrophy. The new postoperative deficits in some patients tend to improve on follow up. Transtemporal and transparietal approaches may be employed, based on multiple factors like tumour extension, loculation of temporal horn, size of lesion with no significant difference in their safety profile.
三角区脑膜瘤是罕见的脑室肿瘤，手术极具挑战性。目前对于此类病变的最佳手术入路尚未达成共识，不过经颞叶和顶叶入路是最常采用的方法。我们旨在探讨治疗三角区脑膜瘤的手术入路相关发病率和手术要点。本回顾性研究纳入了 15 年间手术治疗的 64 例三角区脑膜瘤患者的数据。记录了临床影像学表现、手术入路和术中印象、病理学及各种术后并发症的发生率等详细信息。在我们的研究中，三角区脑膜瘤最常表现为头痛和视力下降。肿瘤的中位数体积为 63.6cc。31 例（48.4%）为 WHO 1 级，31 例（48.4%）为 WHO 2 级，2 例（3.1%）为 WHO 3 级。最常采用的入路是经颞叶（38 例，59.4%），其次是经顶叶（22 例，34.4%）。术后所有患者的颅内压升高和意识状态改变均得到缓解，而对侧肢体无力缓解率为 80%，失语症为 60%，癫痫发作为 70%，视力丧失为 46.2%。18 例（28.13%）患者出现短暂性术后神经功能缺损，1 例（1.5%）患者出现永久性并发症。IVMs 患者的手术可迅速改善神经状态，但术前视力较差、症状持续时间较长和视神经萎缩的患者术后视力较差。一些患者的新术后并发症在随访中往往会得到改善。颞叶和顶叶入路都可采用，这取决于肿瘤延伸、颞角分隔、病变大小等多种因素，其安全性无显著差异。
