Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(03): e257-e262
DOI: 10.1055/s-0037-1604037
Case Report | Relato de Caso

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

Caso raro de paciente jovem com meningioma angiomatoso intraventricular
Gabriel Carvalho Heemann
1   Medicine Student, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
,
Rafael Silva Paglioli
2   Resident doctor, Neurosurgery Service, Hospital São Lucas, PUC-RS, Porto Alegre, RS, Brazil
,
Ricardo Chmelnitsky Wainberg
3   Preceptor doctor, Neurosurgery Service, Hospital São Lucas, PUC-RS, Porto Alegre, RS, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Pediatric meningiomas are rare and account for only 2.2% of the central nervous system (CNS) tumors. In this age group, they are more frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of all meningiomas, the rarity of the case reported here is corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there were no neurological sequelae. With a follow-up of 26 months, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach a considerable size until they cause symptoms and then are diagnosed. In addition, the deep location of the tumor and its proximity to eloquent areas make these tumors a neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of > 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcalosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

Resumo

Meningiomas pediátricos são raros, representando apenas 2,2% dos tumores do sistema nervoso central (SNC). Em tal faixa etária, localizam-se com maior frequência em sítios atípicos, como, principalmente, o sistema ventricular – com frequência de 8,8 a 13,6%. Em vista disso, e de que o subtipo angiomatoso constitui apenas 2,1% de todos meningiomas, corrobora-se a raridade do caso aqui relatado: paciente feminina de 17 anos diagnosticada com meningioma angiomatoso intraventricular. Foi submetida à ressecção cirúrgica de tumor em corpo e corno frontal do ventrículo lateral direito, não havendo sequela neurológica. Com acompanhamento de 26 meses, não apresentou recidiva e demonstra estabilidade clínica. Tumores intraventriculares geralmente possuem crescimento lento e atingem tamanho considerável até ocasionarem sintomas e serem, então, diagnosticados. Somado a isso, a localização profunda do tumor e a proximidade com áreas eloquentes tornam tais tumores um evidente desafio neurocirúrgico. O subtipo angiomatoso, por apresentar hipervascularização (é constituído por > 50% de componentes vasculares), pode tanto dificultar, em alguns casos, a ressecção cirúrgica quanto ser erroneamente diagnosticado. Porém, o tratamento cirúrgico visando à ressecção da lesão mantém-se como a conduta de escolha no caso aqui relatado, especialmente em pacientes nas duas primeiras décadas de vida, nos quais se evita o uso de radiação. Especificamente em relação à cirurgia, optou-se por uma abordagem transcalosa que possibilita uma boa visualização transoperatória da lesão quando localizada em corpo e corno frontal do ventrículo lateral.

Keywords

meningioma - intraventricular neoplasms - pediatrics - lateral ventricles

Palavras-chave

meningioma - neoplasia intraventricular - pediatria - ventrículos laterais


Publication History

Received: 20 February 2017

Accepted: 31 May 2017

Article published online:
23 June 2017

© 2017. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Ostrom QT, Gittleman H, Fulop J. et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro-oncol 2015; 17 (Suppl. 04) iv1-iv62
    CrossrefPubMedGoogle Scholar
  • 2 Kotecha RS, Pascoe EM, Rushing EJ. et al. Meningiomas in children and adolescents: a meta-analysis of individual patient data. Lancet Oncol 2011; 12 (13) 1229-1239
    CrossrefPubMedGoogle Scholar
  • 3 Menon G, Nair S, Sudhir J, Rao BR, Mathew A, Bahuleyan B. Childhood and adolescent meningiomas: a report of 38 cases and review of literature. Acta Neurochir (Wien) 2009; 151 (03) 239-244 , discussion 244
    CrossrefPubMedGoogle Scholar
  • 4 Bhatoe HS, Singh P, Dutta V. Intraventricular meningiomas: a clinicopathological study and review. Neurosurg Focus 2006; 20 (03) E9
    CrossrefPubMedGoogle Scholar
  • 5 Nanda A, Bir SÇ, Maiti T, Konar S. Intraventricular Meningioma: Technical Nuances in Surgical Management. World Neurosurg 2016; 88: 526-537
    CrossrefPubMedGoogle Scholar
  • 6 Lyngdoh BT, Giri PJ, Behari S, Banerji D, Chhabra DK, Jain VK. Intraventricular meningiomas: a surgical challenge. J Clin Neurosci 2007; 14 (05) 442-448
    CrossrefPubMedGoogle Scholar
  • 7 Hasselblatt M, Nolte KW, Paulus W. Angiomatous meningioma: a clinicopathologic study of 38 cases. Am J Surg Pathol 2004; 28 (03) 390-393
    CrossrefPubMedGoogle Scholar
  • 8 Kwee LE, van Veelen-Vincent ML, Michiels EM, Kros JM, Dammers R. The importance of microsurgery in childhood meningioma: a case report. Childs Nerv Syst 2015; 31 (01) 161-165
    CrossrefPubMedGoogle Scholar
  • 9 Liu Y, Li F, Zhu S, Liu M, Wu C. Clinical features and treatment of meningiomas in children: report of 12 cases and literature review. Pediatr Neurosurg 2008; 44 (02) 112-117
    CrossrefPubMedGoogle Scholar
  • 10 Ravindranath K, Vasudevan MÇ, Pande A, Symss N. Management of pediatric intracranial meningiomas: an analysis of 31 cases and review of literature. Childs Nerv Syst 2013; 29 (04) 573-582
    CrossrefPubMedGoogle Scholar
  • 11 Santos MV, Furlanetti L, Valera ET, Brassesco MS, Tone LG, de Oliveira RS. Pediatric meningiomas: a single-center experience with 15 consecutive cases and review of the literature. Childs Nerv Syst 2012; 28 (11) 1887-1896
    CrossrefPubMedGoogle Scholar
  • 12 Cushing HL, Eisenhardt L. Meningiomas: their classification, regional behavior, life history and surgical end results. Charles C Thomas Springfield, III; 1938
    Google Scholar
  • 13 Mehta N, Bhagwati S, Parulekar G. Meningiomas in children: A study of 18 cases. J Pediatr Neurosci 2009; 4 (02) 61-65
    CrossrefPubMedGoogle Scholar
  • 14 Arivazhagan A, Devi BI, Kolluri SV, Abraham RG, Sampath S, Chandramouli BA. Pediatric intracranial meningiomas--do they differ from their counterparts in adults?. Pediatr Neurosurg 2008; 44 (01) 43-48
    CrossrefPubMedGoogle Scholar
  • 15 Jaiswal S, Vij M, Mehrotra A, Jaiswal AK, Srivastava AK, Behari S. A clinicopathological and neuroradiological study of paediatric meningioma from a single centre. J Clin Neurosci 2011; 18 (08) 1084-1089
    CrossrefPubMedGoogle Scholar
  • 16 Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet 2004; 363 (9420): 1535-1543
    CrossrefPubMedGoogle Scholar
  • 17 Donnell MS, Meyer GA, Donegan WL. Estrogen-receptor protein in intracranial meningiomas. J Neurosurg 1979; 50 (04) 499-502
    CrossrefPubMedGoogle Scholar
  • 18 Kotecha RS, Junckerstorff RÇ, Lee S, Cole CH, Gottardo NG. Pediatric meningioma: current approaches and future direction. J Neurooncol 2011; 104 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 19 Liu Z, Wang C, Wang H, Wang Y, Li JY, Liu Y. Clinical characteristics and treatment of angiomatous meningiomas: a report of 27 cases. Int J Clin Exp Pathol 2013; 6 (04) 695-702
    PubMedGoogle Scholar
  • 20 Rao S, Rajkumar A, Kuruvilla S. Angiomatous meningioma: a diagnostic dilemma. Indian J Pathol Microbiol 2008; 51 (01) 53-55
    CrossrefPubMedGoogle Scholar
  • 21 Bansal D, Diwaker P, Gogoi P, Nazir W, Tandon A. Intraparenchymal Angiomatous Meningioma: A Diagnostic Dilemma. J Clin Diagn Res 2015; 9 (10) ED07-ED08
    PubMedGoogle Scholar
  • 22 Rathod GB, Vyas K, Shinde P, Goswami SS, Tandan RK. Angiomatous meningioma in 49 years old male A rare case report. Int J Curr Microbiol Appl Sci 2014; 3 (11) 256-260
    PubMedGoogle Scholar
  • 23 Meng Y, Chaohu W, Yi L, Jun P, Songtao Q. Preoperative radiologic characters to predict hemangiopericytoma from angiomatous meningioma. Clin Neurol Neurosurg 2015; 138: 78-82
    CrossrefPubMedGoogle Scholar
  • 24 Hwang J, Kong D-S, Seol HJ, Nam D-H, Lee J-I, Choi JW. Clinical and Radiological Characteristics of Angiomatous Meningiomas. Brain Tumor Res Treat 2016; 4 (02) 94-99
    CrossrefPubMedGoogle Scholar
  • 25 Ben Nsir A, Chabaane M, Krifa H, Jeme H, Hattab N. Intracranial angiomatous meningiomas: A 15-year, multicenter study. Clin Neurol Neurosurg 2016; 149: 111-117
    CrossrefPubMedGoogle Scholar
  • 26 Rushing EJ, Olsen C, Mena H. et al. Central nervous system meningiomas in the first two decades of life: a clinicopathological analysis of 87 patients. J Neurosurg 2005; 103 (6, Suppl): 489-495
    PubMedGoogle Scholar
  • 27 Ødegaard KM, Helseth E, Meling TR. Intraventricular meningiomas: a consecutive series of 22 patients and literature review. Neurosurg Rev 2013; 36 (01) 57-64 , discussion 64
    CrossrefPubMedGoogle Scholar
  • 28 Deen Jr HG, Scheithauer BW, Ebersold MJ. Clinical and pathological study of meningiomas of the first two decades of life. J Neurosurg 1982; 56 (03) 317-322
    CrossrefPubMedGoogle Scholar
  • 29 Fusco DJ, Spetzler RF. Surgical considerations for intraventricular meningiomas. World Neurosurg 2015; 83 (04) 460-461
    CrossrefPubMedGoogle Scholar
  • 30 Liu M, Wei Y, Liu Y, Zhu S, Li X. Intraventricular meninigiomas: a report of 25 cases. Neurosurg Rev 2006; 29 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 31 Rochat P, Johannesen HH, Gjerris F. Long-term follow up of children with meningiomas in Denmark: 1935 to 1984. J Neuro Surg 2004; 100 (2, Suppl Pediatrics) 179-182
    PubMedGoogle Scholar
  • 32 Kashiwazaki D, Takaiwa A, Nagai S. et al. Reversal of cognitive dysfunction by total removal of a large lateral ventricle meningioma: a case report with neuropsychological assessments. Case Rep Neurol 2014; 6 (01) 44-49
    CrossrefPubMedGoogle Scholar
  • 33 Nakamura M, Roser F, Bundschuh O, Vorkapic P, Samii M. Intraventricular meningiomas: a review of 16 cases with reference to the literature. Surg Neurol 2003; 59 (06) 491-503 , discussion 503–504
    CrossrefPubMedGoogle Scholar
  • 34 Grujicic D, Cavallo LM, Somma T. et al. Intraventricular Meningiomas: A Series of 42 Patients at a Single Institution and Literature Review. World Neurosurg 2017; 97: 178-188
    CrossrefPubMedGoogle Scholar
  • 35 Agarwal A, Kanekar S. Intraventricular Tumors. Semin Ultrasound CT MR 2016; 37 (02) 150-158
    CrossrefPubMedGoogle Scholar
  • 36 Caroli E, Russillo M, Ferrante L. Intracranial meningiomas in children: report of 27 new cases and critical analysis of 440 cases reported in the literature. J Child Neurol 2006; 21 (01) 31-36
    CrossrefPubMedGoogle Scholar
  • 37 Okechi H, Albright AL. Intraventricular meningioma: case report and literature review. Pediatr Neurosurg 2012; 48 (01) 30-34
    CrossrefPubMedGoogle Scholar
  • 38 Paglioli E, Martins WA, Azambuja N. et al. Selective posterior callosotomy for drop attacks: A new approach sparing prefrontal connectivity. Neurology 2016; 87 (19) 1968-1974
    CrossrefPubMedGoogle Scholar