- Neurosurgical Department, UHC Ibn Rochd, Hassan II University, Casablanca, Morocco
Neurosurgical Department, UHC Ibn Rochd, Hassan II University, Casablanca, Morocco
DOI:10.4103/2152-7806.195580Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Said Hilmani, Yassine Houass, Abdessamad El Azhari. Paraventricular meningioma revealed by mental disorder. 12-Dec-2016;7:
How to cite this URL: Said Hilmani, Yassine Houass, Abdessamad El Azhari. Paraventricular meningioma revealed by mental disorder. 12-Dec-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/paraventricular-meningioma-revealed-by-mental-disorder/
Background:Ventricular meningioma constitutes 2% of intracranial meningioma, representing a challenging disease for neurosurgeons. Although cognitive impairment is one of the major symptoms of ventricular tumors, few studies have reported the details of cognitive impairment before and after their surgical removal. The expected effects on cognitive function should also be considered when choosing a surgical approach.
Case Descriptions:We report the case of a large lateral ventricle meningioma revealed by cognitive dysfunction and moderate intellectual disability. The patient underwent subtotal resection of the tumor which had partial improvement in cognitive disorders. It is important to precisely assess neuropsychological function in patients with large brain tumors, and judicious preoperative plan, adequate knowledge of anatomy, and use of correct microsurgical techniques are fundamental in achieving complete resection of paraventricular meningioma with low morbidity.
Conclusion:Pre and postoperative precise neuropsychological examinations may identify the potential cognitive impairment and beneficial effects of surgery in patients with large lateral ventricle meningiomas.
Keywords: Meningioma, mental disorder, ventricle
Ventricular meningioma constitutes 2% of intracranial meningioma,[
Here, we report the case of a large lateral ventricle meningioma associated with cognitive dysfunction and intellectual disability. The patient underwent subtotal resection of the tumor with an improvement in cognitive disorders.
A 26-year-old women had moderate intellectual disability with cognitive disorders. She presented with increase intracranial hypertension and seizure, but without motor or sensitive disturbance. The fundus showed papillary edema. Computed tomography (CT) scan demonstrated an isodense tumor located in the right paraventricular at the occipitotemporal region [
Meningiomas arising in the ventricular system without dural attachment are extremely rare, with an incidence of 0.5–3% (average 2%) among all intracranial meningiomas.[
Cognitive impairment is well known as a major symptom of entlateral vricular tumors and may potentially be complicated after their surgical removal.[
RBANS score was selected to identify and evaluate cognitive disorders before and after the surgery. The RBANS consists of 12 subtests and yields index scores for 5 traits, namely, attention (digit span, coding), language (picture naming, semantic fluency), visuospatial/constructional abilities (figure copy, line orientation), immediate memory (list learning, story memory), and delayed memory (list recall, list recognition, story recall, figure recall). Scores can be normalized for age, sex, ethnicity, and level of education, with a score of 100 and a standard deviation of 15 for the index group.[
The optimal surgical approach for a paraventricular meningioma is still controversial. In general, there are three main surgical approaches to remove lateral ventricle tumors, namely the superior parietal, transcallosal, and middle temporal gyrus approaches.[
In our opinion, the objective is not to obtain maximum tumor resection but extirpation with less surgical morbidity and minimal or no damage to surrounding brain tissue. The aim must be a good exposure of the lesion as well as an early visualization of the arterial pedicle. Occlusion of these vessels results in tumor hemostasis. Piecemeal removal is crucial for achieving resection of the tumor with minimum damage and for careful intraoperative hemostasis to ovoid intraventricular hemorrhage.
In conclusion, pre and postoperative precise neuropsychological examinations may identify the potential cognitive impairment and beneficial effects of surgery in patients with large lateral ventricle meningiomas. The cure of meningioma of this tumor can be achieved with appropriately selecting surgical route according to the anatomical features of the region, characteristics of the individual presentation such as size, location, growing patterns, and clinical preoperative deficits.
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