- Department of Neurosurgery, Notre-Dame Hospital, University of Montreal, 1560 East Sherbrooke Street, Montréal, Québec, Canada
Correspondence Address:
Michel W. Bojanowski
Department of Neurosurgery, Notre-Dame Hospital, University of Montreal, 1560 East Sherbrooke Street, Montréal, Québec, Canada
DOI:10.4103/2152-7806.155703
Copyright: © 2015 Champagne P This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Champagne P, Bojanowski MW. Meningioma of the superior leaflet of the velum interpositum: A case report. Surg Neurol Int 22-Apr-2015;6:
How to cite this URL: Champagne P, Bojanowski MW. Meningioma of the superior leaflet of the velum interpositum: A case report. Surg Neurol Int 22-Apr-2015;6:. Available from: http://sni.wpengine.com/surgicalint_articles/meningioma-superior-leaflet-velum-interpositum-case-report/
Abstract
Background:Meningiomas of the velum interpositum in the roof of the third ventricle are rare. Knowing from which leaflet the meningioma originates and thus its relationships with the internal cerebral and Galen veins, may help in choosing the surgical approach.
Case Description:We report the case of a 40-year-old male with a meningioma arising from the superior leaflet of the velum interpositum. The tumor was resected successfully using the infratentorial-supracerebellar approach. Reviewing the literature, of the 22 reported cases of velum interpositum meningiomas, sufficient information regarding the precise location of the origin of the tumor was provided in 14 cases, all of which were from the inferior leaflet.
Conclusion:We report the first case of velum interpositum meningioma arising from the superior leaflet and give a potential explanation as to why meningiomas of the velum interpositum occur more commonly on the inferior leaflet. Distinguishing from which of the two leaflets the tumor originates may influence the surgical strategy.
Keywords: Meningioma, meningiomas without dural attachment, pineal region, velum interpositum
INTRODUCTION
Meningiomas arising from the velum interpositum (VI) in the roof of the third ventricle are rare. Potentially, they may come from the upper or lower leaflet, displacing the internal cerebral veins accordingly. We describe the first case of a meningioma arising from the superior leaflet of the VI.
CASE REPORT
History and examination
A 40-year-old male consulted in June 2001 for a head trauma following alcohol consumption. His past medical history revealed long-standing alcohol abuse, smoking, and a depressive disorder with anxiety. In addition, he suffered from severe episodic headaches without nausea or vomiting. The neurological examination was entirely normal with good awareness and no focal deficit.
Imagery
The head computed tomography (CT) showed a mild left frontal contusion and a pineal region tumor. A magnetic resonance imaging (MRI) showed an isointense 1.4 cm, well delineated spherical tumor of the pineal region [
Operation
Even though the relation between the severe intermittent headaches and the tumor was uncertain, given the unknown nature of the lesion, we eventually opted for surgery since the patient was young and the estimated risk was low. The tumor was successfully and completely resected via a supracerebellar infratentorial approach [
Postoperative course
The postoperative period was uneventful. Postoperative head CT scan and MRI revealed no residual tumor [
DISCUSSION
Tumors arising from the pineal region represent roughly 1–4% of all intracranial neoplasms.[
The VI consists of the potential space between the two leaflets of the tela choroidea, a double layered fold of arachnoid-pia mater in the roof of the third ventricle.[
Although some authors have stated that meningiomas coming from the VI can potentially come from either its superior or inferior leaflet; in our review of the literature, we only found cases of meningiomas arising from the inferior leaflet.
Lozier et al. reviewed all the cases of VI meningiomas up to 2003 and reported a total of 17 cases, including their own, in which there was sufficient reliable information supporting the VI as the origin of the meningiomas.[
Since the location of the meningioma may have an impact on the surgical approach, in examining these 22 cases of VI meningiomas, we searched for evidence as to whether the meningioma arose from the superior or inferior layer of the VI. In fourteen cases the tumor clearly originated from the inferior leaflet as seen directly during surgery or on imagery where the internal cerebral veins were displaced superiorly. In the remaining eight cases of VI meningiomas, there was insufficient information to determine the location. Therefore, to our knowledge, there is no previously reported case of VI meningioma arising from the superior leaflet. We herein report such a case.
Even taking into consideration the eight cases with insufficient information as to location, it would appear that VI meningiomas are more commonly found on the inferior leaflet. A possible explanation could be that most meningiomas arise not from the velum itself, but from the cap cells present in the choroid plexus, which is adjacent to the inferior leaflet of the VI. Indeed, starting in the 6th week of embryogenesis, the roof of the ventricular system invaginates in order to form the choroid plexus.[
Many approaches have been described to treat pineal region meningiomas such as the suboccipital transtenorial, supracerbellar infratentorial and posterior interhemispheric approaches.[
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