Surgical strategy of trigonal ventricular meningiomas (44 cases and review)

Objective To investigate the surgery treatment of trigone ventricular meningiomas.Methods It is reported 44 cases of trigone ventricular meningiomas from our neurosurgery department from Jan.2007 to Sep.2012,with the review of past literatures.Results The symptoms were related to the tumor location and size.The pre-operative CT,MRI,or MRA examination could help identifying tumor entity,location,size,and blood supply.The total tumor resection was performed for each patient through the ranssulcal approach with the intra-operative ultrasound assistant.37 of them were given drainage.2 of them were confirmed distant epidural hematoma through intra-operative ultrasound and hematoma evacuation were performed immediately.1 was re-operated on 4 days later for extensive brain edema and received decompressive craniotomy.1 of those 37 patients with drainage developed intracranial hypertension after drainage removal and was given lateral ventricle aspiration again.Other complications included 3 localized hydrocephalus.31 out of the 38 patients with obvious symptoms improved after the operation.1 with WHO grade 1Ⅱ and 1 with WHO grade Ⅲ meningioma went on for adjuvant radiotherapy after the operation.The patients improved well with a follow-up period of 2 months to 6 years,with no recurrences.Conclusions The total tumor resection through transsulcal approach with intra-operative ultrasound assistant is recommended for treatment of trigone ventricular meningiomas with good prognosis.Pre operative image examination is helpful.Improved operation skill and individualized treatment strategy are critical for a good prognosis. Key words: Meningioma;  Trigone of the Lateral ventricle ;  Surgery;  Trans-sulcus approach;  Intra-operative ultrasound