Intraventricular meningioma

Case contributed by Dr Ian Bickle

Presentation

Memory loss, ataxia and loss of weight.

Patient Data

Age: 45 years
Gender: Male
CT

7 x 5cm lobulated hyperdense, enhancing mass centered on the trigone of the left lateral ventricle extending into the left parietal lobe and left thalamus extending down to and compressing the upper aspect of the midbrain. Mild perilesional edema.

Compression of the third ventricle resulting in moderate hydrocephalus with mild transpendymal edema.

MRI

6 x 4.5cm well defined lobulated homogenously enhancing mass involving the left thalamus, upper left midbrain, body and trigone of the left lateral ventricle, and part of the splenium of the corpus callosum.  The mass extends into the left parietal periventricular white matter with resultant mild perilesional edema in the left parietal lobe.

Enlarged lateral ventricles due to compressive effect of the mass on the third ventricle with periventricular high T2 signal due to transependymal edema.

Photo

Intra-operative tissue from the intraventricular mass, consistent with a meningioma.

Case Discussion

Meningiomas are commonly identified on imaging, however intraventricular meningiomas are a rare subtype of the more classical extra-axial meningioma. They represent between 0.5-2% of all meningiomas and as in this case have a strong prelidiction for the trigone of the lateral ventricles, with 80% occuring at this site.  This is one type of several intraventricular lesions.

A common pathology at an uncommon site may catch the unwary and is exactly why this kind of case is popular in fellowship exams such as the FRCR 2B.  It is used to assess the generic approach of the candidate.

 

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Case information

rID: 45529
Published: 6th Jun 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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