Presentation
Headache.
Patient Data
There is a solid, well-defined intraventricular mass at the trigone of the left lateral ventricle, with macro lobulated contours, low T1 and high T2 signal compared to the adjacent brain, and showing relatively homogeneous but not vivid contrast enhancement. There is diffusion restriction when compared to the adjacent brain. No signs of hemorrhage or necrosis. A few small vessels noted within the lesion on the gradient sequence. The adjacent brain demonstrates vasogenic edema.
MRI one mth after surgery noncontrast study
Previous left parasagittal craniotomy with subjacent chronic post-operative brain changes are again demonstrated, unaltered in appearance when compared to previous imaging, with no nodular regions to suggest tumor recurrence. The remainder of the brain is unremarkable.
Case Discussion
This patient has had the tumor resection in another service, with the confirmation of a xanthomatous meningioma. Histopathologically, this tumor differs from conventional meningiomas by the presence of xanthomatous tumor cells. This meningioma subtype appears to share similar clinical presentation and treatment and prognosis as other meningiomas.
The enhancement, in this case, is less vivid than usually seen on meningiomas.
Intraventricular meningiomas are rare and represent an uncommon subtype of the more classical extra-axial meningioma and represent between 0.5 and 2% of all meningiomas. 80% of them, as in this case, is located in the trigone of the lateral ventricle.
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