intraventricular meningioma
Introduction
Introduction to intraventricular meningioma Intraventricular meningioma is a meningioma that occurs in the ventricles and originates from the choroid plexus of the ventricular system. Clinically a rare type of meningioma. Among them, meningiomas of the lateral ventricle originating from the choroid plexus of the lateral ventricle are the most common. basic knowledge The proportion of illness: 0.0005%-0.0007% Susceptible people: no special people Mode of infection: non-infectious Complications: ventriculitis intraventricular hemorrhage cerebrospinal fluid leakage hydrocephalus
Cause
Intraventricular meningioma etiology
Most of the tumors are fibrous, hard, and the tumors are mostly located in the lateral ventricle triangle. They can also grow to the lateral ventricle or the lower corner. Occasionally, the lateral ventricle is developed. Occasionally, there is a fourth or third ventricle meningioma. It is reported that the blood supply is mostly from the choroidal artery and posterior choroidal artery.
Prevention
Intraventricular meningioma prevention
No special precautions.
Complication
Intraventricular meningioma complications Complications, ventricular inflammation, intraventricular hemorrhage, cerebrospinal fluid, hydrocephalus
1. High fever is caused by stimulation of bloody cerebrospinal fluid in the ventricle, repeated flushing during surgery, postoperative application of glucocorticoids and physical cooling.
2. Inflammation of ventriculitis or tumor cyst fluid stimulation, repeated lumbar puncture or lumbar subarachnoid space for continuous drainage, antibiotics and glucocorticoids.
3. Intraventricular hemorrhage carefully hemostasis and irrigation, drainage after surgery, the formation of hematoma can be treated surgically.
4. Neurological dysfunction is related to the design of surgical approach and cortical incision. For example, the middle approach can cause aphasia (when dominant hemisphere), hemianopia (injury radiation), and the top pillow approach rarely causes language barrier, but easy Simultaneous hemianopia occurs; incision of the corpus callosum sometimes causes loss of reading, but less epilepsy and coping.
5. Cerebrospinal fluid leakage should be tightly sutured in the dura mater, once it can be dehydrated and hypotensive, taking acetazolamide (acetic acid amide) to inhibit the secretion of cerebrospinal fluid, it is also feasible to lumbar puncture subarachnoid drainage, generally more can be resolved.
6. Cerebrospinal fluid cerebrospinal fluid circulation blockage, can be caused by blood cell agglutination block or absorptive gelatin sponge in the operation area, blocking cerebrospinal fluid circulation pathway, can be dehydrated and hypotensive in the acute phase, and can be used for external drainage of ventricle puncture in severe cases. Ventricular peritoneal shunt.
Symptom
Intraventricular meningioma symptoms Common symptoms Weak hydrocephalus increased intracranial pressure localization signs lateral ventricle widening
Because the tumor in the lateral ventricle is growing in the ventricle, the early nervous system damage is not obvious. The tumor is much larger at the time of the visit, and the patient has already showed an increase in intracranial pressure. Therefore, the clinical manifestations are common headaches and optic disc edema, and some cases come to the hospital. There are cerebral palsy, these patients only have a history of paroxysmal headache, but lack of localization signs, not taken seriously, sudden onset of headache is due to tumor compression of interventricular pores when changing position, causing acute intracranial pressure, lateral ventricle meningioma Cerebral cortex damage is mild, and late stage may also have localized symptoms or signs such as mild facial paralysis and limb weakness due to compression of adjacent brain tissue. In addition, patients with lateral ventricular meningioma may have epilepsy, mood disorder, vision loss and unilateral hemianopia. Tumor patients in the hemisphere may also have sensory or motor aphasia.
Third, meningioma in the fourth ventricle can cause cerebrospinal fluid circulation disorder due to early tumor, so the intracranial pressure is increased, obstructive hydrocephalus is a common symptom of meningiomas in these two parts, and the anterior tumor of the third ventricle may have hypothalamic damage. Symptoms, the posterior tumor of the third ventricle may appear in two eyes of the upper visual disorder. Four intraventricular meningioma may cause ataxia, nystagmus and other cerebellar symptoms. Compression of the cranial nerve nucleus may also cause brain damage and brain stem symptoms.
Examine
Examination of intraventricular meningioma
1. Cerebral angiography Cerebral angiography can show that the blood supply artery of the tumor is the choroidal artery and posterior choroidal artery. The above-mentioned arterial thickening and distortion can be seen on the angiogram, with or without abnormal neovascularization or blood vessel staining, and the distal branch is introduced. The small arterial network of the tumor, followed by a typical meningioma cycle, and sometimes the displacement of the anterior cerebral artery and middle cerebral artery.
2. CT scan can understand the size of the tumor, the location of the ventricle, the relationship between the interventricular space and the aqueduct, and whether or not the hydrocephalus is combined, and the plain is more uniform in the ventricle, which is slightly higher than the density of the brain tissue. There is no obvious calcification. After enhancement, the CT scan shows moderate enhancement. Sometimes the center of the lesion can be intensified. It can be seen that the tumor is connected with the choroid plexus in the brain. Generally, the tumor boundary is clear and smooth, and it does not invade the brain tissue. The tumor can also cause side The ventricle of the ventricle is enlarged and the choroid is displaced from the calcification point. The lateral ventricle meningioma is located in the triangular region. Sometimes the enhanced CT shows that the tumor is connected with the choroid plexus and the lateral ventricle is enlarged.
3. MRI scan of lateral ventricle meningioma MRI signal is similar to other areas of meningioma, but MRI and CT can more clearly show the tumor contour and surrounding edema, better show tumor and interventricular pores, The relationship between the brain aqueduct, the lateral ventricle wall and the surrounding important brain tissue structure has certain guiding significance for surgery. In addition, MRI scan can find smaller meningioma in the third ventricle and the fourth ventricle, but it needs to be distinguished.
Diagnosis
Diagnosis and diagnosis of intraventricular meningioma
In the past, intraventricular brain tumors were mainly diagnosed by ventriculography and cerebral angiography, so early diagnosis is difficult. CT or MRI is the most reliable method for the diagnosis of this disease.
For atypical intraventricular meningioma, it needs to be differentiated from ependymoma, choroid plexus papilloma, glioma and germ cell tumor.
