Fourth ventricular meningioma: a case report and literature review

Abstract

A 60-year-old man was admitted with slowly progressive dizziness. Cranial nerve evaluation found no abnormalities. Magnetic resonance imaging revealed a well-circumscribed mass with homogeneous enhancement located in the fourth ventricle. The patient underwent surgery for the removal of the tumor via the bilateral suboccipital approach. Subtotal removal of the tumor was achieved in a piecemeal fashion. Histological diagnosis was meningothelial meningioma. Fourth ventricular meningiomas are extremely rare. We reviewed the literature and discussed the features of fourth ventricular meningiomas.

Meningioma of the Fourth Ventricle: Literature Review

“…Meningiomas of the fourth ventricle are defined as those that have their origin in the local choroid plexus and occupy this ventricular cavity without meningeal implantation. 1,3,5 In 1963, Abraham and Chandy suggested a classification for posterior fossa meningiomas, without dural implant, consisting of three types: 1) choroid plexus meningiomas, which develop only in the fourth ventricle; 2) choroid screen meningiomas, which develop partially in the interior of the ventricle and partially in the cerebellar hemisphere and vermis; and 3) cisterna magna meningiomas, without dural implantation and with intraventricular extension, which are originate from the most lateral portion of the choroid plexus, outside the Luschka formen. 1,8,9 Those classified as types 1 or 2 are deemed true.…”

“…Among the differential diagnosis of fourth-ventricle tumors are metastasis, choroid plexus papilloma, hemangioblastoma, medulloblastoma and ependymoma. 3,5,11 The radiological differentiation of such lesions is important for the surgical planning, because it implies different levels of difficulty for total excision and, therefore, different initial forms of intraoperative management of the lesions. The characteristics of meningiomas, both in the MRI and in computeed tomograhy (CT), indicate well-circumscribed lesions with regular and mild edges, probably of slow growth, with homogeneous and very intense enhancement by the contrast agent.…”

“…The characteristics of meningiomas, both in the MRI and in computeed tomograhy (CT), indicate well-circumscribed lesions with regular and mild edges, probably of slow growth, with homogeneous and very intense enhancement by the contrast agent. 3,6 The treatment of choice is the microsurgical excision of the lesion, using intralesional emptying, with aid, if possible, given the characteristics of the neoplasia, ultrasonic aspiration or piacemeal resection when necessary, initially avoiding traction maneuvers, and paying special attention to the dissection along the floor of the fourth ventricle, usually with a clear cleavage plane, which, together with the fact that it does not present meningeal fixation, leads to the good results published in the literature, with complete excision of the lesion. 12 Considering the cases with resection volumes reported so far, only four did not indicate complete resection.…”

“…2 Out of these, 77.8% occur in the lateral ventricle trigone, with a higher frequency on the left side; 15.6% occur in the third ventricle; and 6.6%, in the fourth ventricle. 1,3,4 It is believed that the meningiomas in the fourth ventricle originate from the choroid plexus, and do not present dural adhesions. 1,3,5 The first case was described by Cushing and operated by Sachs in 1938.…”

“…1,3,4 It is believed that the meningiomas in the fourth ventricle originate from the choroid plexus, and do not present dural adhesions. 1,3,5 The first case was described by Cushing and operated by Sachs in 1938. 3,6,7 We describe the case of a 31-year-old patient, who was operated at our service for resection of a tumor in the fourth ventricle whose anatomopathological diagnosis indicated meningioma; we also performed a review of the literature.…”