Intraventricular meningioma

Case contributed by Dr Ian Bickle

Presentation

Memory loss, ataxia and loss of weight.

Patient Data

Age: 43
Gender: Male
Modality: CT

7 x 5cm lobulated hyperdense, enhancing mass centred 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 oedema.

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

Modality: 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 oedema 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 oedema.

Modality: 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 if 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
Case created: 28th May 2016
Last edited: 8th Jan 2017
Inclusion in quiz mode: Included

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