Surgical Management of Meningioma of the Trigone Area of the Lateral Ventricle

OBJECTIVE: Lateral ventricular trigone meningioma is relatively rare and surgical resection is the main treatment strategy. It is a challenge to achieve total resection without any complication. We analyzed a series of cases using literature review. METHODS: Retrospective data was collected on patients who underwent surgical treatment for trigone meningioma at our department from 2007 to 2012. RESULTS: Forty-three patients were included (12 men, 31 women). The average age was 42.8 years old. The symptoms depended on tumor size and location; 38 had prominent symptoms. The preoperative neuroimaging help assess the entity, size, location, and blood supply of the tumor. All lesions were resected using the trans-sulcal temporal or parietal approach, with intraoperative ultrasound assistance. Total resection was achieved in all patients. Thirty-six patients had a ventricular drain, which was removed 1 to 14 days later. Of the patients having prominent symptoms, 31 had relief soon after the operation, the other 7 patients improved to some extent at long-term follow-up. Two patients developed intraoperative distant epidural hematoma, which was confirmed by ultrasound, and underwent hematoma evacuation immediately. Two patients were reoperated for extensive intracranial hypertension. Three patients developed localized hydrocephalus and 2 of those underwent ventriculoperitoneal shunt several months later and 1 patient had spontaneous relief. One patient had grade II meningioma and 2 had grade III; they underwent adjuvant radiotherapy. The follow-up period ranged from 2 to 71 months, with no recurrence. CONCLUSIONS: Surgical resection, using the trans-sulcal approach with intraoperative ultrasound assistance, can achieve a high rate of total resection and a low rate of complication, promising a good prognosis. The management technique and the perioperative treatment have to be individualized.