Trigone ventricular meningioma [Neurosurgery Wiki]

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====== Trigone ventricular meningioma ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1RMSezfb-YLzPE6pgmSgE3KWwpdHfzadjnZr3eKJJvXDEikAep/?limit=15&utm_campaign=pubmed-2&fc=20221219105556}}

[[Trigone]] meningioma is a [[intraventricular meningioma]] in a deep-seated location surrounded by intact neural tissue, near to vital ventricular structures, and deeply vascularized. 

Intraventricular [[intracranial meningioma]]s as a rule arise in the [[trigone]].

===== Diagnosis =====
Thirty patients with trigone meningiomas were enrolled in this retrospective study. Conventional MRI was performed in all patients; SWI (17 cases), dynamic contrast-enhanced PWI (10 cases), and dynamic susceptibility contrast PWI (6 cases) were performed. Demographics, conventional MRI features, SWI- and PWI-derived parameters were compared between different grades of trigone meningiomas.

On conventional MRI, the irregularity of tumor shape (ρ = 0.497, P = 0.005) and the extent of peritumoral edema (ρ = 0.187, P = 0.022) might help distinguish low-grade and high-grade trigone meningiomas. On multiparametric functional MRI, rTTPmax (1.17 ± 0.06 vs 1.30 ± 0.05, P = 0.048), Kep, Ve, and iAUC demonstrated their potentiality to predict World Health Organization grades I, II, and III trigone meningiomas.

Conventional MRI combined with dynamic susceptibility contrast and dynamic contrast-enhanced can help predict the World Health Organization grade of trigone meningiomas
((Yang X, Xiao Z, Xing Z, Lin X, Wang F, Cao D. Grading Trigone Meningiomas Using Conventional Magnetic Resonance Imaging With Susceptibility-Weighted Imaging and Perfusion-Weighted Imaging. J Comput Assist Tomogr. 2022 Jan-Feb 01;46(1):103-109. doi: 10.1097/RCT.0000000000001256. PMID: 35027521.)).

===== Treatment =====

[[Trigone ventricular meningioma treatment]].

===== Case series =====

[[Trigone ventricular meningioma case series]].

===== Case reports =====

[[Trigone ventricular meningioma case reports]].


===== Trigone Meningioma General University Hospital of Alicante Cases =====

A 65-year-old female refers to a [[speech disorder]] (slowed [[speech]] and stuttering) for months of evolution, the reason for which an MRI study was performed. Refers to impaired reading ([[blurred vision]] of some letters) associated.

Brain MRI:

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In the left hemisphere, a rounded tumor of 28 mm in greater diameter is located inside the lateral ventricle. It is a tumor slightly hypointense on T1, slightly hyperintense on Flair, and practically isointense on T2. The lesion uptakes contrast
intense and relatively uniform way. The posterior horn of the ventricle appears dilated and there is a modification
of the signal intensity of the adjacent tissue. However, the midline does not appear displaced. the ventricle
right lateral and third ventricles are dilated


[[General anesthesia]]. Right [[lateral decubitus position]] with [[Mayfield skull clamp]]. [[Incision]] and [[craniotomy]] location with [[craniometric point]]s ([[intraparietal point]]). Left [[parietal craniotomy]] with the high-speed motor. U-shaped dural opening with a sagittal sinus base. The [[postcentral sulcus]] and [[intraparietal sulcus]] are visualized in the [[cortex]]. Location of the [[atrium]] and tumor with [[intraoperative ultrasound]]. Approach through the [[intraparietal sulcus]] in its lower portion until the [[ventricle]] was opened and a pinkish-colored tumor with a rubbery consistency visible, macroscopically compatible with [[meningioma]]. Dissection of the edges at the intraventricular level, separating the [[choroid plexus]] and coagulating and sectioning several nutrient arteries. Tumor dissection with [[CUSA]] until leaving a small fragment that is dissected from the medial wall of the [[ventricle]] and excised. Macroscopically [[complete resection]]. Careful [[hemostasis]] and abundant washing. [[Dural closure]] is almost hermetic and sealed with [[Tachosil]]. [[Bone]] [[replacement]] with [[titanium]] trephine [[plate]]s and plugs. Cutaneous closure by planes. Stapled skin. The sample is sent to pathology.