Case Report
Pediatr Neurosurg 2012;48:3034
DOI: 10.1159/000341176
Intraventricular Meningioma:
Case Report and Literature Review
Humphrey Okechi a A. Leland Albright a, b
a
Kijabe Hospital, Kijabe, Kenya; b University of Wisconsin Health Center, Madison, Wisc., USA
Key Words
Pediatric meningioma Radiological characteristics
Surgery Neuropathology Adjuvant therapy
Abstract
In this article we describe the clinical course of a child with an
intraventricular meningioma and review the relevant litera-
ture. A 7-year-old girl with a several-month history of head-
aches had a CT scan that demonstrated a large, enhancing,
intraventricular tumor. The tumor was completely excised via
a superior parietal approach. Pathological examination re-
vealed a pleomorphic meningioma. Postoperative scans
demonstrated no residual tumor. Pediatric intraventricular
tumors are rare. The surgical objective is complete resection,
which appears to be associated with excellent outcomes.
Copyright 2012 S. Karger AG, Basel
Introduction
Meningiomas are rare in children and intraventricu-
lar meningiomas are even rarer. In a review of 764 pedi-
atric tumors conducted by the International Society for
Pediatric Neurosurgery, 2% of the tumors were menin-
giomas and, of those, only 10% were intraventricular [1].
We report herein a 7-year-old girl with an intraventricu-
2012 S. Karger AG, Basel
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Received: April 10, 2012
Accepted after revision: June 11, 2012
Published online: August 21, 2012
lar meningioma that was completely resected, and review
the radiological and pathological features and outcomes
of pediatric intraventricular meningiomas.
Case Presentation
A 7-year-old right-handed girl presented with headache and
progressive right hemiparesis for 3 months. Her headache was
primarily nocturnal and was accompanied by nausea and vomit-
ing which improved the headache. She had no history of seizures
but a decline in school performance had been noted in the previ-
ous 7 months. On physical examination, she was healthy and alert
but unable to stand without support. She was macrocephalic, with
an abnormal cranial percussion sound. She had a right central
facial nerve paresis and a right hemiparesis, with exaggerated
deep tendon reflexes at the ankle joint but no clonus. Hoffmanns
sign was absent bilaterally.
Her brain MRI scan revealed a large, isodense, intraventricu-
lar mass in the atrium of the left lateral ventricle. On T1-weighted
images the mass enhanced homogeneously (fig. 13).
The mass was completely excised via a left parietooccipital
craniotomy with no postoperative neurological deficits. The his-
topathological diagnosis of the mass was a transitional-type me-
ningioma (fig. 4, 5). Postoperatively she developed aseptic menin-
gitis and a subdural effusion that was initially treated success-
fully with a subdural drain. The effusion recurred after 3 months
and resolved permanently after a second subdural drain was in-
serted for several days (fig. 6). At her last follow-up, 6 months
postoperatively, she was asymptomatic and her right hemiparesis
had completely resolved.
Humphrey Okechi, MD
Kijabe Hospital
PO Box 20
Kijabe 00220 (Kenya)
E-Mail humphreyokechi@yahoo.com
Fig. 1. Noncontrast-enhanced lateral T1
MRI.

Fig. 2. Contrast-enhanced axial T1 MRI.

Intraventricular Meningioma: Pediatr Neurosurg 2012;48:3034 31

Case Report and Literature Review
Fig. 3. Contrast-enhanced coronal T1
MRI.
Color version available online

Color version available online

Fig. 4. Low-power magnification showing histopathological fea- Fig. 5. High-power magnification showing histopathological fea-
tures of the transitional type meningioma, with characteristic tures of the transitional type meningioma, with characteristic
whorls. whorls.

Discussion the development of pediatric meningiomas: neurofibro-

Pediatric meningiomas are unquestionably rare tu-
mors, comprising about 2% of pediatric brain tumors in
many series 1.6% of 1,294 in the series reported by Mal-
lucci et al. [1] and 1.9% of 934 meningiomas reported by
Mehta et al. [2]. Two factors are known to predispose to
matosis and prior cranial irradiation. The child in our
case report had neither neurofibromatosis nor prior ir-
radiation. The frequency of concomitant neurofibroma-
tosis in children with meningiomas ranges from 19 to
29% [1, 3, 4]. A congenital intraventricular meningioma
associated with NF2 has also been reported [5].

32 Pediatr Neurosurg 2012;48:3034 Okechi /Albright

Fig. 6. Contrast-enhanced postoperative
axial CT scan.
The frequency of meningiomas is increased after
childhood irradiation but the latency period is long. Ba-
nerjee et al. [6] reviewed MR scans of 49 adults who re-
ceived radiation for childhood leukemia when they were
18 years old. Eleven of the 49 (22%) developed menin-
giomas 1434 years later (mean 25 years).
In most series of pediatric meningiomas, the tumors
occur within the ventricles much more commonly than
in adults. In a series of 675 adult meningiomas reported
by Liu et al. [7], only 3.7% were intraventricular. In 4 pe-
diatric series of 98 combined cases, 19 (19.4%) were intra-
ventricular [1, 2, 7, 8]. Ney et al. [9] reported an intraven-
tricular meningioma that developed 23 years after cra-
nial irradiation for acute lymphoblastic leukemia.
Children with intraventricular tumors typically pres-
ent with generalized symptoms such as headache, leth-
argy and vomiting and without lateralizing signs. Intra-
ventricular meningiomas are typically large noninfiltrat-
ing tumors that enhance homogeneously and contain
calcifications in 32% of cases [3]. The majority occur in
the trigone of the lateral ventricle. The differential diag-
nosis includes choroid plexus papillomas, ependymomas,
primitive neuroectodermal tumors, teratomas and astro-
cytomas.
Complete surgical resection is the preferred treatment.
Most intraventricular meningiomas have no dural at-
tachment. The surgical trajectory to tumors within the
atrium requires consideration of the location of the optic
Intraventricular Meningioma:
Case Report and Literature Review
radiation, lateral and inferior to the atrium. Because the
tumors are typically large, their removal is often followed
by the development of ipsilateral subdural hygromas,
which may need to be drained or shunted. Outcomes of
complete excision are not known and subtotal excisions
are associated with worse prognosis [1, 7].
Intraventricular meningiomas arise from arachnoid
cells contained within the choroid plexus, the tela choroi-
dea or the velum interpositum. In a series of 51 cases of
pediatric meningiomas from the Mayo clinic, ranging in
age from 7 to 20 years, 5 histological types were seen: me-
ningotheliomatous, fibrous, transitional, psammoma-
tous, and papillary [10]. In the series of 18 cases from
Mehta et al. [2], the frequency of atypical and aggressive
meningiomas was higher than in adults, with 8 transi-
tional tumors, 1 sarcomatous, 1 aggressive syncitial, and
1 malignamt tumor. In the study by Mallucci et al. [1], 5
of 21 pediatric meningiomas were malignant. Byard et al.
[11] reported two 9-year-old children with intraventricu-
lar meningiomas; 1 was fibroblastic/angioblastic and the
other fibroblastic. The intraventricular meningioma re-
ported by Curiea et al. [12] had atypical features with ar-
eas of nectosis and a high nuclear:cytoplasmic ratio, with
15% of cells being positive for Ki 67. The intraventricular
meningioma in the report by Orakdogen et al. [13] was
transitional. A metaplastic intraventricular meningioma
has also been reported in a child [14].
Pediatr Neurosurg 2012;48:3034 33
 In the Mayo clinic series of pediatric meningiomas,
the 15-year survival rate was 68% and survival correlated
with pathology, with papillary tumors having the lowest
survival [10]. Outcomes were not reported separately for
intraventricular meningiomas.
Adjuvant radiotherapy has been used following subto-
tal resection of pediatric meningiomas, with generally
poor outcomes. In a series of 34 pediatric and adolescent
patients with intracranial meningimomas, adjuvant ra-
diotherapy was given to patients with residual, malig-
nant, and recurrent tumors, with unclear benefit [15]. In
a meta-analysis of 35 series in which 547 children and
adolescents were eligible for overall survival analysis, re-
lapse-free survival and overall survival were significantly
better for those who had gross total resections than for
those with subtotal resections, and upfront radiotherapy
was found to be of no benefit [16].
Conclusion
Pediatric intraventricular meningiomas are rare tu-
mors with characteristic features on MR scans and histo-
pathological features different from their adult counter-
parts. Gross total resection is the preferred treatment and
appears to be associated with excellent outcomes.

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34 Pediatr Neurosurg 2012;48:3034 Okechi /Albright

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