Fourth ventricular meningioma

Fourth ventricular meningioma

Epidemiology

Of the intraventricular meningiomas, only 6% are primarily in the fourth ventricle1).

The most common age of onset was from the third decade to sixth decade of life. The female/male ratio was about 1.16:1. The most frequent subtype of meningioma was fibrous meningioma 2).

Diagnosis

The FVMs had specific imaging features, such as calcification (20%), peritumoral edema (30.3%), heterogeneous enhancement (22.5%), cystic formation (4.3%) and hydrocephalus (52.8%) 3).


The computed tomography (CT; n=5), magnetic resonance imaging (MRI; n=9) features and clinical presentations of 10 patients with pathologically documented fourth-ventricular meningiomas were retrospectively analysed.

All tumours appeared as well-demarcated masses in the fourth ventricle at CT and MRI. The tumour shape was round in eight cases (80%) and irregular in two cases (20%). The CT images of five cases showed predominantly isoattenuation in three cases and high attenuation in two cases, with a mean attenuation value of 52 HU. In addition, calcifications were seen in three cases. At MRI, nine masses were isointense (n=6) or hypointense (n=3) to grey matter on T1-weighted images and mildly hyperintense (n=4), isointense (n=3), hypointense (n=1), and of mixed signal intensity (n=1) on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. Signal voids were visible in two cases. Enhancement after injection of contrast material was marked homogeneous (n=5) or heterogeneous (n=5) on CT or T1-weighted images. Three tumours had mild peritumoural oedema. Three tumours were associated with obstructive hydrocephalus. The pathological subtype of the 10 meningiomas was fibromatous (n=5), atypical (n=2), and one each of transitional, psammomatous, and clear-cell type.

The relatively typical radiological appearance, combined the age and sex of patients, can suggest the diagnosis of fourth-ventricular meningioma 4).

Treatment

The recommended treatment is surgical treatment via the telovelar approach with suboccipital craniotomy/craniectomyAdjuvant therapy is needed in some of the high grade meningiomas and in cases underwent partial resection 5).

Outcome

The prognosis is relatively good, with less postoperative complications and higher rate of total resection 6).

In the series of Luo et al., the proportion of total tumor resection was about 94.9%, with 15.3% of postoperative complications. During follow-up, the recurrent rate of FVMs was about 6.8%. There was no significant difference in the analysis of correlation between hydrocephalus and the maximum diameter of tumors, correlation between hydrocephalus and the volume of tumor, correlation between peritumoral edema and the volume of tumor, as well as correlation between heterogeneous enhancement and the grade of meningiomas 7).

Case series

Luo et al., published a series of eleven Fourth ventricular meningioma at one single institution. A comprehensive literature analysis was conducted.

The information of eleven cases were extracted from the patient data. And English cases were obtained from the literature. Including the 11 cases, 71 cases were analyzed in this study. 8).


Sadashiva et al., published two cases harboring a primary fourth ventricular meningioma Grade II, which was surgically excised successfully. Total excision was achieved in both cases and as the tumor was firm to soft and vermian splitting was not required. Understanding the clinical features and a careful preoperative radiological examination is required to differentiate this tumor from more commonly occurring lesions at this location 9).


Zhang et al., presented the neuroradiological and clinical findings of fourth-ventricular meningiomas to increase awareness of this entity.

The computed tomography (CT; n=5), magnetic resonance imaging (MRI; n=9) features and clinical presentations of 10 patients with pathologically documented fourth-ventricular meningiomas were retrospectively analysed.

All tumours appeared as well-demarcated masses in the fourth ventricle at CT and MRI. The tumour shape was round in eight cases (80%) and irregular in two cases (20%). The CT images of five cases showed predominantly isoattenuation in three cases and high attenuation in two cases, with a mean attenuation value of 52 HU. In addition, calcifications were seen in three cases. At MRI, nine masses were isointense (n=6) or hypointense (n=3) to grey matter on T1-weighted images and mildly hyperintense (n=4), isointense (n=3), hypointense (n=1), and of mixed signal intensity (n=1) on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. Signal voids were visible in two cases. Enhancement after injection of contrast material was marked homogeneous (n=5) or heterogeneous (n=5) on CT or T1-weighted images. Three tumours had mild peritumoural oedema. Three tumours were associated with obstructive hydrocephalus. The pathological subtype of the 10 meningiomas was fibromatous (n=5), atypical (n=2), and one each of transitional, psammomatous, and clear-cell type.

Although fourth-ventricular meningioma is quite rare, it should be considered in differential diagnosis of neoplasms within the fourth ventricle. The relatively typical radiological appearance, combined the age and sex of patients, can suggest the diagnosis of fourth-ventricular meningioma 10).


A adult patient with a rare chordoid meningioma located within the fourth ventricle. This lesion was treated with gross total resection. Chordoid meningioma must be considered within the differential diagnosis of intraventricular tumors. This histological subtype of meningioma warrants close follow-up. The patient must also be evaluated for systemic manifestations of Castleman’s disease 11).


Case reports

A 14-year-old man with seizure and headache. The magnetic resonance imaging reported bilateral acoustic neuroma and fourth ventricle meningioma. The patient was scheduled for total tumor resection and the histopathology revealed psammomatous type of meningioma. The patient discharged with good general status 12).


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 13).


A 25-year-old man with fourth ventricular meningioma. Qin et al., refer to the usefulness of diffusion-weighted imaging and apparent diffusion coefficient measurements for the differential diagnosis of fourth ventricular tumors 14).


A fourth ventricular clear cell meningioma without dural attachment in a 14-year-old boy with an unusual presentation of failure to thrive 15).


Lyngdoh et al., published in 2007 two cases 16).


Liu et al., published one case in a series of intraventricular meningiomas 17).


A 76 year old male patient presenting with a 2-week history of headache and cognitive disorders with agitation and restlessness particularly exacerbated at night or when lying down. CT scan and MR imaging showed a contrast-enhancing lesion located purely within the whole fourth ventricle, with slight ventricular enlargement. At surgery, we totally removed a well-vascularised, greyish encapsulated mass attached to the choroid plexus. Pathological examination revealed a WHO grade I fibroblastic meningioma 18).


A 72-year-old female presented with an intra-fourth ventricular meningioma manifesting as truncal ataxia. Computed tomography (CT) showed a slightly high-density, well-demarcated, and homogeneously enhanced mass located in the fourth ventricle and extending to the right lateral recess. T2-weighted magnetic resonance (MR) imaging revealed a peritumoral high-intensity band without dural tail sign. Bilateral vertebral angiography revealed faint tumor staining supplied from the choroidal branches of the posterior inferior cerebellar arteries. The mass was totally resected via a suboccipital approach. CT, T2-weighted MR imaging, and vertebral angiography are informative for the preoperative diagnosis of fourth ventricular meningioma 19).


A 72-year-old man operated upon for such a tumor. The pre-operative magnetic resonance images revealed a well circumscribed mass in the fourth ventricle that exhibited a low signal on T1-weighted magnetic resonance images and homogenously enhanced with gadolinium. By light microscopy the tumor was composed of tightly packed spindle cells separated by collagen. Immunohistochemistry showed the tumor cells to be positive for vimentin and epithelial membrane antigen, and negative for glial fibrillary acidic protein. Electron microscopy revealed typical findings of meningioma, including interdigitating cell processes, desmosomes, and intermediate filaments. Although rare, fibroblastic meningioma must be included in the differential diagnosis of a fourth ventricular spindle cell tumor in elderly patients 20).


In 1992 a rare case of fourth ventricle meningioma with a combined intraventricular-intracerebellar localization, successfully removed by surgical treatment, is reported 21).


Perry et al., reported two cases, one with typical CT, angiographic, and magnetic resonance (MR) appearances and one with atypical features of central cyst formation on CT and MR. The utility of MR in demonstrating intraventricular location in three imaging planes is illustrated. Given the rarity of these tumors, atypical features may preclude accurate preoperative diagnosis, even with MR 22)


Rodriguez-Carbajal and Palacios published in 1974 2 cases 23).

References

1)

Alver I, Abuzayed B, Kafadar AM, Muhammedrezai S, Sanus GZ, Akar Z. Primary fourth ventricular meningioma: Case report and review of the literature. Turk Neurosurg. 2011;21:249–53.
2) , 3) , 5) , 6) , 7) , 8)

Luo W, Xu Y, Yang J, Liu Z, Liu H. Fourth ventricular meningiomas. World Neurosurg. 2019 Apr 17. pii: S1878-8750(19)31089-7. doi: 10.1016/j.wneu.2019.04.097. [Epub ahead of print] PubMed PMID: 31004862.
4) , 10)

Zhang BY, Yin B, Li YX, Wu JS, Chen H, Wang XQ, Geng DY. Neuroradiological findings and clinical features of fourth-ventricular meningioma: a study of 10 cases. Clin Radiol. 2012 May;67(5):455-60. doi: 10.1016/j.crad.2011.10.017. Epub 2011 Dec 6. PubMed PMID: 22153230.
9)

Sadashiva N, Rao S, Srinivas D, Shukla D. Primary intra-fourth ventricular meningioma: Report two cases. J Neurosci Rural Pract. 2016 Apr-Jun;7(2):276-8. doi: 10.4103/0976-3147.178665. PubMed PMID: 27114661; PubMed Central PMCID: PMC4821938.
11)

Wind JJ, Jones RV, Roberti F. Fourth ventricular chordoid meningioma. J Clin Neurosci. 2010 Oct;17(10):1301-3. doi: 10.1016/j.jocn.2010.03.013. Epub 2010 Jul 31. PubMed PMID: 20673720.
12)

Salehpour F, Aghazadeh J, Bazzazi AM, Mirzaei F, Eftekhar Saadat AT, Alavi SAN. Meningioma in Fourth Ventricle of Brain: A Case Report and Literature Review. Asian J Neurosurg. 2018 Apr-Jun;13(2):428-430. doi: 10.4103/1793-5482.228551. PubMed PMID: 29682051; PubMed Central PMCID: PMC5898122.
13)

Takeuchi S, Sugawara T, Masaoka H, Takasato Y. Fourth ventricular meningioma: a case report and literature review. Acta Neurol Belg. 2012 Mar;112(1):97-100. doi: 10.1007/s13760-012-0040-2. Epub 2012 Feb 3. Review. PubMed PMID: 22427300.
14)

Qin Y, Kanasaki Y, Takasugi M, Shinohara Y, Kaminou T, Kurosaki M, Ogawa T. Primary fourth ventricular meningioma: a case report of an adult male. Clin Imaging. 2012 Jul-Aug;36(4):379-82. doi: 10.1016/j.clinimag.2011.11.034. Epub 2012 Jun 8. PubMed PMID: 22726979.
15)

Burgan OT, Bahl A, Critcher V, Zaki HS, McMullan PJ, Sinha S. Clear cell meningioma of the fourth ventricle in a child: a case report and literature review. Pediatr Neurosurg. 2010;46(6):462-5. doi: 10.1159/000325072. Epub 2011 May 3. Review. PubMed PMID: 21540624.
16)

Lyngdoh BT, Giri PJ, Behari S, Banerji D, Chhabra DK, Jain VK. Intraventricular meningiomas: a surgical challenge. J Clin Neurosci. 2007 May;14(5):442-8. Epub 2007 Mar 12. PubMed PMID: 17350844.
17)

Liu M, Wei Y, Liu Y, Zhu S, Li X. Intraventricular meninigiomas: a report of 25 cases. Neurosurg Rev. 2006 Jan;29(1):36-40. Epub 2005 Oct 12. PubMed PMID: 16220350.
18)

Chaskis C, Buisseret T, Michotte A, D’Haens J. Meningioma of the fourth ventricle presenting with intermittent behaviour disorders: a case report and review of the literature. J Clin Neurosci. 2001 May;8 Suppl 1:59-62. Review. PubMed PMID: 11386828.
19)

Akimoto J, Sato Y, Tsutsumi M, Haraoka J. Fourth ventricular meningioma in an adult–case report. Neurol Med Chir (Tokyo). 2001 Aug;41(8):402-5. PubMed PMID: 11561352.
20)

Cummings TJ, Bentley RC, Gray L, Check WE, Lanier TE, McLendon RE. Meningioma of the fourth ventricle. Clin Neuropathol. 1999 Sep-Oct;18(5):265-9. PubMed PMID: 10505436.
21)

Delfini R, Capone R, Ciappetta P, Domenicucci M. Meningioma of the fourth ventricle: a case report. Neurosurg Rev. 1992;15(2):147-9. PubMed PMID: 1635630.
22)

Perry RD, Parker GD, Hallinan JM. CT and MR imaging of fourth ventricular meningiomas. J Comput Assist Tomogr. 1990 Mar-Apr;14(2):276-80. PubMed PMID: 2312858.
23)

Rodriguez-Carbajal J, Palacios E. Intraventricular meningiomas of the fourth ventricle. Am J Roentgenol Radium Ther Nucl Med. 1974 Jan;120(1):27-31. PubMed PMID: 4543954.

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Sylvian fissure meningioma without dural attachment

Sylvian fissure meningioma without dural attachment

Sylvian fissure meningiomas (SFMs) represent a rare subgroup of nondural-based tumors arising from the meningothelial cells within the arachnoid of the Sylvian fissure.

In 1938 Harvey Williams Cushing and Louise Eisenhardt reported two cases of this type of tumor named as “Deep Sylvian Meningiomas” 1).

Epidemiology

The reported adult SFMs patients are young (mean age of 34.95 ± 3.35 years; 95% CI [27.93–41.97]) with a M:F ratio of 1.22 (11/9) and in the pediatric population (mean age is 5.71 ± 1.61 years; 95% CI [1.76-9.66]; the M:F ratio is 2:1 (4/2 and 1 unknown). When comparing grade I and grade II lesions, there is no significant differences in terms of mean age (grade I: 26.87 ± 3.90 years; vs grade II 24.33 ± 7.01 years; t-test p > 0.05), gender (grade I M:F ratio – 1.2 [12/10] versus grade II M:F ratio – 5 [5/1)]), clinical presentation (seizures is the most common presentation in both groups – grade 1 – 74% (17/23) and grade II – 67% (4/6)] and extent of resection (total resection in grade 1 – 65% [1/23] and total resection in grade II – 50% [3/6].

Only six atypical WHO grade II SFMs have been previously described 2).

Clinical features

They usually manifest with seizures and display the same radiological features of meningiomas in other locations.

Differential diagnosis

SFMs are rare entities and it is important to differentiate them from the sphenoid wing meningiomas. These are attached to the dura overlying the sphenoid wings, are usually associated with hyperostosis and they displace the MCA backwards as they grow, while the SFMs do not have dural attachment, do not produce hyperostosis and grow inbetween the MCA branches 3).

Treatment

Although the absence of dural attachment makes these tumors suitable for a complete resection, their anatomical relationships with the middle cerebral artery branches may impair its achievement.

In the case of recurrent meningioma, surgical resection and adjuvant radiation therapy could be effective for long-term control of the tumor. 4).

Case reports

Hong et al., presented a histologically regressed relapsed meningioma, which spontaneously regressed after subtotal resection. In the case of recurrent meningioma, surgical resection and adjuvant radiation therapy could be effective for long-term control of the tumor. 5).


Donovan and Thavapalan, report two additional cases of sylvian fissure meningioma without dural attachment and one case of perisylvian meningioangiomatosis in the medial temporal lobe. All three patients presented with complex partial seizures, but the diagnosis was delayed in each case because the symptoms were misinterpreted to be behavioral rather than epileptic. The seizures were eventually confirmed with electroencephalogram, and subsequent imaging showed enhancing masses within the sylvian fissure region that were at least partially calcified in all three cases. Each patient underwent craniotomy. In the first case, gross total resection was achieved, and in the second case, a small residual portion of tumor was densely calcified and adherent to the middle cerebral artery branches. Both of these were World Health Organization (WHO) grade I meningiomas. The third patient underwent biopsy and limited resection of meningioangiomatosis. No dural attachments were noted in any of the tumors, but one of the meningiomas was intraparenchymal in location, surrounding the sylvian fissure in both the frontal and temporal lobes, which has been described in only a small number of these cases previously. The patients underwent pre- and postsurgical neuropsychiatric testing and did not experience any significant cognitive deficits. At 10-year follow-up, the patient who had gross total resection of the tumor has had no recurrence and is seizure-free without anticonvulsant medications. The incompletely resected intraparenchymal meningioma in the second patient recurred after 5 years, however, and at repeat surgery was found to have transformed to a WHO grade II tumor. Radiation therapy was delivered and the tumor has been stable for 2 years, but the patient continues to have occasional seizures despite medication. The patient with meningioangiomatosis has had no further growth and has excellent control of seizures but remains on medication. 6).


A heterogeneous contrast-enhanced mass in the right sylvian fissure of a 10-year-old boy with a 3-year history of epilepsy was identified via magnetic resonance imaging. The patient underwent partial surgical resection because the tumor was hard and contained numerous perforators arising from the right middle cerebral artery. The tumor was histologically diagnosed as sclerosing meningioma. Twelve months after surgery, the patient was asymptomatic and did not require any additional therapies. This case is the first report of a sclerosing meningioma arising in the deep sylvian fissure 7).


Aras et al., reported staged surgery for sylvian fissure meningiomas without dural attachment in two cases 8).


In 2013 a Deep Sylvian Meningioma in a 43-Year-Old Man 9).


Ma et al., reported a case of sylvian fissure atypical meningioma with a 20-year history. The tumor was excised subtotally, thereafter a postoperative radiation therapy was done. The patient had a favorable outcome during the two-year follow-up 10).


Miyahara et al., reported a 34-year-old female with an 8-year history of temporal lobe epilepsy. Magnetic resonance imaging showed a multilobular, well-demarcated and homogeneous tumorous lesion of 5 cm in diameter deep in the left sylvian fissure. Intraoperative findings revealed that the tumor was mainly in the left insular region without dural attachment and strongly adhered to the left middle cerebral artery and its perforators. The histopathological diagnosis was transitional meningioma without malignancy 11).


Cecchi et al., described an atypical sylvian fissure meningioma in a 23-year-old male with a brief history of headache and mild hemiparesis 12).


A 6-year-old boy presented with seizures. Computed tomography and magnetic resonance imaging showed a large enhancing mass in the left temporo-parietal region.

He underwent left temporo-parietal craniotomy and total excision of the lesion. At surgery, there was no dural attachment, and the tumor was mainly in the posterior part of left sylvian fissure. The biopsy was reported as WHO grade I meningioma.

At 4-year follow-up, he was asymptomatic, and there was no tumor recurrence. 13).


Brain CT scan performed on a 73-year-old woman on admission for non-specific symptoms revealed. a heterodense temporoparietal mass which was demonstrated on carotid angiography as being fed by the middle cerebral artery. Preoperatively, a glioma was considered as being most probable because of its radiological features. The mass, which at surgery was found to be located in the sylvian fissure, was histologically confirmed to be a meningotheliomatous meningioma with fibroblastic component 14).


In 2005 McIver et al., first reported case of a chordoid meningioma without dural attachment arising in the sylvian fissure.

The patient presented with a generalized seizure. A heterogeneously enhancing right frontotemporal mass was identified on magnetic resonance imaging of the brain.

The patient underwent a failed stereotactic biopsy attempt elsewhere. The tumor was ultimately resected using standard microsurgical techniques.15).


A 35-year-old male. The patient visited the hospital because of a 10-year history of simple partial seizures. Magnetic resonance imaging revealed a 3.5-cm, well-circumscribed, homogenously enhanced, circular mass without dural attachments in the left insular region. The tumor was not stained on angiogram. The tumor was located in the extra-axial space of the sylvian fissure without any dural attachment, and was strongly attached to the middle cerebral artery. The tumor was excised, and a histological diagnosis of a transitional meningioma without a malignancy was made 16).


In 2002 a Pediatric sylvian fissure meningioma 17).


A one-year-eight-month old child who experienced the onset of a convulsive seizure. He had no neurological deficit and no developmental disorders. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large left temporal tumor which was well enhanced and without dural attachment. Angiography revealed a slight tumor stain in the left Sylvian fissure supplied by branches of the internal carotid artery. Total removal of the tumor was performed, and they found that the tumor had no dural attachment, but was strongly attached to the M2 segment of the left middle cerebral artery. Pathological examinations revealed it to be a fibrous meningioma without malignancy 18).


Cooper et al., reported in 1997 a case in a 4-year-old child 19).


A 62-year-old woman was admitted because of one year history of temporal lobe epilepsy. She had no neurological deficit except for EEG abnormality. CT scans showed a small calcified mass in the left temporal lobe adjacent to the sylvian fissure with no enhancement by contrast medium. The mass was low-intense in both T1- and T2-weighted MR images. The T1-weighted image after the infusion of gadolinium revealed enhancement of the middle cerebral artery adjacent to the mass, similar to dural tail sign. Left external carotid angiography did not show any tumor stain nor the dilatation of the middle meningeal artery. Left internal carotid angiography disclosed enlarged middle cerebral artery without tumor stain. A left frontotemporal craniotomy was performed and the mass was totally removed. The tumor was located deep in sylvian fissure without any connection to the dura or ventricular system, which was firmly adherent to the middle cerebral artery. The histological examination of the surgical specimen revealed a psammomatous meningioma MR findings in deep sylvian meningioma was described 20).


Mori et al., reported a 12-year-old boy who has been suffering from severe headache for a month. Neurological examination was normal. CT scan and MR images showed a well-enhanced 7 cm mass lesion with small cysts, located in the left sylvian fissure. Peritumoral edema was slight and the midline structures were minimally shifted in spite of its large size. A fronto-temporal craniotomy was made and the tumor was grossly totally removed. The tumor had no dural attachment and existed in the left sylvian fissure, involving the middle cerebral artery and its branches. The histological diagnosis was transitional meningioma without malignancy. The postoperative course was uneventful except for transient mild left oculomotor palsy for several days. He is doing well now one year after the surgery and follow-up MR images showed no recurrence. Intracranial meningioma is rare in children. According to the literature, meningioma in children is slightly more frequent in males. There is a higher incidence of lack of dural attachment and cystic tumors than in adults. Deep sylvian meningioma without dural attachment is also very rare. Including our case, 13 cases of deep sylvian meningioma were reported in the literature. Four of them were under 20 years old. We report this case in detail with other cases reported previously. 21).


Chiocca et al., reported a deep sylvian fissure meningioma without dural attachments in the right hemisphere of an adult patient. The patient initially presented with simple partial seizures. Magnetic resonance imaging revealed a contrast-enhancing circular mass in the superior aspect of the insular region, deep to the inferior parietal lobule. Surgical exploration confirmed the absence of dural attachments. Microscopically, the tumor was found to be a sparsely cellular meningioma with an extensive collagenous matrix 22).


Graziani et al., in 1992 reported a case 23).


Cho et al., published a 2-year-old boy with a deep sylvian meningioma 24).


Silbergeld et al., a Sylvian fissure meningioma in a 4-year-old female 25).


In 1986 a 34-year-old Japanese woman, who had experienced several episodes of fainting attacks since 19 years old, was admitted to our hospital on March 22, 1983. Her plain skull roentgenogram showed abnormal calcification in her left fronto-temporal region. CT scan demonstrated clear-marginal high density mass in the left sylvian fissure which was homogeneously enhanced after administration of contrast medium. Left carotid angiogram showed intrasylvian mass with small tumor stain in late arterial phase, but external carotid artery had no concern with this tumor. On March 30, left fronto-temporal craniotomy was performed. The tumor was located in the extra-axial space of the sylvian fissure without any attachment to the dura mater or to the choroid plexus of the ventricles. This hard tumor, 70 grams in its weight, was successfully removed. It was histologically diagnosed fibroblastic meningioma. The patient was discharged without any neurological deficits. Twenty-four cases of meningiomas not attached to the dura mater or to choroid plexus could be reviewed from the literature. This type of meningioma is occasionally called “deep sylvian meningioma”, but in some reports the tumors developed far from sylvian fissure. And even in the cases in which the tumors were reported to be located in the sylvian fissure, macroscopic space where tumors developed was various. The clinical features, diagnosis, and surgical management of this tumor were also discussed in the report 26).


Okamoto et al., published a 35-year-old woman who was precisely diagnosed preoperatively with the aid of computed tomography and stereoscopic cerebral angiography. On reviewing the literature, it appears to be the first case that has been accurately diagnosed preoperatively and successfully treated by a total excision without serious complication 27).


Tsuchida et al., in 1981 published the only one of deep sylvian meningioma in the whole series of 181 intracranial meningiomas and probably the twentieth case reported so far in the literature. 28).


Saito et al., reported a case of 31-year-old female who had episodes of fainting attack. She had no significant neurological deficit but had EEG abnormality. Carotid angiography showed a tumor stain, ca. 1.7 cm in diameter, near the right insula. CT scan also revealed a high density area at the same site. At the time of operation, a small tumor located deeply in the right sylvian fissure was found out and successfully removed. Histologically, this tumor was diagnosed as a meningioma having some typical psammomatous features 29).


Mori et al., reported a case of “deep sylvian meningioma” 30).


Barcia-Goyanes and Calvo-Garra described a case in 1953 31),

References

1)

Cushing H, Eisenhardt L: Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, Charles C. Thomas, 1938.
2)

Brogna C, Lavrador JP, Patel S, Ribas EC, Aizpurua M, Vergani F, Ashkan K, Bhangoo R. Grade II Sylvian fissure meningiomas without dural attachment: case report and review of the literature. CNS Oncol. 2018 Dec 1;7(4):CNS20. doi: 10.2217/cns-2018-0004. Epub 2018 Oct 2. PubMed PMID: 30277091; PubMed Central PMCID: PMC6331700.
3)

Cecchi PC, Campello M, Rizzo P, Mair K, Schwarz A. Atypical meningioma of the sylvian fissure. J Clin Neurosci. 2009 Sep;16(9):1234-9. doi: 10.1016/j.jocn.2008.10.027. Epub 2009 Jun 3. PubMed PMID: 19497747.
4) , 5)

Hong S, Usami K, Hirokawa D, Ogiwara H. Pediatric meningiomas: a report of 5 cases and review of literature. Childs Nerv Syst. 2019 Apr 18. doi: 10.1007/s00381-019-04142-y. [Epub ahead of print] PubMed PMID: 31001646.
6)

Donovan DJ, Thavapalan V. Pediatric Meningeal Tumors of the Sylvian Fissure Region without Dural Attachment: A Series of Three Patients and Review of the Literature. Surg J (N Y). 2016 May 26;2(2):e31-e36. doi: 10.1055/s-0036-1584166. eCollection 2016 Apr. Review. PubMed PMID: 28824987; PubMed Central PMCID: PMC5553465.
7)

Fukushima S, Narita Y, Yonezawa M, Ohno M, Arita H, Miyakita Y, Ichimura K, Yoshida A, Shibui S. Short communication: sclerosing meningioma in the deep sylvian fissure. Brain Tumor Pathol. 2014 Oct;31(4):289-92. doi: 10.1007/s10014-013-0167-8. Epub 2013 Oct 19. PubMed PMID: 24141724.
8)

Aras Y, Akcakaya MO, Aydoseli A, Izgi N. Staged surgery for sylvian fissure meningiomas without dural attachment: report of two cases. Clin Neurol Neurosurg. 2013 Aug;115(8):1527-9. doi: 10.1016/j.clineuro.2012.12.010. Epub 2013 Jan 3. PubMed PMID: 23290420.
9)

Kim JY, Lee EJ, Chang HW, et al. Deep Sylvian meningioma in a 43-year-old man: a case report. J. Korean Soc. Magn. Reson. Med. 2013;17(4):308–311
10)

Ma L, Xiao SY, Zhang YK. Atypical meningioma of sylvian fissure with a 20-year history: a rare case report. Neurol Sci. 2012 Feb;33(1):143-5. doi: 10.1007/s10072-011-0637-x. Epub 2011 May 27. PubMed PMID: 21617950.
11)

Miyahara K, Ichikawa T, Yagishita S, Mukaihara S, Okada T, Kaku S, Tanino S, Uriu Y, Fujitsu K, Niino H. [Deep sylvian meningioma without dural attachment: a case report]. No Shinkei Geka. 2011 Nov;39(11):1067-72. Review. Japanese. PubMed PMID: 22036818.
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