Resident Brigham and Women's Hospital Boston, Massachusetts, United States
Introduction: Intraventricular meningiomas often present with giant size after an indolent clinical course. We sought to define the clinical course of intraventricular meningioma and characterize predictors of progression and survival.
Methods: This is an institutional retrospective cohort study including all adult cases of intraventricular meningioma diagnosed between 1993 and 2020 at the Brigham and Women’s Hospital.
Results: A total of 41 patients surgically treated for a intraventricular meningioma were identified, including 33 female patients (81%). The average age was 52 years (interquartile range 40-62). Patients most frequently presented with headache (59%), vision change (27%), and weakness (17%). Amongst the patients that had accessible preoperative imaging, 44% were calcified and 10% were hemorrhagic. Simpson grade 1 resection was achieved in 35 cases (85%), and gross total resection (GTR) was achieved in 31 of these cases (75%). 21 cases were WHO Grade I (51%), 13 cases were WHO Grade II (32%), and 7 cases were ungraded (17%). Five of seven cases without a WHO grade had atypical features, including prominent nucleoli and high mitotic indices. Eight cases had cytogenetic testing - seven had loss of 22q, 5 had loss of 1p, and 4 had loss of 6p. Post-operative stroke and hemorrhage were observed in 7% and 4% of patients, respectively. 15% of patients required ventriculoperitoneal shunts. By follow-up, 7 cases progressed or recurred (17%); including 11% after GTR and 50% after near-total or subtotal resection (STR) (p=0.001). The progression free survival was shorter for hemorrhagic lesions (p=0.005). 33% of cases with shunts experienced progression or recurrence compared to 14% of cases without shunts, though this was not statistically significant.
Conclusion : We identify a disproportionate number of higher-grade meningiomas in this cohort. Pre-operative hemorrhage and extent of resection predict progression or recurrence after surgery.
