Нейрорадіологічна діагностика менінгіом серед первинних пухлин бічних шлуночків

Abstract

Objective – to determine the main of neuroimaging characteristics meningiomas among primary tumors of the lateral ventricles. Materials and methods. The work is based on the analysis of a retrospective and prospective multicentric study. 275 history of disease patients with primary lateral ventricular tumors, among which 52 cases of the lateral ventricles meningiomas (LVM). Patients with LVM since 1990 to 2016 were treated in 6 neurosurgical institutions in Ukraine at SI «Romodanov Neurosurgery Institute NAMS of Ukraine» (n = 25, including 1 patient who was further operated in ^iv Regional Clinical Emergency Hospital), ^iv Regional Clinical Emergency Hospital (n = 13), Clinical Hospital «Feofaniya» (n = 5), Regional Clinical Hospital in Dnipro (n = 6), Uzhgorod (n = 3), Rivne (n = 1). All patients with a tumor of the lateral ventricle underwent magnetic resonance imaging (MRI) and computed tomography (CT) in standard modes, which were performed with a contrast. In the period since 1990 to 2000 CT was intended for all patients as the main method of diagnosis of this pathology, in the period since 1993 to 2016 – MRI. MRI allows to measure the tumor in three projections, identify adjacent structures located in close proximity to the tumor, and also provides images in the axial, coronary and sagittal sections. Results. According to CT and MRI data LVM were predominantly clearly delineated borders. In the anterior horn, meningiomas were localized in 2 (3.85 %) cases (one on the right and one on the left), in the trigone – in 22 (42.31 %o) cases (10 on the right and 12 on the left), in the posterior horn – in 20 (38.46 %) cases (8 on the right and 12 on the left). Less commonly in our study, neoplasms that spread beyond the limits of one ventricular chamber were detected: occupying the trigone within the left lateral ventricle with distribution in the temporal horn – 1 (1.92 %) case, occupying the frontal horn and the body of lateral ventricle – 2 (3.85 %) cases, both on the left. Also in establishing the preoperative diagnosis a cases of multiple meningiomas with great diagnostic value: in the area of the posterior horn on both side – 3 (5.77 %) cases (in one of which meningiomatosis was observed in the structure of the neurofibromatosis II), in the region of the anterior and posterior horns – 1 (1.92 %) case (in this patient individual meningeomas were located in the III and IV ventricles), the tumor occupying all the left ventricle from the frontal to the occipital horn, and another meningiomas occupying the occipital horn contralateral on the right side – 1 (1.92 %) case. Conclusions. Neuroimaging is important for determining the localization, structure, distribution and configuration of lateral ventricular tumors, involvement of adjacent structures. Careful study of CT/MRI images, taking into account age and general condition of patients (presence of concomitant diseases – neurofibromatosis, tuberous sclerosis, oncopathology of internal organs), allows at the preoperative diagnoses Identifying the histological type of tumor within the ventricle. Determination of specific features of the LVM according to neuroimaging allows to choose the optimal surgical access for each case.