Meningioma of the Fourth Ventricle: Literature Review

Meningiomas are among the most common central nervous system tumors, with an incidence that ranges from 15% to 40% of intracranial tumors. Of these, only 0.5% to 3% are intraventricular, and the rarest of them occurs in the fourth ventricle. Fourth-ventricle meningiomas originate generally fromthe choroid plexus and have no dural adhesions. Most often, they manifest in young patients, around 41 years of age, with a possible predominance in females, through intracranial hypertension and cerebellar syndromes. The treatment consists of surgical resection, which commonly presents good results due to the characteristics of the tumor. So, for better preoperative planning, the radiological differentiation of the most frequent tumors in this location is important. Themost common histologic subtypes are fibroblastic and meningothelial, both grade I according to the World Health Organization (WHO), although there are reports of tumors of grades II and III. We report a case ofmeningioma of the fourth ventricle operated in our institution, and we have conducted a literature review, through which we found that 57 cases have been reported so far, with the first one reported in 1938.

Trapped Fourth Ventricle in Recurrent Acoustic Schwannoma - A Rarity

Fourth ventricular dilatation is usually seen along with tri-ventriculomegaly in patients with communicating hydrocephalus. Isolated fourth ventricular dilatation is uncommon, especially as a sequelae following infective or post hemorrhagic communicating hydrocephalus. Communicating hydrocephalus is reported in vestibular schwannoma with an incidence of 3.7 to 23.5%, but 4th ventricular dilatation following its treatment has not been reported in the literature. We report a novel case of isolated fourth ventricular obstruction following surgery for recurrent vestibular schwannoma and ventriculoperitoneal shunt placement for communicating hydrocephalus. Management strategies range from endoscopic procedures to ventricular shunt placement. We describe the surgical technique for the placement of a fourth ventricular shunt with the use of a Y connector.

Em pacientes com hidrocefalia comunicante, a dilatação do quarto ventrículo é normalmente vista acompanhada de triventriculomegalia. A dilatação do quarto ventrículo isolado é incomum, especialmente como uma sequela subsequente à hidrocefalia comunicante infecciosa ou hemorrágica. Hidrocefalia comunicante é relatada em schwannoma vestibular com incidência de 3,7 a 23,5%, mas a dilatação do quarto ventrículo subsequente ao tratamento não foi encontrada na literatura. Relatamos caso de obstrução do quarto ventrículo isolado subsequente a cirurgia para schwannoma vestibular recorrente e shunt ventriculoperitoneal para hidrocefalia comunicante. As estratégias de manejo variam de procedimentos endoscópicos a shunt ventricular. Descrevemos técnica cirúrgica para alocação de shunt do quarto ventrículo com o uso de conector Y.

Chordoid Glioma with Intraventricular Dissemination: A Case Report with Perfusion MR Imaging Features

Chordoid glioma is a rare low grade tumor typically located in the third ventricle. Although a chordoid glioma can arise from ventricle with tumor cells having features of ependymal differentiation, intraventricular dissemination has not been reported. Here we report a case of a patient with third ventricular chordoid glioma and intraventricular dissemination in the lateral and fourth ventricles. We described the perfusion MR imaging features of our case different from a previous report.

Choroid plexus papilloma of the fourth ventricle.

A 14 year old girl presented with a 6 months' history of headache with vomiting, ataxia and cerebellar signs. CT and MRI revealed obstructive hydrocephalus secondary to a large fourth ventricular mass which enhanced markedly on contrast administration. Histopathology of the resected mass revealed papillary structures lined by cuboidal cells confirming choroid plexus papilloma.