Resection of a dominant-hemisphere intraventricular meningioma facilitated by functional magnetic resonance imaging

Case report

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Intraventricular meningiomas of the lateral ventricle occur relatively rarely, but they are often large at the time of detection and present more commonly on the left side. Although the ability to resect these tumors safely has greatly improved over time, standard surgical approaches often traverse cortex close to areas of specific cortical function. Precise cortical mapping of language and sensorimotor cortices can be accomplished noninvasively by using functional magnetic resonance (fMR) imaging. The authors used fMR imaging in planning the cortical incision for resection of a large intraventricular trigone meningioma in the dominant hemisphere of a patient who, postoperatively, suffered no aphasia or hemiparesis. The authors discuss the advantages of mapping cortical function preoperatively with fMR imaging when approaching intraventricular lesions.

Abbreviations used in this paper:AVM = arteriovenous malformation; BOLD = blood oxygen level–dependent; CBF = cerebral blood flow; ECS = electrical cortical stimulation; fMR = functional magnetic resonance; MR = magnetic resonance; PET = positron emission tomography.

Intraventricular meningiomas of the lateral ventricle occur relatively rarely, but they are often large at the time of detection and present more commonly on the left side. Although the ability to resect these tumors safely has greatly improved over time, standard surgical approaches often traverse cortex close to areas of specific cortical function. Precise cortical mapping of language and sensorimotor cortices can be accomplished noninvasively by using functional magnetic resonance (fMR) imaging. The authors used fMR imaging in planning the cortical incision for resection of a large intraventricular trigone meningioma in the dominant hemisphere of a patient who, postoperatively, suffered no aphasia or hemiparesis. The authors discuss the advantages of mapping cortical function preoperatively with fMR imaging when approaching intraventricular lesions.

Abbreviations used in this paper:AVM = arteriovenous malformation; BOLD = blood oxygen level–dependent; CBF = cerebral blood flow; ECS = electrical cortical stimulation; fMR = functional magnetic resonance; MR = magnetic resonance; PET = positron emission tomography.

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Address reprint requests to: G. Rees Cosgrove, M.D., F.R.C.S.(C), Massachusetts General Hospital, 15 Parkman Street, Suite 331, Boston, Massachusetts 02114–2696. email: cosgrove@helix.mgh.harvard.edu.

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