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Cr(VI) reduction by bacteria species isolated from Cr(VI) polluted landfill
181
Clinicctl Neurology and A’eueurosurgery, 94 ( 1992) I8 1-I 84 0 1992 Elsevier Science Publishers B.V. All rights reserved 0303-8467/92/$05.00
CLINEIJ 00192
Case report
Intraventricular
meningioma of the fourth ventricle
S. Ceylan”, K. Ilbay”, K. Kuzeyl’i”, M. Kaleli’o&f,
F. Aktiirk” and Y. &oranb
~ep~~rF~ents of“Neurosurger,v and ‘p~t~lolo~~~, IYTC‘j,Medical Faculty, Trabzon, Turkey (Received 19 August, 1991) (Revised, received 7 February, 1992) (Accepted 7 February, 1992)
KeJ: wards:
Meningioma: Fourth ventricle
A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor.
Intraventri~uiar meningiomas account for about 0.52% of all intracranial meningiomas. To our knowledge, only 24 cases of meningioma of the fourth ventricle have been reported [l-5]. We present a new case and summarize the ~linicopathological features of all 25 cases here (Table 1).
Case report A 48-year-old male was evaluated in January 1990 with a 2-month history of headache, nausea, vomiting and balance disturbance. Neurological examination revealed bilateral papilledema, horizontal nystagmus and ataxic gait. Plain skull films were normal and CT scan demonstrated dilatation of the lateral and 3rd ventricles. In the area of the 4th ventricle, there was a well demarcated mass lesion that was well enhanced by the contrast agent (Fig. 1). A suboccipital craniectomy was performed in the sit-
C~rr~.~pu~~en~e fo: Dr. Sava$ Ceylan, KTij, N~ro$ir~rji Biiliimii, 61080 Trabzon, Turkey.
Tip Fakiiltesi,
ting position. After splitting of the lower vermis, a well encapsulated tumor was readily identified at the inferior of the 4th ventricle. The tumor appeared to have arisen from the choroid plexus of the 4th ventricle. The mass was removed totally after hemostasis of the feeding arteries. Pathological examination revealed that the tumor was composed of meningothelial cells and numerous capillaries (angiomatous type according to WHO classification) (Fig. 2). The postoperative course was uneventful except for a mild vertigo. A postoperative CT scan demonstrated complete disappearance of the tumor. The patient was discharged 16 days after surgery.
Discussion Meningiomas constitute about 15% of primary brain tumors and of these intraventricular lesions account for only 0.52% [22]. The majority of intraventri~ular meningiomas are found in the trigone of the lateral ventricle f&7,23], Meningiomas of the 4th ventricle are very rare lesions [6,20,23,24]. Abraham and Chandy classified fourth ventricle meningiomas into three groups accord-
182 TABLE I SUMMARY
OF REPORTED
CASES OF PRIMARY
___ Sachs ( 1938) 161 Abbott and Courvill (19443)[7]
38/F 15/M
Petit-Dutaillis and Daum (1950) [8] Vogel and Stevenson f 1950)[5] Haas and Ritter (1954) f9] Zuleta ( 1955) [IO] Zuleta (1955) [IO] Schaerer and Robert ( 1960) [I I] Abraham and Chandy (1963)
55fF 65/M 41/M 8/M 11/M 42/F 40/F
Chaffee and
38/F
(1963)
HofTman et al. ( 1972) [ 131
44iF
Hoffman et al. (1971) [I31
61/M
Rodriguez-C~rb~j~l and Palacios ( 1974) [ f41 Rodriguez-Carbajal and Palacios ( 1974) [ 141 Klisek (1975) [15]
32/F 49/F
Magliocco et al. (I 97X) [ 161
7/F
Magliocco et al. ( 197X)1161
IS/M
Giikafp et al. (1981) [3]
30iF
Giromini et al. ( 19XI ) [I 71 Tsuboi et al. (19831 [I81
14/F 30/F
I l/M
Nagata et al. ( 1988) [ 191 Matsumara et al. (198X) [?OJ
62/M
Nakano et al. ( 1080) [4]
5X/F
Johnson et af. C1989) [2!] Present case
53/M 48/M
MENINGIOMA
Diagnostic procedure
Age/sex Signs and symptoms
Author (year)
Donaghy
INTRAVENTRICULAR
..__li __...._. ___
OF THE 4TH VENTRICLE -.-l--.I.
Extent of tumor removal
Histology __-
_II.- _..”_^__ _-.-.
auditory disturbance headache. vomiting. ataxia vomiting, ataxia
clinical examination total clinical ex~~rni~l~tion partial
fibroblastic fibrous
PVC
total
not reported
~~syrnpt~)in~ti~ ~sylnptom~ti~ headache. vomiting headache. nystagmus ataxia. nystagmus headache. vomiting, ;ita.xia headache, dysmetria. euphoria headache. vomiting. ataxia headache, ataxia memory deficit headache. vornitill~, ataxia nystagmus, ataxia
clinical examination clinical ex~lnjn~tion PVG PVG PEG clinical examination
autopsy autopsy only biopsy taken partial total
nienitl~othel~~l not reported diffuse type laminar type tibroblastic fibroblastic
angiography
total
rne~~i~~~~)thel~~l
angiography
t0td
trdnsitionril
PEC
total
transitional
~ligiogr~ph~ PEG
total
~~e~~i~~~othe~i~i
angiogrnphy, RI scan not reported
partial
meningotheliai
total
atypical
PVG
total
rn~ilin~otheli~[
CT. angiography
total
tibroblastic
CT, RI scan
total
CT CT. angiography
total
elldo~thelioln~~tous fibroblastic
CT, angiography
total
tibroblastic
CT. MR imaging, ~tigiogr~phy CT. IMR imaging, angiography CT. M R imaging CT
total
fibrobfastic
angiography.
headache, vomiting, ataxia headache. vomiting, ataxia headache, vomiting, ataxia headache. vomiting. ataxia headache, ataxia headache, vomiting, ataxia headache, vomiting, anisocoria ataxia
PEG.
total
total
total total total
-PVC: pneumoventriculography:
PEG: pneumoencephalography:
ing to the site of origin: I, meningiomas arising from the choroid plexus of the 4th ventricle and Iyirlg entirely within it: II, menin~iom~~s arising from the inferior tcla
RI: radioisotope.
and residing partly in the 4th ventricle and partly in the cerebcllar hemisphere, and III, lnetlingiom~s within the cisterna magna [l]. Our case was a type I meni~~gioln~,
183 there is no tumor more tumor
accurate
blush [ 191. MR imaging information
and surrounding
not perform
preoperative
about
structures
provides
the location
much of the
[4,20,21], but we did
MR imaging.
References J. and Chandy, J. (1963) Meningiomas of the I Abraham, posterior fossa without dural attachment: a case report. J. Neurosurg.. 20: 177-I 79. 2 Cantore, G., Ciapetta. P., Delfini. R. and Race. A. (1986) Meningiomas of the posterior cranial fossa without dural attachment. Surg. Neural., 25: 127 130. 3 Giikalp. H.Z.. Ozkal, E.. Erdogan. A. and Selcuk, M. ( 1981) A giant meningioma of the fourth ventricle associated with Sttirge-Weber disease. Acta Neurochir. (Wien), 57: 115 Fig. I. Preoperative enhanced CT scans show a circumscribed mass lesion in the 4th ventricle.
Some reported
series
of 4th ventricle
meningiomas
con-
only type I and II meningiomas [19,20]. According to Cushing and Eisenhardt [6], meningiomas of the 4th ventricle arise either from the choroid stituted
plexus of the 4th ventricle or from the inferior tela choroidea. In the case of 4th ventricle meningioma, the anatomical relationship to the 4th ventricle is important. At surgery, even meningiomas in the ventricle that were adherent to the choroid plexus were easily dissected from the ventricular wail and were completely excised without difficulty. Some authors have noted the usefulness of CT scanning [ 18, IO]. Although vertebral angiography is certainly useful, it may not provide the correct diagnosis when
Fig. 2. Photomicrographs
show meningothelial
120. K. 4 Nakano, S.. Uehara, H., Wakisaka, S. and Kinoshita. (1989) Meningioma of the fourth ventricle. Case report. Neurol. Med. Chir. (Tokyo), 29: 52254. L.D. (1950) Meningothelial 5 Vogel, F.S. and Stevenson. meningioma of the fourth ventricle. J. Neuropathol. Exp. Neural. 9: 443448. Thcit 6 Gushing. H. and Eisenhardt, L. (1962) Meningiomas. classification. Regional Behavior, Life History and Surgical End Results, Hafner. New York. pp. 139 140. 7 Abbott. K.H. and Courvill, C.B. (1942) Intraventriculnt meningiomas. Review of the literature and report of two cases. Bull. Los Angeles Neural. Sot., 2: 12 2X. 8 Petit-Dutaillis and Daum. S. (1950) Les meningiomcs fosse posterieure. Rev. Neural. (Paris). X3: 241 255. 9 Haas, A. and Ritter. S.A. (1954) A post-thyroidecomy
de la fatal-
ity due to a silent pedunculated meningioma of the fourth ventricle of the brain. Am. J. Surg., XX: 346350. 10 Zuleta, E.B. and Londone. L.R. (1955) Meningiomas dcl IV ventriculo. Acta Neurochir. (Wien). 22X 232.
cell nests among capillaries
(hematoxylineosin,
A: x12.5; B: x35).
184 11 Schaerer.
J.P. and
meningiomas
Robert,
D.W. (1960) lntraventricular
of the fourth ventricle. J. Neurosurg.,
I9 Nagata,
17: 337-
341. 12 Chaffee. B. and Donaghy, P. ( 1963) Case reports and technical notes. Meningioma of the fourth ventricle. J. Neurosurg.. 20: 520-522. 13 Hoffman, J.C., Bufkin, W.J. and Richardson, H.D. (1972) Primary intraventricular meningiomas of the fourth ventricle. Am. J. Radiol.. 115: lOO&lO4.
I4 Rodriguez-Carbajal. ular meningiomas
J. and Palacios. E. (I 974) Intraventricof the fourth ventricle. Am. J. Radiol..
120.27 31. I5 Killisek. L. ( 1975) Meningiom IV komory (meningioma the fourth chamber). Rozhl. Chir.. 54: 737-739.
of
I6 Magliocco. C.. Santucci, N.. Tenenbaum, P. and Kropp, F. (1978) Meningiomi de1 recess0 laterale del IV ventricolo. Osservazioni su 2 casi operati. Rev. Neurobiol., 24: 274280. I7 Giromini. D.. Peiffer. J. and Tzonos. T. (1981) ijber zwei Falle von Ventrikelmeningiomen im Kindesalter. Neurochirurgia. 24: 144-~146. I8 Tsuboi. K.. Nose. T. and Maki. Y. (1983) Meningioma of the fourth ventricle: a case report. Neurosurgery, 13: 1633 166.
Manaka,
K..
Basugi,
S. and
N.,
Sasaki,
Takakura,
T.,
K. (1988)
Hashimoto,
K.,
Intraventricular
meningioma of the fourth ventricle. Case report. Neurol. Med. Chir. (Tokyo), 28: 86690. 20 Matsamura. M., Takahashi, S.. Kurachi, H. and Tamura. M. (1988) Primary intraventricular meningioma of the fourth ventricle. Case report. Neurol. Med. Chir. (Tokyo). 28: 99661000. 21 Johnson, M., Tulipan, N. and Whetsell. W.O. (1989) Osteoblastic meningioma surgery, 24: 5877590.
of the
fourth
ventricle.
Neuro-
22 Wakai, S., Nakamura, K., Niizaki, K., Nagai. M., Nishizawa, T., Yokoyoma. S. and Katayama, S. (1984) Meningioma of the anterior third ventricle presenting with parkinsonizm. Surg. Neurol., 21: 88-92. 23 Kendall, B., Reider-Grosswasser. I. and Valentine, A. (1983) Diagnosis of masses presenting within the ventricles on computed tomography. Neuroradiology. 25: I I-22. 24 Corrales. M. (1972) Fourth ventricle. III. Intra- and extraaxial tumors. Acta Radiol. (Diagn.) (Stockh.), 13: 370390.
Clinicctl Neurology and A’eueurosurgery, 94 ( 1992) I8 1-I 84 0 1992 Elsevier Science Publishers B.V. All rights reserved 0303-8467/92/$05.00
CLINEIJ 00192
Case report
Intraventricular
meningioma of the fourth ventricle
S. Ceylan”, K. Ilbay”, K. Kuzeyl’i”, M. Kaleli’o&f,
F. Aktiirk” and Y. &oranb
~ep~~rF~ents of“Neurosurger,v and ‘p~t~lolo~~~, IYTC‘j,Medical Faculty, Trabzon, Turkey (Received 19 August, 1991) (Revised, received 7 February, 1992) (Accepted 7 February, 1992)
KeJ: wards:
Meningioma: Fourth ventricle
A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor.
Intraventri~uiar meningiomas account for about 0.52% of all intracranial meningiomas. To our knowledge, only 24 cases of meningioma of the fourth ventricle have been reported [l-5]. We present a new case and summarize the ~linicopathological features of all 25 cases here (Table 1).
Case report A 48-year-old male was evaluated in January 1990 with a 2-month history of headache, nausea, vomiting and balance disturbance. Neurological examination revealed bilateral papilledema, horizontal nystagmus and ataxic gait. Plain skull films were normal and CT scan demonstrated dilatation of the lateral and 3rd ventricles. In the area of the 4th ventricle, there was a well demarcated mass lesion that was well enhanced by the contrast agent (Fig. 1). A suboccipital craniectomy was performed in the sit-
C~rr~.~pu~~en~e fo: Dr. Sava$ Ceylan, KTij, N~ro$ir~rji Biiliimii, 61080 Trabzon, Turkey.
Tip Fakiiltesi,
ting position. After splitting of the lower vermis, a well encapsulated tumor was readily identified at the inferior of the 4th ventricle. The tumor appeared to have arisen from the choroid plexus of the 4th ventricle. The mass was removed totally after hemostasis of the feeding arteries. Pathological examination revealed that the tumor was composed of meningothelial cells and numerous capillaries (angiomatous type according to WHO classification) (Fig. 2). The postoperative course was uneventful except for a mild vertigo. A postoperative CT scan demonstrated complete disappearance of the tumor. The patient was discharged 16 days after surgery.
Discussion Meningiomas constitute about 15% of primary brain tumors and of these intraventricular lesions account for only 0.52% [22]. The majority of intraventri~ular meningiomas are found in the trigone of the lateral ventricle f&7,23], Meningiomas of the 4th ventricle are very rare lesions [6,20,23,24]. Abraham and Chandy classified fourth ventricle meningiomas into three groups accord-
182 TABLE I SUMMARY
OF REPORTED
CASES OF PRIMARY
___ Sachs ( 1938) 161 Abbott and Courvill (19443)[7]
38/F 15/M
Petit-Dutaillis and Daum (1950) [8] Vogel and Stevenson f 1950)[5] Haas and Ritter (1954) f9] Zuleta ( 1955) [IO] Zuleta (1955) [IO] Schaerer and Robert ( 1960) [I I] Abraham and Chandy (1963)
55fF 65/M 41/M 8/M 11/M 42/F 40/F
Chaffee and
38/F
(1963)
HofTman et al. ( 1972) [ 131
44iF
Hoffman et al. (1971) [I31
61/M
Rodriguez-C~rb~j~l and Palacios ( 1974) [ f41 Rodriguez-Carbajal and Palacios ( 1974) [ 141 Klisek (1975) [15]
32/F 49/F
Magliocco et al. (I 97X) [ 161
7/F
Magliocco et al. ( 197X)1161
IS/M
Giikafp et al. (1981) [3]
30iF
Giromini et al. ( 19XI ) [I 71 Tsuboi et al. (19831 [I81
14/F 30/F
I l/M
Nagata et al. ( 1988) [ 191 Matsumara et al. (198X) [?OJ
62/M
Nakano et al. ( 1080) [4]
5X/F
Johnson et af. C1989) [2!] Present case
53/M 48/M
MENINGIOMA
Diagnostic procedure
Age/sex Signs and symptoms
Author (year)
Donaghy
INTRAVENTRICULAR
..__li __...._. ___
OF THE 4TH VENTRICLE -.-l--.I.
Extent of tumor removal
Histology __-
_II.- _..”_^__ _-.-.
auditory disturbance headache. vomiting. ataxia vomiting, ataxia
clinical examination total clinical ex~~rni~l~tion partial
fibroblastic fibrous
PVC
total
not reported
~~syrnpt~)in~ti~ ~sylnptom~ti~ headache. vomiting headache. nystagmus ataxia. nystagmus headache. vomiting, ;ita.xia headache, dysmetria. euphoria headache. vomiting. ataxia headache, ataxia memory deficit headache. vornitill~, ataxia nystagmus, ataxia
clinical examination clinical ex~lnjn~tion PVG PVG PEG clinical examination
autopsy autopsy only biopsy taken partial total
nienitl~othel~~l not reported diffuse type laminar type tibroblastic fibroblastic
angiography
total
rne~~i~~~~)thel~~l
angiography
t0td
trdnsitionril
PEC
total
transitional
~ligiogr~ph~ PEG
total
~~e~~i~~~othe~i~i
angiogrnphy, RI scan not reported
partial
meningotheliai
total
atypical
PVG
total
rn~ilin~otheli~[
CT. angiography
total
tibroblastic
CT, RI scan
total
CT CT. angiography
total
elldo~thelioln~~tous fibroblastic
CT, angiography
total
tibroblastic
CT. MR imaging, ~tigiogr~phy CT. IMR imaging, angiography CT. M R imaging CT
total
fibrobfastic
angiography.
headache, vomiting, ataxia headache. vomiting, ataxia headache, vomiting, ataxia headache. vomiting. ataxia headache, ataxia headache, vomiting, ataxia headache, vomiting, anisocoria ataxia
PEG.
total
total
total total total
-PVC: pneumoventriculography:
PEG: pneumoencephalography:
ing to the site of origin: I, meningiomas arising from the choroid plexus of the 4th ventricle and Iyirlg entirely within it: II, menin~iom~~s arising from the inferior tcla
RI: radioisotope.
and residing partly in the 4th ventricle and partly in the cerebcllar hemisphere, and III, lnetlingiom~s within the cisterna magna [l]. Our case was a type I meni~~gioln~,
183 there is no tumor more tumor
accurate
blush [ 191. MR imaging information
and surrounding
not perform
preoperative
about
structures
provides
the location
much of the
[4,20,21], but we did
MR imaging.
References J. and Chandy, J. (1963) Meningiomas of the I Abraham, posterior fossa without dural attachment: a case report. J. Neurosurg.. 20: 177-I 79. 2 Cantore, G., Ciapetta. P., Delfini. R. and Race. A. (1986) Meningiomas of the posterior cranial fossa without dural attachment. Surg. Neural., 25: 127 130. 3 Giikalp. H.Z.. Ozkal, E.. Erdogan. A. and Selcuk, M. ( 1981) A giant meningioma of the fourth ventricle associated with Sttirge-Weber disease. Acta Neurochir. (Wien), 57: 115 Fig. I. Preoperative enhanced CT scans show a circumscribed mass lesion in the 4th ventricle.
Some reported
series
of 4th ventricle
meningiomas
con-
only type I and II meningiomas [19,20]. According to Cushing and Eisenhardt [6], meningiomas of the 4th ventricle arise either from the choroid stituted
plexus of the 4th ventricle or from the inferior tela choroidea. In the case of 4th ventricle meningioma, the anatomical relationship to the 4th ventricle is important. At surgery, even meningiomas in the ventricle that were adherent to the choroid plexus were easily dissected from the ventricular wail and were completely excised without difficulty. Some authors have noted the usefulness of CT scanning [ 18, IO]. Although vertebral angiography is certainly useful, it may not provide the correct diagnosis when
Fig. 2. Photomicrographs
show meningothelial
120. K. 4 Nakano, S.. Uehara, H., Wakisaka, S. and Kinoshita. (1989) Meningioma of the fourth ventricle. Case report. Neurol. Med. Chir. (Tokyo), 29: 52254. L.D. (1950) Meningothelial 5 Vogel, F.S. and Stevenson. meningioma of the fourth ventricle. J. Neuropathol. Exp. Neural. 9: 443448. Thcit 6 Gushing. H. and Eisenhardt, L. (1962) Meningiomas. classification. Regional Behavior, Life History and Surgical End Results, Hafner. New York. pp. 139 140. 7 Abbott. K.H. and Courvill, C.B. (1942) Intraventriculnt meningiomas. Review of the literature and report of two cases. Bull. Los Angeles Neural. Sot., 2: 12 2X. 8 Petit-Dutaillis and Daum. S. (1950) Les meningiomcs fosse posterieure. Rev. Neural. (Paris). X3: 241 255. 9 Haas, A. and Ritter. S.A. (1954) A post-thyroidecomy
de la fatal-
ity due to a silent pedunculated meningioma of the fourth ventricle of the brain. Am. J. Surg., XX: 346350. 10 Zuleta, E.B. and Londone. L.R. (1955) Meningiomas dcl IV ventriculo. Acta Neurochir. (Wien). 22X 232.
cell nests among capillaries
(hematoxylineosin,
A: x12.5; B: x35).
184 11 Schaerer.
J.P. and
meningiomas
Robert,
D.W. (1960) lntraventricular
of the fourth ventricle. J. Neurosurg.,
I9 Nagata,
17: 337-
341. 12 Chaffee. B. and Donaghy, P. ( 1963) Case reports and technical notes. Meningioma of the fourth ventricle. J. Neurosurg.. 20: 520-522. 13 Hoffman, J.C., Bufkin, W.J. and Richardson, H.D. (1972) Primary intraventricular meningiomas of the fourth ventricle. Am. J. Radiol.. 115: lOO&lO4.
I4 Rodriguez-Carbajal. ular meningiomas
J. and Palacios. E. (I 974) Intraventricof the fourth ventricle. Am. J. Radiol..
120.27 31. I5 Killisek. L. ( 1975) Meningiom IV komory (meningioma the fourth chamber). Rozhl. Chir.. 54: 737-739.
of
I6 Magliocco. C.. Santucci, N.. Tenenbaum, P. and Kropp, F. (1978) Meningiomi de1 recess0 laterale del IV ventricolo. Osservazioni su 2 casi operati. Rev. Neurobiol., 24: 274280. I7 Giromini. D.. Peiffer. J. and Tzonos. T. (1981) ijber zwei Falle von Ventrikelmeningiomen im Kindesalter. Neurochirurgia. 24: 144-~146. I8 Tsuboi. K.. Nose. T. and Maki. Y. (1983) Meningioma of the fourth ventricle: a case report. Neurosurgery, 13: 1633 166.
Manaka,
K..
Basugi,
S. and
N.,
Sasaki,
Takakura,
T.,
K. (1988)
Hashimoto,
K.,
Intraventricular
meningioma of the fourth ventricle. Case report. Neurol. Med. Chir. (Tokyo), 28: 86690. 20 Matsamura. M., Takahashi, S.. Kurachi, H. and Tamura. M. (1988) Primary intraventricular meningioma of the fourth ventricle. Case report. Neurol. Med. Chir. (Tokyo). 28: 99661000. 21 Johnson, M., Tulipan, N. and Whetsell. W.O. (1989) Osteoblastic meningioma surgery, 24: 5877590.
of the
fourth
ventricle.
Neuro-
22 Wakai, S., Nakamura, K., Niizaki, K., Nagai. M., Nishizawa, T., Yokoyoma. S. and Katayama, S. (1984) Meningioma of the anterior third ventricle presenting with parkinsonizm. Surg. Neurol., 21: 88-92. 23 Kendall, B., Reider-Grosswasser. I. and Valentine, A. (1983) Diagnosis of masses presenting within the ventricles on computed tomography. Neuroradiology. 25: I I-22. 24 Corrales. M. (1972) Fourth ventricle. III. Intra- and extraaxial tumors. Acta Radiol. (Diagn.) (Stockh.), 13: 370390.