Management of pediatric intracranial meningiomas: an analysis of 31 cases and review of literature (original) (raw)
Related papers
Child's Nervous System, 2012
Objective The goal of this study was to determine the epidemiology, clinical presentation, associated factors, pathological features, and treatment outcome of pediatric meningiomas in a single-center institution. Methods Clinical data of 15 patients under 18 years of age operated on for meningiomas from January 1994 to December 2010 were reviewed. Results The study group included nine males and six females (mean age of 13 years at surgery). The most common symptoms at presentation were headaches in 6 out of 15 (40 %), raised intracranial pressure in 3 out of 15 (20 %), and seizures in 3 out of 15 (20 %). Sole operated tumors were found in 12 out of 15 (80 %), whose location is as follows: parasagittal in 4 out of 12 (33.3 %), 2 in the convexity (16.6 %), 2 at the skull base (16.6 %), and 4 in other sites (33.3 %). Six children presented with radiationinduced (RT) meningiomas and five had evidence of neurofibromatosis type 2 (NF2). Three patients had multiple meningiomas (all of them had NF2). Simpson's grade I excision was achieved in 12 out of 15 (80 %). On histopathology, 11 out of 15 (73.3 %) were grade I and 4 out of 15 (26.6 %) were grade II (all of them atypical). Five tumors (33.3 %) recurred, four of which had RT or NF2. During the mean follow-up period of 5 years, 12 out of 15 (80 %) had a good outcome (GOS05). Conclusions Childhood meningiomas are uncommon lesions with a slight male predominance. Absence of large series with long follow-up precludes any definite conclusions on the clinical course and outcome of these tumors. Associated factors (such as RT and NF2), location, and extent of excision appear to be more important than histopathological grade in predicting outcome.
Childhood and adolescent meningiomas: a report of 38 cases and review of literature
Acta Neurochirurgica, 2009
Background The aim is to study the clinical, radiological and pathological features of childhood and adolescent meningiomas and analyse outcome prognosticators. Method A retrospective analysis of the case records of patients less than 20 years of age operated for a meningioma in our institute since 1982 was performed. The variables analysed included age, sex, presentation, associated neurofibromatosis (NF), imaging characteristics, extent of resection and histopathology.
Management of pediatric CNS meningiomas: CCHE-57357 experience in 39 cases
Child's Nervous System, 2019
Purpose Our aim is to present our experience in the management of pediatric meningiomas in the largest referral center in Egypt for pediatric tumors focusing on variables including clinical picture, anatomic location, histopathology, treatment strategies, and outcome together with their possible correlation to prognosis. Methods We retrospectively reviewed the medical records of 39 pediatric patients who were treated for CNS meningiomas in Children's Cancer Hospital-Egypt (CCHE-57357) 2007-2017. Results The prevalence of pediatric meningioma was 1.42%. Four cases had type 2 neurofibromatosis (NFII). The mean age was 8.19 years. The presence of NFII was associated with challenging multiple lesions, older age of presentation and poorer prognosis and functional outcome. Convexity was the commonest location. Gross total resection (GTR) was achieved in 28 cases, subtotal resection (STR) in 8 cases, and biopsy was decided in 3 patients. Histopathological examination revealed WHO grade I in 16 patients and higher grades in 23 patients (59%). The 5-year overall survival (OS) rate was 87.8% while the 5-years event-free survival (EFS) rate was 85.6%. Tumor location, histopathology, and clinical presentation were not statistically correlated to prognosis. Conclusions Pediatric CNS meningiomas are uncommon pediatric tumors but of an aggressive clinical and pathological behaviors as compared to adult meningiomas. The presence of NFII is associated with a poorer prognosis and functional outcomes. Although being challenging, the maximum and safe surgical excision should be exercised even in recurrent cases in order to achieve the best outcome. Adjuvant radiotherapy provides good tumor control for inoperable residual atypical or anaplastic meningiomas.
Pediatric Meningiomas-A Case Report and Review of the Literature
Surgical Medicine Open Access Journal, 2018
Background: Pediatric meningiomas are relatively rare accounting for only 3% of intracranial neoplasms. As such most of the literature on pediatric meningiomas exists in the form of isolated case reports or as a case series with small patient numbers. Despite this scarcity of literature several important features distinguish pediatric meningiomas from those that occur in adults. These include unique risk factors; a male predominance; larger tumor sizes at presentation; unusual sites of occurrence including intraventricular and parenchymal; higher World Health Organization histological grades; more aggressive clinical behavior and an increased tendency for recurrence. We present a 12-year-old male patient whom presented to our unit with a left fronto-parietal convexity meningioma of an alarming size. Methods: A 12-year-old male patient presented to our unit with an eight-month history of a progressive headache complicated by a two-week history of vomiting. He also complained of progressive weakness of the right side of his body which had worsened to a point that he was no longer independently ambulant. General examination revealed craniomegaly with tortuous scalp veins. Neurological examination revealed a right upper motor neuron facial nerve palsy and a right hemiplegia of 2/5. Radiological investigation revealed an extremely large left fronto-parietal dural based space-occupying lesion which crossed the midline. Due to the adolescent’s progressive neurology he was taken to the operating room for emergency resection of the lesion. Gross total resection was achieved, and histopathological analysis confirmed the lesion to be a fibroblastic meningioma. Result: Post-operatively the patient demonstrated a complete resolution of his hemiplegia and at three weeks post operatively he was already independently ambulant with power 4/5 on the previously hemiplegic side. Conclusion: Despite the notorious features that characterize pediatric meningiomas, as well as an often-intimidating radiological appearance, adherence to standard Neurosurgical operating principles has the best chance of ensuring a successful outcome.
Morbidity in survivors of child and adolescent meningioma
Cancer, 2013
BACKGROUND: The extent of initial surgical resection has been identified as the strongest prognostic indicator for survival in child and adolescent meningioma. Given the paucity of data concerning long-term outcome, the authors undertook a meta-analysis to analyze morbidity in survivors of this disease. METHODS: Individual patient data were obtained from 19 case series published over the last 23 years through direct communication with the authors. Ordinal logistic regression models were used to assess the influence of risk factors on morbidity. RESULTS: Of 261 patients, 48% reported a completely normal life with no morbidity, and 25% had modera-te=severe meningioma-associated morbidity at last follow-up. Multivariate analysis identified relapse as the only independent variable associated with an increased risk of morbidity (odds ratio, 4.02; 95% confidence interval, 2.11-7.65; P .001). Univariate analysis also revealed an increased risk for patients with neurofibromatosis (odds ratio, 1.90; 95% confidence interval, 1.04-3.48; P 5.04). Subgroup analysis identified a higher incidence of morbidity among patients who had intracranial tumors with a skull base location compared with a nonskull base location (P .001). Timing at which morbidity occurred was available for 70 patients, with persistence of preoperative tumor-related symptoms in 67% and as a result of therapy in 20%. CONCLUSIONS: The majority of survivors of child and adolescent meningioma had no or only mild long-term morbidity, whereas 25% had moderate=severe morbidity, with a significantly increased risk in patients with relapsed disease. In the majority, morbidity occurred as a consequence of the tumor itself, justifying aggressive surgery to achieve gross total resection. However, for patients with neurofibromatosis and skull base meningioma, a more cautious surgical approach should be reserved.
Long-term follow up of children with meningiomas in Denmark: 1935 to 1984
Journal of neurosurgery, 2004
Meningiomas in children are rare, infrequently described in the literature, and often associated with neurofibromatosis Type 2 (NF2). The authors report a series of 22 children treated for an intracranial meningioma in Denmark between 1935 and 1984. Of 1542 cases of pediatric intracranial tumors in children younger than 15 years of age, 22 harbored meningiomas. Three children suffered from NF. The male/female ratio was 8:14. The mean age at the time of diagnosis was 5 years for boys and 11.5 years for girls. At the time of diagnosis all tumors were large. All patients underwent surgery. In 20 cases, the final histological diagnoses were low-grade and in two cases high-grade tumors. The follow-up period ranged from I to 45 years (mean 16 years). Two patients were lost to follow up. Four of seven boys and three of 13 girls survived. Five of 13 children in whom the tumor was completely removed survived, whereas two of seven in whom the lesion was partially removed survived. The mean su...
Sporadic pediatric meningiomas: a neuroradiological and neuropathological study of 15 cases
Journal of Neurosurgery: Pediatrics, 2017
OBJECTIVESporadic meningiomas have been classified in many different ways. Radiographically, these lesions can be described as occurring in either typical or atypical locations. The purpose of this study was to determine if there are any histopathological differences between sporadic meningiomas that arise in these varying locations in children.METHODSThe neuroimaging, histopathological findings, and clinical records in patients with sporadic pediatric meningiomas not associated with neurofibromatosis Type 2 or prior radiation therapy were retrospectively reviewed. Tumors were classified by radiological findings as either typical or atypical, and they were categorized histopathologically by using the latest WHO nomenclature and grading criteria.RESULTSFifteen sporadic meningiomas in pediatric patients were biopsied or resected at the authors’ institution between 1989 and 2013. Five (33%) were typical in radiographic appearance and/or location and 10 (67%) were atypical. Four (80%) t...
A clinicopathological and neuroradiological study of paediatric meningioma from a single centre
Journal of Clinical Neuroscience, 2011
Paediatric meningiomas are rare intracranial neoplasms representing 0.4% to 4.1% of tumours in paediatric patients and 1.5% to 1.8% of all intracranial meningiomas. The goal of this study was to determine the epidemiology, clinical presentation, radiological features, morphological spectrum and treatment outcome of paediatric meningiomas. All evaluable reports of meningioma in children from 1 January 1999 to 31 December 2009 were retrieved from the database of our Department of Pathology and were assessed retrospectively. This study describes 12 patients (nine males, three females; age range, 4-18 years; mean, 12.8 years). Their age and sex distribution, presenting symptoms, neurological findings, location, neuroradiological and histopathological findings were reviewed and the results were compared with published reports. Atypical and malignant meningiomas seem to be more common in childhood and adolescence than in adulthood.
Intracranial Meningiomas in Children: Ten-Year Experience
Pediatric Neurology, 2008
Meningiomas are central nervous system neoplasms derived from arachnoid cap cells. They are the second most common brain tumors after gliomas, but are rare in children. Furthermore, meningiomas exhibit different behavior in this age group. From 1997From -2007 children with brain meningiomas were treated at the Department of Neurosurgery, Brazilian National Cancer Institute, Rio de Janeiro, Brazil. They represented 2.7% of all brain meningiomas, and 2.1% of all brain tumors, in children followed during this period at our institution. There were 4 boys, and the mean age at diagnosis was 7.3 years. Headaches, seizures, and motor deficits were the most frequent signs at presentation. All patients underwent surgery, and total resection was achieved in 6 of 7 patients. Most lesions were World Health Organization class I meningiomas. There were no deaths, and patients were asymptomatic or demonstrated mild motor or sensory signs at follow-up. In conclusion, meningiomas are rare in the pediatric population. Most of the lesions are low-grade, and the prognosis in this setting is good. Ó
Meningiomas in children and adolescents: a meta-analysis of individual patient data
The Lancet Oncology, 2011
Background The epidemiological, prognostic, and therapeutic features of child and adolescent meningioma are poorly defi ned. Clinical knowledge has been drawn from small case series and extrapolation from adult studies. This study was done to pool and analyse the clinical evidence on child and adolescent meningioma. Methods Searches of PubMed, Medline, and Embase identifi ed 35 case series of child and adolescent meningioma completed over the past 21 years. Individual patient data were obtained from 30 studies via direct communication with investigators. Primary outcomes were relapse-free survival (RFS) and overall survival. Prognostic variables were extent of initial surgery, use of upfront radiotherapy, age, sex, presence of neuro fi bromatosis, tumour location, and tumour grade. RFS and overall survival were analysed using Kaplan-Meier survival curves and multivariable Cox regression models. Findings From a total of 677 children and adolescents with meningioma, 518 were eligible for RFS analysis and 547 for overall survival analysis. Multivariable analysis showed that patients who underwent initial gross-total resection had better RFS (hazard ratio 0•16, 95% CI 0•10-0•25; p<0•0001) and overall survival (0•21, 0•11-0•39; p<0•0001) than those who had subtotal resection. No signifi cant benefi t was seen for upfront radiotherapy in terms of RFS (0•59, 0•30-1•16; p=0•128) or overall survival (1•10, 0•53-2•28; p=0•791). Patients with neurofi bromatosis type 2 (NF2) had worse RFS than those without neurofi bromatosis (2•36, 1•23-4•51; p=0•010). There was a signifi cant change in overall survival with time between patients with NF2 compared with those without neurofi bromatosis (1•45, 1•09-1•92; p=0•011); although overall survival was initially better for patients with NF2 than for those without neuro fi bromatosis, overall survival at 10 years was worse for patients with NF2. Patients with WHO grade III tumours had worse RFS than those with WHO grade I (3•90, 2•10-7•26; p<0•0001) and grade II tumours (2•49, 1•11-5•56; p=0•027). Interpretation Extent of initial surgical resection is the strongest independent prognostic factor for child and adolescent meningioma. No benefi t for upfront radiotherapy was noted. Hence, aggressive surgical management, to achieve gross-total resection, is the initial treatment of choice. In the event of a subtotal resection, repeat resection is recommended to achieve maximum extirpation. Close observation is warranted for patients who have a subtotal resection or who have WHO grade III tumours. Patients without neuro fi bromatosis should have a minimum 10-year follow-up, whereas patients with NF2 should be considered a special risk category, necessitating lifelong follow-up. Funding None.