Pediatric infratentorial meningiomas: a series of 19 cases and review of the literature

Abstract

Purpose: Pediatric infratentorial meningiomas are extremely rare. In this article, we present a series of 19 cases operated at our institution in the last 8 years.

Methods: During the 8-year period from January 2008 to December 2015, we encountered 21 cases suffered from infratentorial meningiomas. Two patients were excluded. The clinical profiles, radiological features, surgical procedures, intraoperative findings, and outcomes were extracted from the patient records and neuroimaging data.

Results: The 19 cases with pediatric infratentorial meningiomas account for about 12.8% of all pediatric intracranial meningiomas. The age distribution of the patients ranged from 7 to 18 years. There were 9 male and 10 female patients. Cranial nerve defects were the first common signs and symptoms found in most cases (n = 14). One meningioma localized in cerebellum, one originated in jugular foramen. Meningioma involving internal auditory canal was only seen in one of the six patients with CPA meningioma. One tumor was totally ossified. In all, total resection was achieved in 14 patients, subtotal resection in 5 patients. Gamma knife was used for the recurrent and subtotally resected tumors. Conventional radiotherapy was applied for high-grade meningiomas (WHO grade II and WHO grade III).

Conclusion: Pediatric infratentorial meningiomas are different from supratentorial ones in many aspects, such as onset age, gender ratio, and neuroradiological characteristics. Surgical excision is challenging. According to the locations of tumors, different surgical approaches would be chosen to maximally resect the lesions without damage to brain stem and cranial nerves. Gamma knife and conventional radiotherapy could be used as postoperative adjuvant therapies. Long-term clinical follow-up and serial imaging are recommended.

Keywords: Clinical features; Infratentorial; Pediatric meningiomas; Surgery.