A Treatise on Pediatric Meningiomas: Single-center Retrospective Cohort Experience and Review of Literature

Abstract

Background: Pediatric meningiomas are infrequently encountered in clinical practice. In comparison to adults, they have a distinct pathophysiology and clinical presentation. They are benign but locally aggressive tumors. Radical excision often culminates in good outcome.

Aim: The aim of this study was to study the demographic profile, clinico-radiological features, pathophysiology, and surgical outcome of childhood meningiomas.

Materials and methods: The case records of patients <18 years of age operated for meningiomas in our institute from 1985 to 2015 were retrieved. The demographic profile, clinical and radiological features, surgical approach, extension of resection, and surgical outcome were recorded and subsequently analyzed.

Results: Among 37 patients, 20 were males and 17 were females. The mean age was 13 years. Predisposing etiologies such as neurofibromatosis and radiation exposure were identified in 20% of the study population. There were 31 intracranial and 6 spinal meningiomas. Headache associated with vomiting was the most common presenting complaint. Majority were supratentorial tumors. A safe maximal excision was attempted in each case. Recurrence was noted in five patients. Average follow-up was approximately 24 months. Two patients succumbed to the illness. Approximately, 30% of patients were rendered morbid.

Conclusion: Although rare, pediatric meningiomas are biologically different from their adult counterparts. They have a male predominance, common in intraventricular region and cystic in nature. Radical excision is associated with good prognosis. Although benign, they are aggressive in nature and have a tendency to recur. The response to adjuvant therapy is modest. Further molecular research and genetic studies are necessary to understand the biology of pediatric meningiomas, which will help in the identification of targeted molecular therapy.

Keywords: Pediatric; meningioma; surgery.

Figure 1

Right anterior clinoidal meningioma: (A) preoperative axial T1 CT image postcontrast showing right anterior clinoidal meningioma, (B) preoperative axial T2-weighted magnetic resonance image showing right anterior clinoidal meningioma, and (C) postoperative axial CT image postcontrast showing partial staged resection of the lateral portion of the meningioma

Figure 2

Right frontoparietal meningioma: (A) preoperative axial CT image postcontrast showing right frontoparietal convexity meningioma and (B) postoperative axial CT image postcontrast showing radical resection of the meningioma

Figure 3

Preoperative image of a patient with foramen magnum meningioma: sagittal T1-weighted magnetic resonance image showing foramen magnum meningioma