Childhood and adolescent meningiomas: a report of 38 cases and review of literature

• Published in: Acta neurochirurgica Vol. 151; no. 3; pp. 239 - 244
• Main Authors: Menon, G., Nair, S., Sudhir, J., Rao, B. R. M., Mathew, A., Bahuleyan, B.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-03-2009; Springer Nature B.V
• Subjects: Adolescent; Age Factors; Child; Clinical Article; Comorbidity; Dura Mater - pathology; Dura Mater - surgery; Female; Humans; Interventional Radiology; Intracranial Hypertension - etiology; Male; Medicine; Medicine & Public Health; Meningeal Neoplasms - epidemiology; Meningeal Neoplasms - pathology; Meningeal Neoplasms - surgery; Meningioma - epidemiology; Meningioma - pathology; Meningioma - surgery; Minimally Invasive Surgery; Neoplasm Recurrence, Local - epidemiology; Neurofibromatoses - epidemiology; Neurology; Neuroma, Acoustic - epidemiology; Neuroradiology; Neurosurgery; Neurosurgical Procedures; Optic Nerve - pathology; Retrospective Studies; Seizures - etiology; Skull - pathology; Skull - surgery; Skull Base Neoplasms - epidemiology; Skull Base Neoplasms - pathology; Skull Base Neoplasms - surgery; Spinal Neoplasms - epidemiology; Spinal Neoplasms - pathology; Spinal Neoplasms - surgery; Surgical Orthopedics; Treatment Outcome; Paediatric; Adolescence; Neurofibromatosis; Meningioma
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-009-0206-8

Summary
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.
Results
The study group included 20 males and 18 females with a mean age of 15.53 years. Eleven children (28.9%) had evidence of NF of whom three had NF2 with bilateral vestibular schwannomas. The common presenting symptoms were seizures (76.3%), raised intracranial tension (71%), and focal neurological deficits (39.4%). The location of the operated tumours were as follows: ten skull base (24.4%), ten falx/parasagittal (24.4%), eight spinal (19.5%), five convexity (12.2%), three posterior fossa (7.3%), three intraventricular (7.3%) and two optic nerve sheath (4.9%). Two children (4.9%) had cystic meningiomas. Grade I excision was achieved only in twenty tumours (48.8%). On histopathology, thirty (73.2%) were grade I, nine (21.9%) were grade II and two (4.9%) were grade III meningiomas. Seven tumours recurred of which six were located at the skull base. During the mean follow up period of 4.74 years, the majority, 32 (84.2%) had a good outcome and five (13.2%) had a poor outcome. One child (2.6%) expired due to post-operative sepsis.
Conclusion
Childhood meningiomas are uncommon but not rare lesions with a marginal male predominance. Absence of large series with long follow up precludes any definite conclusions on the clinical course and outcome. Uniform observations made in different series including ours, include a higher incidence of the skull base location and tumours with atypical histopathology. Favourable prognostic factors include younger age (<than 10 years), superficial location, total excision and absence of neurofibromatosis. Location and extent of excision appear to be more important than histopathology grade in predicting outcome.