Childhood and juvenile meningiomas: 25 years experience in a single institution

Indroduction: Meningiomas are uncommon childhood tumors, accounting for 0.4–4.6% of central nervous system tumors in this population and differ in various clinical and biological aspects from their adult counterparts, reflecting different tumor dynamics. Management approaches have been drawn from reports and extrapolated from the treatment of adult meningiomas, without clear, statistically validated guidelines for the management of child and adolescent meningiomas.

Objective: The goal of this study was to determine the epidemiology, clinical presentation, associated factors, pathological features, and treatment outcome of pediatric meningiomas, and attempt to evaluate such features in the context of published literature.

Methods: Clinical data of 19 patients under 18 years of age operated on for meningiomas from January 1994 to December 2017 were reviewed.

Results: The group included 10 males and 9 females (mean age of 12.9 years at surgery). The most common symptoms at presentation were headaches in 9 out of 19 (47%), raised intracranial pressure, seizures and cranial nerves palsies in 3 out of 19 each (15% each). Sole operated tumors were found in 16 out of 19 (84 %), whose location is as follows: parasagittal in 4 out of 16 (25%), 4 in the convexity (25%), 2 at the skull base (12%), 2 intraventricular (12%) and 4 in other sites (25%). 3 patients (15%) had multiple meningiomas, all of which had Neurofibromatosis type 2(NF2). 6 children presented with radiation induced (RT) meningiomas and 5 had evidence of NF2. Simpson’s grade I excision was achieved in 14 out of 19 (74%). On histopathology, 14 out of 19 (74%) were grade I and 5 (26%) were grade II. 6 tumors (31%) recurred, 4 of which had RT or NF2. During the mean follow-up period of 5 years, 16 out of 19 (84%) had a good outcome (GOS05).

Conclusions: Meningiomas are relatively rare lesions in the pediatric population. Although there are several known risk factors, many of which were observed in the patients in our study, sporadic meningiomas can be observed in children. They show higher rates of atypical features when compared with adult meningiomas, so it should be thought of as an entity separate from its adult counterpart as it behaves more aggressively on the whole. Location, associated factors (such as RT and NF2), and extent of excision appear to be more important than histology in predicting outcome. Early treatment should be considered, and close follow-up is mandatory.