MRI of primary meningeal tumours in children

Primary sphenoid sinus meningioma resection via transnasal transsphenoid approach: a case report

Meningiomas are slow-growing benign lesions that constitute ∼ 25% of primary intracranial tumours. Extracranial meningioma of the sphenoid sinus is extremely rare and may arise from ectopic arachnoid nests left behind during embryonic development. We present the case of a 61-year-old woman with left oculomotor nerve paralysis. Magnetic resonance imaging (MRI) revealed a 43 × 31 × 33 mm mass in the sphenoid sinus invading anteriorly into the posterior ethmoid sinus and superiorly into the base of the anterior cranial fossa. Microscopic transnasal transsphenoidal surgery was performed with multilayer reconstruction to the cranial base. Postoperative MRI confirmed total resection and recovery was uneventful. The pathological diagnosis was grade I meningothelial meningioma. Meningioma should be included in the differential diagnosis of sphenoid sinus mass. Surgery is the first-choice treatment and a transnasal transphenoidal approach is recommended. Cranial base reconstruction is important to avoid postoperative cerebrospinal fluid leakage.

Morbidity in survivors of child and adolescent meningioma

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 moderate/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 = .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.

Pediatric meningiomas: a single-center experience with 15 consecutive cases and review of the literature

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 radiation-induced (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 (GOS=5).

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.

Sphenoid masses in children: radiologic differential diagnosis with pathologic correlation

Childhood central skull base masses are rare, often difficult to diagnose, and have overlapping imaging findings. In this review, we provide an overview of the epidemiology, clinical findings, and management of pediatric sphenoid bone and sphenoid sinus masses with an emphasis on imaging findings that may help to differentiate lesions. Radiologic-pathologic correlation is provided. Finally, an imaging-based algorithm is presented as a guide to help radiologists narrow their differential diagnoses. Some of the entities discussed are virtually unique to the pediatric population; others occur rarely in this age group but should be considered in the appropriate clinical setting. Entities included in the discussion are grouped into 2 categories: those that cause nonaggressive osseous remodeling and those that are more commonly associated with aggressive bone changes. Mucocele, aneurysmal bone cyst, giant cell lesions, meningioma, and fibrous dysplasia tend to remodel bone, while entities such as chordoma, craniopharyngioma, rhabdomyosarcoma, sinonasal carcinoma, and neuroblastoma may cause more aggressive local bone changes.

Childhood and juvenile meningiomas

PURPOSE

The purpose of this paper was to study the clinical characteristic, treatment, and prognosis of childhood meningioma.

MATERIALS AND METHODS

Fifty-four meningioma cases below the age of 18 have been treated in Huashan Hospital in the last 15 years (from 1993 to 2008), their sex and age distribution, clinical manifestation, radiological finding, pathological subtype, treatment, and prognosis are retrospectively analyzed, and the results are compared with those reported in the literature.

RESULTS

The ratio of male to female was 1.16:1 (29:25) and mean age was 13.14 years (ranging from 2.75 to 18 years). Five patients in this series were associated with neurofibromatosis-2. The most common symptoms and signs were the signs of increased intracranial pressure including headache, papilledema, and vomiting. The most common radiological finding was homogeneous enhancement with contrast. The most common locations of meningiomas in this series were intraventricular and anterior/middle fossa. All of these patients were surgically treated; resection both in Simpson grades I and II could be achieved in 39 out of 54 patients. Perioperative mortality was 3.7% (2 out of 54); the most common postoperative complications were intracranial infection and injury of cranial nerve. Fibroblastic meningiomas were the most common pathological subtype, and malignant and atypical meningiomas (both of grades II and III according to WHO classification) accounted for 18.5% of the whole series.

CONCLUSION

Childhood meningiomas are scarce in clinical practice, which are characterized with its male predominance, large size, distinctive radiological features, and high rate of atypical/malignant histological subtypes; favorable outcome is accessible with total removal.

Intracranial meningiomas of childhood and adolescence

Meningiomas are rare intracranial neoplasms in childhood and adolescence, representing 0.4-4.1% of the pediatric-age tumors and 1.5-1.8% of all intracranial meningiomas. The goal of this study was to determine epidemiology, clinical and radiological features, and long-term outcome of childhood and adolescence meningiomas. Patients operated for intracranial meningiomas of childhood and adolescence between 1983 and 2003 at Gazi University School of Medicine, Department of Neurosurgery, were evaluated retrospectively. This study presents 11 cases (6 male, 5 female), ranging in age from 14 months to 17 years. Age and sex distribution, presenting symptoms, neurological examination results, location of meningiomas, radiological and histopathological findings, and prognosis were reviewed. The results were compared with those reported in the existing literature. Atypical and malignant meningiomas seem to be more common in childhood and adolescence with respect to adult meningiomas. Tumor location, completeness of tumor removal, and pathological grade are the most important prognostic factors.

Malignant meningioma of the lateral ventricle

This 65-year-old man presented with a very rare malignant meningioma in the trigonum of the right lateral ventricle. Neurological examination showed bilateral papilledema. Magnetic resonance imaging revealed a solid, enhancing tumor in the right trigonum with a hypointense cystic component located in the center of the tumor. The lesion was totally resected via a superior parietooccipital transcortical approach. Histological examination showed an anaplastic (malignant) meningioma with architectural disarray, high mitotic activity (20/10 hpf), necrosis, and cytological atypism. As in our case, heterogeneous signal, due to necrotic tissue and frequently demonstrated on both T1- and T2-weighted sequences, is suggestive of an aggressive type of meningioma.

Extenso meningioma atípico na infância: relato de caso

Meningiomas são raros na criança e pequeno número de casos foi publicado até hoje. Eles são tumores tipicamente indolentes, mas, podem apresentar comportamento mais agressivo na infância. A conduta ideal é a cirurgia com ressecção completa do tumor. Na impossibilidade da remoção cirúrgica completa do tumor, as opções de tratamento são reduzidas. Nosso objetivo é descrever um caso de meningioma atípico na infância em menina de três anos, e sua evolução.

Seeding of malignant meningioma along a surgical trajectory on the scalp. Case report and review of the literature

The authors report the case of an 11-year-old boy with a malignant meningioma of the right frontal meninges. The tumor was asymptomatic, despite visible exophytic extracranial growth. Neuroimaging demonstrated an en plaque meningioma bulging into the brain. Six months after the tumor had been totally removed by surgery, an isolated subcutaneous metastasis developed at the right preauricular area of the scalp, originating at the scar left by the first surgery. After removal of this metastasis, radiotherapy was conducted. To date the follow-up examinations have not revealed any additional metastases. To the best of the authors' knowledge, this is the first report of a seeding of a subcutaneous metastasis in a child with a malignant meningioma. The authors review the literature with reference to malignant meningiomas and their formation of metastasis. In cases of malignant meningiomas, piecemeal tumor removal carries the risk of iatrogenic cell dissemination even when precautions are taken.

Meningiomas em pacientes pediátricos: relato de 2 casos

Os meningiomas correspondem de 1% a 4% das neoplasias intracranianas primárias em pacientes pediátricos; a incidência nesta população aumenta de acordo com a faixa etária. Não há predominância quanto ao sexo, ao contrário do que acontece na população adulta onde predominam no sexo feminino. Relatamos dois casos de meningioma em crianças, discutindo os aspectos clínicos, radiológicos e histológicos desta entidade. O primeiro paciente é do sexo masculino, com 2 anos de idade e apresentava com crises convulsivas há 4 meses. Os exames de imagem revelaram uma lesão expansiva de 20 mm na região parieto-occipital direita, a qual foi totalmente ressecada. Os exames histológico e imunohistoquímico definiram o diagnóstico de meningioma. Atualmente, 17 meses após a cirurgia, o paciente encontra-se bem, sem evidências de recidiva tumoral. O segundo paciente é do sexo feminino, com 11 anos, e queixava-se de cefaléia frontal há 2 anos. Os exames radiológicos demonstraram presença de lesão expansiva de 5 cm em região frontal direita. Realizou-se craniotomia frontal com ressecção total do tumor. O diagnóstico histológico foi de meningioma. Atualmente, 20 meses após a cirurgia, encontra-se sem evidência de recidiva tumoral. Os autores discutem ainda o tratamento e prognóstico dos meningiomas pediátricos ressaltando que apesar de incomuns, estes devem fazer parte do diagnóstico diferencial de lesões intracranianas expansivas nesta faixa etária.