A clinicopathological and neuroradiological study of paediatric meningioma from a single centre

Pediatric meningiomas: A literature review and diagnostic update

Background

Meningiomas have always represented the most frequently observed primary central nervous system (CNS) tumor in adults. Multiple advances concerning the genetic and epigenetic characterizations of adult meningiomas have been made over the last few years, and a new proposition for integrated histo-molecular grading has recently been offered in the literature. Pediatric meningiomas represent a very small proportion of all diagnosed meningiomas. New literature has determined that pediatric meningiomas are clinically, histopathologically, genetically, and epigenetically distinct from their adult counterparts. Herein, we reviewed and performed a synthesis of literature investigating pediatric meningiomas. We then compared and contrasted pediatric meningiomas with their adult counterparts.

Methods

We performed an extensive review of cases from English-language literature available in Pubmed using the keywords "pediatric" and "meningioma" as well as "children" and "meningioma". We reviewed and analyzed fifty-six papers that include 498 cases.

Results

This literature review revealed that pediatric meningiomas differ from their adult counterparts clinically (location, sex ratio) and also in terms of etiology (germline mutations), histopathology (a greater incidence of clear cell subtype), molecular biology, and epigenetics.

Conclusions

Pediatric meningiomas are, like other brain tumors (such as low-grade and high-grade gliomas), clinically and biologically different from their adult counterparts. Further studies are needed to better understand the tumorigenesis of pediatric meningiomas and to optimize their stratification in terms of outcome and therapeutic strategy.

Paediatric meningiomas in Singapore - Case series of a rare entity

Paediatric meningiomas are extremely rare. These tumours constitute only 2 to 3% of all childhood brain tumours. Despite similarities in histological features between PMs and their adult counterparts, there are important distinctions between them. In this case series, the authors describe their experience in paediatric meningiomas in Singapore's 2 children's hospitals from 1998 to 2018. The primary aim of this retrospective study is to evaluate the clinical, radiological and pathological characteristics, and associated outcomes of paediatric patients diagnosed with meningioma managed in our local institutions. Following that, the study's findings are secondary aims are corroborated with published literature. A total of 10 patients (4 males and 6 females) were identified for this study within the period of 01 January 1998 to 31 December 2018. Their ages ranged from 1 year old to 18 years old (median age 10.5 years old). Two of the patients had NF1 and NF2 respectively. There were 9 intracranial and 1 intraspinal paediatric meningiomas. Seven patients achieved gross total resection and 3 patients had subtotal resection. Eight patients did not have tumour recurrence or increase in size of tumour remnant during the course of their follow-up. In congruency with the literature, up to 40% of our patients had higher grade meningiomas and 55.6% had large tumour volumes more than 30 cm³. Owing to the paucity of knowledge for this unusual tumour, the authors emphasize the need for closer surveillance and in-depth genomic studies to identify novel therapies for this challenging condition.

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.

Malignant meningioma of the cerebellopontine angle in a 2-year-old girl: a case report and literature review

Meningioma is a common intracranial tumor in adults. Pediatric cases account for approximately 1.5% of all intracranial meningiomas, and very few cases show malignant histological features. Primary pediatric malignant meningioma in the cerebellopontine angle is extremely uncommon. Herein, we report a 2-year-old girl with malignant meningioma in the cerebellopontine angle. The clinical features, diagnosis, and treatment protocol are discussed.

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.