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Roy A, Shashidhar A, Birua GJS, Rao S, Kulanthaivelu K, Arimappamagan A. Metachronous intracranial meningiomas without dural attachment in a child - Rare case report and review of literature. Childs Nerv Syst 2024:10.1007/s00381-024-06582-7. [PMID: 39180697 DOI: 10.1007/s00381-024-06582-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION Meningiomas in children are rare, constituting less than 5% of all paediatric brain tumours and less than 2% of all meningiomas. Multiple meningiomas (synchronous or metachronous) are even more uncommon, typically occurring due to radiation exposure or in patients with phacomatoses like Neurofibromatosis II. This report presents the case of a child with metachronous meningiomas without dural attachment in unusual locations, along with their management. PURPOSE This report aims to describe a rare paediatric case of metachronous meningiomas without dural attachment, detailing their presentation, treatment, and outcomes. CASE DETAILS A 2-year-old female presented with headaches, irritability, and excessive crying for one year. A CT scan revealed a mass in the fourth ventricle, causing obstruction, which was surgically decompressed. The biopsy confirmed a clear cell meningioma, WHO grade II. A follow-up MRI identified a new lesion in the suprasellar area six months later, for which she underwent right pterional craniotomy and gross total resection, which turned out to be a clear cell meningioma, WHO grade II. The patient recovered well and remained asymptomatic, with no recurrence on MRI at one-year follow-up. CONCLUSION This case highlights the unusual presentation of metachronous clear cell meningiomas without dural attachment in a young child. Surgical excision resulted in a favourable outcome, though long-term follow-up is essential due to the high propensity for recurrence.
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Affiliation(s)
- Anup Roy
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Gyani J S Birua
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India.
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Intervention Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
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Jagtiani P, Karabacak M, Le C, Bahadir Z, Morgenstern P, Margetis K. Comprehensive assessment of atypical and anaplastic pediatric meningiomas utilizing national cancer database: a retrospective cohort study. Childs Nerv Syst 2024; 40:2345-2357. [PMID: 38722323 DOI: 10.1007/s00381-024-06431-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/26/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To examine demographic and clinical characteristics and their association with survival in grade 2 and 3 pediatric meningiomas in a large cohort using the National Cancer Database (NCDB). METHODS We conducted a comprehensive analysis using data from NCDB between 2004 to 2018. Tumor-specific data included tumor grade and size. Treatment details, including surgical resection, extent of resection, and radiotherapy, were gathered. Our analytic approach incorporated logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. RESULTS Among the included 239 patients aged 0-21 years, age category distribution was significantly different between grade 2 and grade 3 tumors (p = 0.018). For grade 2 meningiomas, 51.5% of patients were female, and 76.7% were white. 85.3% of patients with grade 2 meningiomas underwent surgical resection, of which 67% underwent gross total resection. Overall survival (OS) was significantly different between resected and non-resected patients (p = 0.048). Uninsured patients were over seven times as likely to have prolonged length of stay (LOS) versus those with private insurance (OR = 7.663, p = 0.014). For grade 3 meningiomas, 51.4% of patients were male, and 82.9% were white. 91.4% of patients with grade 3 meningiomas underwent surgical resection, of which 53.3% underwent subtotal resection. OS was not significantly different between resected and non-resected patients (p = 0.659). CONCLUSION In summary, there were significant differences in age, maximum tumor dimension, unplanned readmission, radiotherapy, and treatment combinations between grade 2 and 3 meningiomas. These findings highlight the intricacies of managing pediatric meningiomas and emphasize the necessity for tailored therapeutic approaches to enhance outcomes in the future.
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Affiliation(s)
- Pemla Jagtiani
- School of Medicine, SUNY Downstate Health Sciences University, New York, NY, United States of America
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Chi Le
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Zeynep Bahadir
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States of America
| | - Peter Morgenstern
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Konstantinos Margetis
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America.
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Gendreau JL, Kuo CC, Patel NA, Brown NJ, Pennington Z, Bui NE, Reardon T, Lien BV, Prevedello DM, Kuan EC, Hsu FP, Mohyeldin A. Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes. J Neurol Surg B Skull Base 2024; 85:131-144. [PMID: 38449578 PMCID: PMC10914469 DOI: 10.1055/a-2015-8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Meningiomas-the most common extra-axial tumors-are benign, slow-growing dural-based lesions that can involve multiple cranial fossae and can progress insidiously for years until coming to clinical attention secondary to compression of adjacent neurovascular structures. For complex, multicompartmental lesions, multistaged surgeries have been increasingly shown to enhance maximal safe resection while minimizing adverse sequela. Here, we systematically review the extant literature to highlight the merits of staged resection. Methods PubMed, Scopus, and Web of Science databases were queried to identify articles reporting resections of intracranial meningiomas using a multistaged approach, and articles were screened for possible inclusion in a systematic process performed by two authors. Results Of 118 identified studies, 36 describing 169 patients (mean age 42.6 ± 21.3 years) met inclusion/exclusion criteria. Petroclival lesions comprised 57% of cases, with the most common indications for a multistaged approach being large size, close approximation of critical neurovascular structures, minimization of brain retraction, identification and ligation of deep vessels feeding the tumor, and resection of residual tumor found on postoperative imaging. Most second-stage surgeries occurred within 3 months of the index surgery. Few complications were reported and multistaged resections appeared to be well tolerated overall. Conclusions Current literature suggests multistaged approaches for meningioma resection are well-tolerated. However, there is insufficient comparative evidence to draw definitive conclusions about its advantages over an unstaged approach. There are similarly insufficient data to generate an evidence-based decision-making framework for when a staged approach should be employed. This highlights the need for collaborative efforts among skull base surgeons to establish an evidentiary to support the use of staged approaches and to outline those indications that merit such an approach.
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Affiliation(s)
- Julian L. Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, United States
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, United States
| | - Neal A. Patel
- School of Medicine, Mercer University School of Medicine, Savannah, Georgia, United States
| | - Nolan J. Brown
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Nicholas E. Bui
- Loma Linda University School of Medicine, Loma Linda, California, United States
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Brian V. Lien
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
| | - Edward C. Kuan
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
- Department of Otolaryngology, University of California, Irvine, Orange, California, United States
| | - Frank P.K. Hsu
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Ahmed Mohyeldin
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
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Samanci Y, Askeroglu MO, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Legarreta A, Fernandes Cabral D, Anand S, Niranjan A, Lunsford LD, Tripathi M, Kumar N, Liščák R, May J, Lee CC, Yang HC, Martínez Moreno N, Martínez Álvarez R, Douri K, Mathieu D, Pikis S, Mantziaris G, Sheehan JP, Bernstein K, Kondziolka D, Peker S. Stereotactic Radiosurgery for Meningiomas in Children and Adolescents: An International Multi-Institutional Study. Neurosurgery 2023; 93:1066-1074. [PMID: 37235980 DOI: 10.1227/neu.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Meningiomas in children are uncommon, with distinct characteristics that set them apart from their adult counterparts. The existing evidence for stereotactic radiosurgery (SRS) in this patient population is limited to only case series. The objective of this study was to evaluate the safety and efficacy of SRS in managing pediatric meningiomas. METHODS Children and adolescents who had been treated for meningioma with single-fraction SRS were included in this retrospective, multicenter study. The assessment included local tumor control, any complications related to the tumor or SRS, and the emergence of new neurological deficits after SRS. RESULTS The cohort included 57 patients (male-to-female ratio 1.6:1) with a mean age of 14.4 years who were managed with single-fraction SRS for 78 meningiomas. The median radiological and clinical follow-up periods were 69 months (range, 6-268) and 71 months (range, 6-268), respectively. At the last follow-up, tumor control (tumor stability and regression) was achieved in 69 (85.9%) tumors. Post-SRS, new neurological deficits occurred in 2 (3.5%) patients. Adverse radiation effects occurred in 5 (8.8%) patients. A de novo aneurysm was observed in a patient 69 months after SRS. CONCLUSION SRS seems to be a safe and effective up-front or adjuvant treatment option for surgically inaccessible, recurrent, or residual pediatric meningiomas.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - M Orbay Askeroglu
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Benha University, Qalubya , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Clinical Oncology, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Andrew Legarreta
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - David Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Sharath Anand
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Narendra Kumar
- Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Roman Liščák
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
- National Yang Ming Chiao Tung University School of Medicine, Hsinchu , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
- National Yang Ming Chiao Tung University School of Medicine, Hsinchu , Taiwan
| | | | | | - Keiss Douri
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, New York University Langone, New York , USA
| | | | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
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García-Marqueta M, Vázquez M, Krcek R, Kliebsch UL, Baust K, Leiser D, van Heerden M, Pica A, Calaminus G, Weber DC. Quality of Life, Clinical, and Patient-Reported Outcomes after Pencil Beam Scanning Proton Therapy Delivered for Intracranial Grade WHO 1-2 Meningioma in Children and Adolescents. Cancers (Basel) 2023; 15:4447. [PMID: 37760417 PMCID: PMC10526222 DOI: 10.3390/cancers15184447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE The purpose of this study was to report the clinical and patient-reported outcomes of children and adolescents with intracranial meningioma treated with pencil beam scanning proton therapy (PBS-PT). MATERIAL AND METHODS Out of a total cohort of 207 intracranial meningioma patients treated with PBS-PT between 1999 and 2022, 10 (4.8%) were children or adolescents aged < 18 years. Median age was 13.9 years (range, 3.2-17.2). Six (60%) children were treated as primary treatment (postoperative PT, n = 4; exclusive PT, n = 2) and four (40%) at the time of tumor recurrence. Acute and late toxicities were registered according to Common Terminology Criteria of Adverse Events (CTCAE). Quality of life (QoL) before PBS-PT was assessed using PEDQOL questionnaires. Educational, functional, and social aspects after PT were assessed through our in-house developed follow-up surveys. Median follow-up time was 71.1 months (range, 2.5-249.7), and median time to last questionnaire available was 37.6 months (range, 5.75-112.6). RESULTS Five (50%) children developed local failure (LF) at a median time of 32.4 months (range, 17.7-55.4) after PBS-PT and four (80%) were considered in-field. One patient died of T-cell lymphoma 127.1 months after PBS-PT. Estimated 5-year local control (LC) and overall survival (OS) rates were 19.4% and 100.0%, respectively. Except for one patient who developed a cataract requiring surgery, no grade ≥3 late toxicities were reported. Before PT, patients rated their QoL lower than their parents in most domains. During the first year after PT, one child required educational support, one needed to attend to a special school, one had social problems and another three children required assistance for daily basic activities (DBA). Three years after PT, only one child required assistance for DBA. CONCLUSIONS The outcome of children with intracranial meningioma treated with PBS-PT is in line with other centers who have reported results of radiation therapy delivered to this particular patient group. This therapy provides acceptable functional status profiles with no high-grade adverse radiation-induced events.
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Affiliation(s)
- Marta García-Marqueta
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Miriam Vázquez
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Ulrike L. Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Michelle van Heerden
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University of Zürich, 8091 Zürich, Switzerland
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Safronova EI, Galstyan SA, Kushel YV. Trans-eyebrow supraorbital endoscope-assisted keyhole approach to suprasellar meningioma in pediatric patient: case report and literature review. Chin Neurosurg J 2022; 8:28. [PMID: 36104809 PMCID: PMC9472336 DOI: 10.1186/s41016-022-00299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Meningiomas are rather uncommon tumors in the pediatric population, differing significantly from those found in adults by their atypical location, higher rate of more malignant types, consequently higher risk of recurrence and a less favorable outcome. Even in children, suprasellar meningiomas without dural matrix are rare findings mimicking more common suprasellar lesions. Case presentation Here we describe a case of a 12-year-old girl who presented with a rapidly progressing chiasmal syndrome and was diagnosed by MRI with an unusual suprasellar tumor that could not fit the diagnoses expected in a case of a parasellar mass in a child, similar to a craniopharyngioma or optic pathway glioma. After multiple clinical investigations, the tumor etiology was still unclear, so the preferred option of treatment was surgical resection. An endoscope-assisted gross total resection through a supraorbital keyhole approach was performed uneventfully, with total vision recovery in a short time. Benign meningiomas located in the skull base without dural attachment appear to be rare, even in pediatric patients. Conclusion Differential diagnoses of suprasellar and para sellar tumor lesions in pediatric patients can be confusing. There are peculiar features of pediatric tumor diseases that should be considered while working out the management strategy. The main principle of meningioma treatment is the highest possible extent of resection minimally affecting the quality of life.
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Venkataramana NK, Rao SV, Sridutt BS, Chaitanya NK. Pediatric skull base meningioma: Case report and review of literature. J Pediatr Neurosci 2022; 16:354-357. [DOI: 10.4103/jpn.jpn_264_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/11/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
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Sood R, Singh A, Karthigeyan M, Gupta K, Salunke P. Customising the surgical management for intraventricular meningiomas - 'one size doesn't fit all'. Br J Neurosurg 2021; 35:633-638. [PMID: 34148479 DOI: 10.1080/02688697.2021.1940858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intraventricular meningiomas are uncommon and gross total resection is the recommended treatment. However, total resection may not always be possible, especially in locations in which the lesions are adherent to veins and neural structures. We share our experience with intraventricular meningiomas, focusing on the management strategies and outcomes. PATIENTS AND METHODS We describe the data of 7 patients with intraventricular meningiomas operated at our institute over the last 9 years. Three patients had a third ventricular tumor of which two had lesions straddling across the foramen of Monro. The remaining 4 patients had trigonal mass. The clinico-radiological features, management strategies and outcomes have been elaborated with a mean follow-up of 57 months. RESULTS The common clinical presentations were raised intracranial pressure symptoms, visual field defects and memory deficits. One patient had multiple meningiomas. Total excision was achieved in all except in 2 patients in whom the lesion straddled across the foramen of Monro with dense adhesions to veins and neural structures. Staged resection was required in one patient with a large trigonal mass. All patients had a low-grade lesion. The tumor recurred in one patient (post-pregnancy) after partial resection. All the patients improved neurologically, and none had added deficits. CONCLUSIONS Gross total resection of intraventricular meningiomas although desirable may not be possible in certain cases in which the risks outweigh the benefits. These tumors often are of low histological grade and the treatment strategies should be individualized. Regular follow-up is warranted as these tumors may recur despite a low histological grade.
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Affiliation(s)
- Ridhi Sood
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | | | - Kirti Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
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Gendle C, Karthigeyan M, Salunke P. Pineal Region Meningioma in a Very Young Child. Pediatr Neurosurg 2021; 56:73-78. [PMID: 33596576 DOI: 10.1159/000513406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Meningiomas in childhood are infrequently seen. Furthermore, they are extremely rare at a pineal location with few reported cases above 5-years of age. We present a very young child with a large pineal region meningioma which mimicked the usually occurring pathologies at this site. CASE PRESENTATION A 2.5-year-old child presented with symptoms of raised intracranial pressure. MRI demonstrated a homogenously enhancing pineal lesion with small cystic areas. After an initial cerebrospinal fluid evaluation for germ cell tumors, the child underwent excision of the lesion by the Krause approach. The tumor showed no definitive dural attachment, had well-defined arachnoid interface, and was completely excised. The final histopathology was meningioma. CONCLUSION Although unusual, we highlight the importance of considering meningiomas among the childhood pineal region lesions, given their good outcome with total resection. Also, pertinent brief literature of the pediatric pineal region meningiomas has been provided. An assessment of preoperative and intraoperative features (clear arachnoid plane) along with adjuncts such as frozen studies can help discern various entities of this region, and decide the extent of excision.
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Affiliation(s)
- Chandrashekhar Gendle
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India,
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Jain S, Muzumdar D, Shah A, Goel A. A Treatise on Pediatric Meningiomas: Single-center Retrospective Cohort Experience and Review of Literature. J Pediatr Neurosci 2020; 15:238-244. [PMID: 33531938 PMCID: PMC7847124 DOI: 10.4103/jpn.jpn_102_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/04/2019] [Accepted: 01/27/2020] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Sonal Jain
- Department of Neurosurgery, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Dattatraya Muzumdar
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India
| | - Abhidha Shah
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India
| | - Atul Goel
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India
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He W, Liu Z, Teng H, Tang L, Jie D, Duan Z, Yu H, Xu J. Pediatric meningiomas: 10-year experience with 39 patients. J Neurooncol 2020; 149:543-553. [PMID: 33064285 DOI: 10.1007/s11060-020-03649-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this article was to study the characteristics of pediatric meningiomas, including the clinical symptom, anatomic location, radiological finding, treatment approaches, and long-term surgical outcome as well as the possible influence factors of the prognosis. METHODS We retrospectively reviewed the medical records and follow-up data of 39 pediatric patients who were treated by operation for intracranial meningiomas in West-China Hospital between 2009-2019. RESULTS The incidence of pediatric meningioma was 0.74%. The mean age at surgery was 12.2 years and the ratio of male to female was 1.3. Three cases (7.7%) were related to neurofibromas. WHO grade I was found in 26 patients (66.7%) and higher grades was seen in 13 (33.3%). The most common location sites were convexity (35.9%). Gross total excision was achieved in 28 patients (71.8%). The mean follow-up period was 54.4 months. The recurrence rate was 41.9%. By survival analysis, only gross total resection (p = 0.028) was associated with favorable outcome. CONCLUSION Meningiomas in children are very rare and have a slight male predominance. Pediatric meningiomas are more commonly located in intraventricular and have higher incidence rate of high-grade than that in adults. Although being challenging, the gross total excision should be underdone to achieve a better prognosis.
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Affiliation(s)
- Wenbo He
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Haibo Teng
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Liansha Tang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Danyang Jie
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Zonghao Duan
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Heye Yu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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12
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Suppiah S, Nassiri F, Bi WL, Dunn IF, Hanemann CO, Horbinski CM, Hashizume R, James CD, Mawrin C, Noushmehr H, Perry A, Sahm F, Sloan A, Von Deimling A, Wen PY, Aldape K, Zadeh G. Molecular and translational advances in meningiomas. Neuro Oncol 2020; 21:i4-i17. [PMID: 30649490 DOI: 10.1093/neuonc/noy178] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Meningiomas are the most common primary intracranial neoplasm. The current World Health Organization (WHO) classification categorizes meningiomas based on histopathological features, but emerging molecular data demonstrate the importance of genomic and epigenomic factors in the clinical behavior of these tumors. Treatment options for symptomatic meningiomas are limited to surgical resection where possible and adjuvant radiation therapy for tumors with concerning histopathological features or recurrent disease. At present, alternative adjuvant treatment options are not available in part due to limited historical biological analysis and clinical trial investigation on meningiomas. With advances in molecular and genomic techniques in the last decade, we have witnessed a surge of interest in understanding the genomic and epigenomic landscape of meningiomas. The field is now at the stage to adopt this molecular knowledge to refine meningioma classification and introduce molecular algorithms that can guide prediction and therapeutics for this tumor type. Animal models that recapitulate meningiomas faithfully are in critical need to test new therapeutics to facilitate rapid-cycle translation to clinical trials. Here we review the most up-to-date knowledge of molecular alterations that provide insight into meningioma behavior and are ready for application to clinical trial investigation, and highlight the landscape of available preclinical models in meningiomas.
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Affiliation(s)
- Suganth Suppiah
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Wenya Linda Bi
- Centre for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian F Dunn
- Centre for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clemens Oliver Hanemann
- Institute of Translational and Stratified Medicine, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, United Kingdom
| | - Craig M Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rintaro Hashizume
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Charles David James
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Houtan Noushmehr
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andrew Sloan
- Department of Neurological Surgery, University Hospital-Case Medical Center, Cleveland, Ohio, USA
| | - Andreas Von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth Aldape
- Department of Laboratory Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
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13
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Toland A, McNulty SN, Pekmezci M, Evenson M, Huntoon K, Pierson CR, Boue DR, Perry A, Dahiya S. Pediatric meningioma: a clinicopathologic and molecular study with potential grading implications. Brain Pathol 2020; 30:1134-1143. [PMID: 32716568 DOI: 10.1111/bpa.12884] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/01/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Meningiomas are common in adults (~35% of brain tumors) but rare in children, where they exhibit unique clinical, pathological and molecular features compared to adult counterparts. Thus, data generated from adult cohorts may be imperfectly suited to guiding diagnostic, prognostic and treatment decisions for children. We studied 50 meningioma patients ≤18 years with available clinical and pathological data to address the need for data obtained in the pediatric setting. As previously described, we noted a slight bias toward male patients and a higher proportion of spinal tumors compared to adults. Thirty-eight of 50 specimens were further analyzed by next generation sequencing. Loss-of-function mutations in NF2 and chromosome 22 losses were common, but pathogenic variants in other genes (SMARCB1, FUBP1, BRAF, TERT promoter, CHEK2, SMAD and GATA3) were identified in a minority of cases. Copy number variants outside of chromosomes 22 and 1 were infrequent. H3K27 hypomethylation, a useful biomarker in adult tumors, was not found in our cohort. In exploring the correlation between mitotic count and recurrence-free survival, we found a threshold of six mitoses per 10 high powered fields as the optimal cutoff in predicting recurrence-free survival. If independently validated in larger studies, adjusted grading thresholds could enhance the clinical management of pediatric meningiomas.
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Affiliation(s)
- Angus Toland
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Samantha N McNulty
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA
| | - Michael Evenson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Kristin Huntoon
- Department of Neurosurgery, Ohio State University, Columbus, OH
| | - Christopher R Pierson
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH.,Department of Pathology, The Ohio State University, Columbus, OH
| | - Daniel R Boue
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH.,Department of Pathology, The Ohio State University, Columbus, OH
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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14
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Szychot E, Goodden J, Whitfield G, Curry S. Children's Cancer and Leukaemia Group (CCLG): review and guidelines for the management of meningioma in children, teenagers and young adults. Br J Neurosurg 2020; 34:142-153. [PMID: 32116043 DOI: 10.1080/02688697.2020.1726286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Primary tumours of the meninges are rare accounting for only 0.4-4.6% of all paediatric tumours of the central nervous system. Due to the rarity of these tumours in children, and the consequent absence of collaborative prospective trials, there is no clear consensus on how the unique characteristics of paediatric meningiomas impact clinical status, management approach, and survival. Much of the evidence and treatment recommendations for paediatric meningiomas are extrapolated from adult data. Translating and adapting adult treatment recommendations into paediatric practice can be challenging and might inadvertently lead to inappropriate management. In 2009, Traunecker et al. published guidelines for the management of intracranial meningioma in children and young people on behalf of UK Children's Cancer and Leukaemia Group (CCLG). Ten years later we have developed the updated guidelines following a comprehensive appraisal of the literature. Complete surgical resection is the treatment of choice for symptomatic meningiomas, while radiotherapy remains the only available adjuvant therapy and may be necessary for those tumours that cannot be completely removed. However, significant advances have been made in the identification of the genetic and molecular alterations of meningioma, which has not only a potential value in the development of therapeutic agents but also in surveillance of childhood meningioma survivors. This guideline builds upon the CCLG 2009 guideline. We summarise recommendations for the diagnosis, treatment, surveillance and long-term follow-up of children and adolescents with meningioma.
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Affiliation(s)
- Elwira Szychot
- Paediatric Oncology Cinical Studies, The Institute of Cancer Research, Sutton, London.,The Royal Marsden Hospital, Sutton, London
| | - John Goodden
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Gillian Whitfield
- Department of Clinical Neuro-oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Curry
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
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15
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Jacobo JA, Mamani R, Jimenez SM, Avendaño J, Nuñez S. Microcystic meningioma associated with other meningioma subtypes: A diagnostic challenge, report of two cases. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Faruqui N, Joshi R, Martiniuk A, Lowe J, Arora R, Anis H, Kalra M, Bakhshi S, Mishra A, Santa A, Sinha S, Siddaiahgari S, Seth R, Bernays S. A health care labyrinth: perspectives of caregivers on the journey to accessing timely cancer diagnosis and treatment for children in India. BMC Public Health 2019; 19:1613. [PMID: 31791308 PMCID: PMC6889559 DOI: 10.1186/s12889-019-7911-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cure rates for children with cancer in India lag behind that of high-income countries. Various disease, treatment and socio-economic related factors contribute to this gap including barriers in timely access of diagnostic and therapeutic care. This study investigated barriers to accessing care from symptom onset to beginning of treatment, from perspectives of caregivers of children with cancer in India. Methods Semi-structured in-depth interviews were conducted with caregivers of children (< 18 years) diagnosed with cancer in seven tertiary care hospitals across New Delhi and Hyderabad. Purposive sampling to saturation was used to ensure adequate representation of the child’s gender, age, cancer type, geographical location and socioeconomic status. Interviews were audio recorded after obtaining informed consent. Thematic content analysis was conducted and organised using NVivo 11. Results Thirty-nine caregivers were interviewed, where three key themes emerged from the narratives: time intervals to definitive diagnosis and treatment, the importance of social supportive care and the overall accumulative impacts of the journey. There were two phases encapsulating the experiences of the family: referral pathways taken to reach the hospital and after reaching the hospital. Most caregivers, especially those from distant geographical areas had variable and inconsistent referral pathways partly due to poor availability of specialist doctors and diagnostic facilities outside major cities, influence from family or friends, and long travel times. Upon reaching the hospital, families mostly from public hospitals faced challenges navigating the hospital facilities, finding accommodation, and comprehending the diagnosis and treatment pathway. Throughout both phases, financial constraint was a recurring issue amongst low-income families. The caregiver’s knowledge and awareness of the disease and health system, religious and social factors were also common barriers. Conclusion This qualitative study highlights and explores some of the barriers to childhood cancer care in India. Our findings show that referral pathways are intrinsically linked to the treatment experience and there should be better recognition of the financial and emotional challenges faced by the family that occur prior to definitive diagnosis and treatment. This information would help inform various stakeholders and contribute to improved interventions addressing these barriers.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,George Institute for Global Health, Sydney, NSW, Australia.
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ramandeep Arora
- Cankids…Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Manas Kalra
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | - Ayyagari Santa
- Basavatarakam Indo American Cancer Hospital, Hyderabad, India
| | | | | | | | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
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17
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Management of pediatric CNS meningiomas: CCHE-57357 experience in 39 cases. Childs Nerv Syst 2019; 35:1323-1331. [PMID: 31127346 DOI: 10.1007/s00381-019-04156-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Our aim is to present our experience in the management of pediatric meningiomas in the largest referral center in Egypt for pediatric tumors focusing on variables including clinical picture, anatomic location, histopathology, treatment strategies, and outcome together with their possible correlation to prognosis. METHODS We retrospectively reviewed the medical records of 39 pediatric patients who were treated for CNS meningiomas in Children's Cancer Hospital-Egypt (CCHE-57357) 2007-2017. RESULTS The prevalence of pediatric meningioma was 1.42%. Four cases had type 2 neurofibromatosis (NFII). The mean age was 8.19 years. The presence of NFII was associated with challenging multiple lesions, older age of presentation and poorer prognosis and functional outcome. Convexity was the commonest location. Gross total resection (GTR) was achieved in 28 cases, subtotal resection (STR) in 8 cases, and biopsy was decided in 3 patients. Histopathological examination revealed WHO grade I in 16 patients and higher grades in 23 patients (59%). The 5-year overall survival (OS) rate was 87.8% while the 5-years event-free survival (EFS) rate was 85.6%. Tumor location, histopathology, and clinical presentation were not statistically correlated to prognosis. CONCLUSIONS Pediatric CNS meningiomas are uncommon pediatric tumors but of an aggressive clinical and pathological behaviors as compared to adult meningiomas. The presence of NFII is associated with a poorer prognosis and functional outcomes. Although being challenging, the maximum and safe surgical excision should be exercised even in recurrent cases in order to achieve the best outcome. Adjuvant radiotherapy provides good tumor control for inoperable residual atypical or anaplastic meningiomas.
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18
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Comparative analysis of intracranial meningiomas in patients younger than 40 years. J Neurooncol 2019; 143:563-571. [PMID: 31087224 DOI: 10.1007/s11060-019-03191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Intracranial meningiomas are relatively rare in young adults, and their specific clinical features remain unclear. The authors analyzed the clinical characteristics of intracranial meningioma in patients younger than 40 years. METHODS Consecutive patients younger than 40 years with meningioma (n = 223) who underwent surgical treatment at our hospital from 2010 to 2018 were retrospectively reviewed. The study cases was further divided into a younger group (≤ 30 years old; n = 63) and an older group (31-40 years old; n = 160). The clinical information, radiological characteristics, intraoperative findings, and pathological outcomes were extracted from the patients' records and statistically analyzed. RESULTS Intracranial meningioma is uncommon in patients younger than 40 years (8.6%). The study group's most common symptoms at presentation were headaches (46.7%), visual impairment (27.8%), limb weakness (20.6%), and epilepsy (13.5%). The mean tumor size was larger (51.47 ± 50.36 cm3) in the younger group than in the older group (22.94 ± 27.20 cm3). According to multivariate analyses, young age was an independent predictor of large tumor size, and large tumor size was significantly associated with peritumoral brain edema and intraoperative blood loss. CONCLUSION Intracranial meningiomas in younger adult patients may have special complexity and perioperative risk due to large tumor sizes. Therefore, individualized treatment strategy is recommended, and the appropriate caution should be taken during surgery.
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19
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Pediatric versus adult meningioma: comparison of epidemiology, treatments, and outcomes using the Surveillance, Epidemiology, and End Results database. J Neurooncol 2018. [DOI: 10.1007/s11060-018-2756-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Battu S, Kumar A, Pathak P, Purkait S, Dhawan L, Sharma MC, Suri A, Singh M, Sarkar C, Suri V. Clinicopathological and molecular characteristics of pediatric meningiomas. Neuropathology 2017; 38:22-33. [PMID: 28901666 DOI: 10.1111/neup.12426] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Abstract
Molecular and clinical characteristics of pediatric meningiomas are poorly defined. Therefore, we analyzed clinical, morphological and molecular profiles of pediatric meningiomas. Forty pediatric meningiomas from January 2002 to June 2015 were studied. 1p36, 14q32 and 22q-deletion were assessed by fluorescent in situ hybridization and mutations of most relevant exons of AKT, SMO, KLF4, TRAF and pTERT using sequencing. Expression of GAB1, stathmin, progesterone receptor (PR), p53 along with MIB-1 LI was examined using immunohistochemistry. There were 36 sporadic and four NF2 associated meningiomas. Among sporadic meningiomas, the majority (72.2%) of cases harbored 22q-deletion. Difference in frequency of combined 1p/14q deletion in Grade-I versus Grade-II/III tumors was not significant (13.7% vs 28.5%, P = 0.57). PR immunoreactivity was seen in 65.5% of Grade-I and 14.2% of Grade-II/III tumors (P = 0.03). The majority (97.2%) of meningiomas were immunonegative for p53. Stathmin and GAB co-expression was observed in 58.3% of cases. Notably, AKT, SMO, KLF4, TRAF7 (exon 17) and pTERT mutations were seen in none of the cases analyzed. 1p/14q codeletion was frequent in skull base as compared to non-skull base meningiomas (23% vs 11.1%, P = 0.37). All NF2 meningiomas harbored 22q-deletion and showed GAB and stathmin co-expression while none showed 1p/14q loss. Pediatric meningiomas share certain phenotypic and cytogenetic characteristics with adult counterparts, but GAB and stathmin co-expression in the majority of cases and non-significant difference in frequency of 1p/14q co-deletion between low- and high-grade meningiomas indicate an inherently aggressive nature. Characteristic AKT/SMO, KLF4/TRAF7 and pTERT genetic alterations seen in adults are distinctly absent in pediatric meningiomas.
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Affiliation(s)
- Sudha Battu
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Pathak
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suvendu Purkait
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Linchi Dhawan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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21
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Honda Y, Shirayama R, Morita H, Kusuhara K. Pulmonary and pleural metastasis of intracranial anaplastic meningioma in a 3-year-old boy: A case report. Mol Clin Oncol 2017; 7:633-636. [PMID: 29046796 DOI: 10.3892/mco.2017.1375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/07/2017] [Indexed: 12/26/2022] Open
Abstract
In adults, meningiomas occasionally display aggressive behavior and may occasionally metastasize. By contrast, pediatric meningiomas are rare, and there is limited information regarding their clinical characteristics, treatment and prognosis. We herein report the case of a 3-year-old boy with anaplastic meningioma with a history of local recurrence and late pulmonary metastasis. At diagnosis, a 70-mm mass lesion in was identified in the right frontal lobe, with intratumoral hemorrhage. The tumor was attached to the falx cerebri and was completely resected. The histological diagnosis was anaplastic meningioma, World Health Organization grade III. Two months after the surgery, the meningioma recurred at the same site. Although the patient received radiotherapy after a second operation, the tumor metastasized to the lung and pleura 8 months after the initial operation. The metastasis was resistant to treatment, even after gross total resection, and the effectiveness of further radiotherapy was limited. The patient succumbed to the disease 1 year and 4 months after the initial diagnosis. The findings of the present case and a review of the relevant literature suggest that recurrence and metastasis of meningiomas are difficult to predict. Therefore, such patients should be carefully monitored throughout the follow-up period.
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Affiliation(s)
- Yuko Honda
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Rie Shirayama
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Hiromi Morita
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
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22
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Clinical features and long-term outcomes of pediatric intraventricular meningiomas: data from a single neurosurgical center. Neurosurg Rev 2017; 41:525-530. [DOI: 10.1007/s10143-017-0884-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/04/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
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23
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Huntoon K, Pluto CP, Ruess L, Boué DR, Pierson CR, Rusin JA, Leonard J. Sporadic pediatric meningiomas: a neuroradiological and neuropathological study of 15 cases. J Neurosurg Pediatr 2017; 20:141-148. [PMID: 28548617 DOI: 10.3171/2017.3.peds16502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sporadic meningiomas have been classified in many different ways. Radiographically, these lesions can be described as occurring in either typical or atypical locations. The purpose of this study was to determine if there are any histopathological differences between sporadic meningiomas that arise in these varying locations in children. METHODS The neuroimaging, histopathological findings, and clinical records in patients with sporadic pediatric meningiomas not associated with neurofibromatosis Type 2 or prior radiation therapy were retrospectively reviewed. Tumors were classified by radiological findings as either typical or atypical, and they were categorized histopathologically by using the latest WHO nomenclature and grading criteria. RESULTS Fifteen sporadic meningiomas in pediatric patients were biopsied or resected at the authors' institution between 1989 and 2013. Five (33%) were typical in radiographic appearance and/or location and 10 (67%) were atypical. Four (80%) typical meningiomas were WHO Grade I tumors. Most (60%) of the atypical meningiomas were WHO Grade II or III. CONCLUSIONS This study is the largest series of sporadic pediatric meningiomas in atypical locations to date. Although sporadic meningiomas are relatively infrequent in children, those with atypical imaging, specifically those with apparently intraparenchymal and intraosseous locations, may be more common than previously recognized. In this study, pediatric sporadic meningiomas arising in atypical locations, in particular intraparenchymal meningiomas, may be of higher histopathological grade. The authors' findings should alert clinicians to the potential for more aggressive clinical behavior in these tumors.
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Affiliation(s)
| | | | | | - Daniel R Boué
- Pathology, The Ohio State University Wexner Medical Center; Departments of.,Pathology and Laboratory Medicine, and
| | - Christopher R Pierson
- Pathology, The Ohio State University Wexner Medical Center; Departments of.,Pathology and Laboratory Medicine, and.,Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio; and
| | | | - Jeffrey Leonard
- Departments of 1 Neurological Surgery.,Neurosurgery, Nationwide Children's Hospital; and
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24
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Fan MC, Fang W, Liu K, Wang C, Deng WS, Sun P, Tang WZ. Paediatric intracranial meningiomas: eight-year experience with 32 cases. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0085-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rossing M, Yde CW, Sehested A, Østrup O, Scheie D, Dangouloff-Ros V, Geoerger B, Vassal G, Nysom K. Genomic diagnostics leading to the identification of a TFG-ROS1 fusion in a child with possible atypical meningioma. Cancer Genet 2017; 212-213:32-37. [PMID: 28449809 DOI: 10.1016/j.cancergen.2017.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/14/2017] [Accepted: 03/18/2017] [Indexed: 11/17/2022]
Abstract
Meningiomas are rare in children. They are highly complex, harboring unique clinical and pathological characteristics, and many occur in patients with neurofibromatosis type 2. Hereby, we present a case of a two-year-old boy presented with a diagnostically challenging intraventricular tumor. It was incompletely resected 6 times over 14 months but kept progressing and was ultimately deemed unresectable. Histologically, the tumor was initially classified as schwannoma, but extensive international review concluded it was most likely an atypical meningioma, WHO grade II. Comprehensive genomic profiling revealed a TFG-ROS1 fusion, suggesting that ROS1-signaling pathway alterations were driving the tumor growth. In light of this new information, the possibility of a diagnosis of inflammatory myofibroblastic tumor was considered; however the histopathological results were not conclusive. This specific molecular finding allowed the potential use of precision medicine and the patient was enrolled in the AcSé phase 2 trial with crizotinib (NCT02034981), leading to a prolonged partial tumor response which is persisting since 14 months. This case highlights the value of precision cancer medicine in children.
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Affiliation(s)
- Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Christina Westmose Yde
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Olga Østrup
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Birgit Geoerger
- Department of Paediatrics and Adolescent Oncology, Vectorology and Anticancer Therapies, UMR 8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Gilles Vassal
- Department of Paediatrics and Adolescent Oncology, Vectorology and Anticancer Therapies, UMR 8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Li Z, Li H, Wang S, Zhao J, Cao Y. Pediatric Skull Base Meningiomas: Clinical Features and Surgical Outcomes. J Child Neurol 2016; 31:1523-1527. [PMID: 27543558 DOI: 10.1177/0883073816664669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to investigate the clinical, pathological, and prognostic characteristics of pediatric skull base meningiomas. A retrospective analysis of 44 pediatric skull base patients younger than 18 years who underwent surgery at Beijing Tiantan Hospital was performed. The study group included 20 males and 24 females. Multiple lesions were seen in 8 patients. WHO grade I was found in 28 patients and higher grade was seen in 16 patients. Recurrence or progression occurred in 10 patients after the initial operation. The overall survival rate in the follow-up period for the entire cohort was 89.7%. The authors found no sex predominance in pediatric skull base meningiomas. In addition, this lesion was more often seen in their second decades. In contrast to skull base meningiomas in adult patients, pediatric skull base meningiomas had a higher incidence of nonbenign histopathological variants and a higher rate of recurrence.
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Affiliation(s)
- Zhicen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Li H, Zhao M, Jiao Y, Ge P, Li Z, Ma J, Wang S, Cao Y, Zhao J. Prediction of High-Grade Pediatric Meningiomas: Magnetic Resonance Imaging Features Based on T1-Weighted, T2-Weighted, and Contrast-Enhanced T1-Weighted Images. World Neurosurg 2016; 91:89-95. [DOI: 10.1016/j.wneu.2016.03.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
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Li H, Zhao M, Wang S, Cao Y, Zhao J. Prediction of pediatric meningioma recurrence by preoperative MRI assessment. Neurosurg Rev 2016; 39:663-9. [PMID: 27037557 DOI: 10.1007/s10143-016-0716-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/06/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
Abstract
Preoperative identification of high-recurrent pediatric meningiomas with MRI features would help clinicians to make optimal treatment strategies; however, the relationships between radiological features and recurrence of meningiomas in pediatric population have not been clearly demonstrated yet. The aim of this study is to identify preoperative MRI features which are significant risk factors for recurrence of pediatric meningiomas. From January 2005 to December 2012, we retrospectively reviewed 52 pediatric meningiomas in terms of preoperative MRI features and their clinical data and followed them up from 22 to 128 months (mean 63 months) after the initial surgery. The relationships between these radiological findings and relapse-free survival (RFS) time were assessed initially with univariate Cox analysis and then corrected by multivariate Cox analysis. According to univariate analysis, irregular shape, narrow-based attachment, and skull base location were significantly correlated with shorter time to recurrences of meningiomas in pediatric patients. When corrected by multivariate analysis, irregular shape (P = 0.05; OR 3.442, 95 % CI 1.001-11.831) and narrow-based attachment (P = 0.004; OR 7.164, 95 % CI 1.894-27.09) were strong independent predictive factors for worse RFS of pediatric meningiomas. In pediatric population, narrow-based attachment and irregular shape were significantly correlated with recurrences of meningiomas. Our results could help clinicians to make optimal therapeutic strategies for pediatric patients with intracranial meningiomas before surgery.
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Affiliation(s)
- Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China.
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Larrew T, Eskandari R. Pediatric Intraparenchymal Meningioma: Case Report and Comparative Review. Pediatr Neurosurg 2016; 51:83-6. [PMID: 26524676 DOI: 10.1159/000441008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
Abstract
Intra-axial (intraparenchymal) meningiomas are an extremely rare pathology with only dozens of cases reported. In children, the unusual characteristics of intraparenchymal meningiomas can easily create an atypical preoperative differential. The authors present the case of an otherwise healthy 14-year-old girl presenting with new-onset seizures and an intracranial lesion upon investigation. CT and MRI revealed a lesion both cystic and calcified in nature, residing completely within the brain parenchyma. Upon operative examination, the mass was found to be completely surrounded by cortex and to be of two disparate consistencies. Pathological analysis revealed the mass to be a meningioma. Despite the rarity in children, meningiomas must be kept on the differential for cystic, calcified lesions. The differential diagnosis based on imaging as well as the operative strategy taken are further discussed. In addition, the authors review the current understanding of pediatric meningiomas as compared with adult meningiomas.
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Affiliation(s)
- Thomas Larrew
- Department of Neurosurgery, Medical University of South Carolina, Charleston, S.C., USA
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Li J, Mzimbiri JM, Zhao J, Zhang Z, Liao X, Liu J. Surviving the Largest Atypical Parasagittal Meningioma in a 2-Year-Old Child: A Case Report and a Brief Review of the Literature. World Neurosurg 2015; 87:662.e1-6. [PMID: 26548821 DOI: 10.1016/j.wneu.2015.10.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Meningiomas arising in pediatric populations are rare neoplasms with distinct biological and clinical features. A rare case of a 2-year-old boy with extremely large intracranial parasagittal meningioma is presented. To our knowledge, this case is the largest parasagittal meningioma to be reported to date in the pediatric age group. CASE DESCRIPTION The tumor size at its largest diameter was 14.2 cm. Two-stage craniotomy was performed within 3 weeks to resect the tumor totally by Simpson grade II while preserving the superior sagittal sinus. Three months after the second resection, the patient had a complication of subdural hematoma, which was managed by external drainage and urokinase. CONCLUSIONS The patient's postoperative recovery was unremarkable, and the previously compressed brain rebounded. There was no evidence of recurrence after two years of follow-up. Every effort should be exerted to achieve radical resection of the tumor, which can result in a satisfactory prognosis and a low recurrence rate.
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Affiliation(s)
- Jian Li
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Hydrocephalus Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Juma M Mzimbiri
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Neurosurgery, Muhimbili Orthopedic and Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Jie Zhao
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Hydrocephalus Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiping Zhang
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Hydrocephalus Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xinbin Liao
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Hydrocephalus Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingping Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Hydrocephalus Center, Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Kalani MYS, Cavallo C, Coons SW, Lettieri SC, Nakaji P, Porter RW, Spetzler RF, Feiz-Erfan I. Long-term follow-up of surgical resection of microcystic meningiomas. J Clin Neurosci 2015; 22:713-7. [DOI: 10.1016/j.jocn.2014.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
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The importance of microsurgery in childhood meningioma: a case report. Childs Nerv Syst 2015; 31:161-5. [PMID: 25034239 DOI: 10.1007/s00381-014-2490-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Although meningiomas are frequently diagnosed in adults, it is a rare (intracranial) tumor in the pediatric population, with an incidence of 0.06/100,000. The pathology and treatment of meningiomas in adulthood has been a topic of increasing investigation. So far, the treatment of pediatric meningiomas has been extrapolated from these results. The question remains, however, whether translation of adult meningioma data into the childhood population is legitimate. METHODS We present the case of a 3-year-old girl diagnosed with an intraventricular malignant meningioma and type 2 neurofibromatosis. She was operated on multiple times to achieve complete resection and received adjuvant chemotherapy. Since, she has been stable with no neurological sequelae and/or recurrence of the meningioma. CONCLUSION Pediatric meningiomas are rare tumors and differ from their adult counterparts in various aspects. We believe that gross total resection of meningioma in the pediatric population, when possible, is the treatment of choice. In the event of a subtotal resection, repeat resection is recommended. Any adjuvant treatment with chemotherapy or radiation therapy should be carefully considered during multidisciplinary meetings.
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Stanuszek A, Piątek P, Kwiatkowski S, Adamek D. Multiple faces of children and juvenile meningiomas: a report of single-center experience and review of literature. Clin Neurol Neurosurg 2014; 118:69-75. [PMID: 24529233 DOI: 10.1016/j.clineuro.2013.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/15/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Pediatric meningiomas are extremely rare tumors often associated with various medical conditions. This report is an attempt to analyze the clinical behavior, pathological presentation and recommended management of both isolated and neurofibromatosis type 2 (NF2) related pediatric meningiomas in comparison to their adult counterparts. METHODS The investigated group consisted of three male and six female patients suffering from meningiomas of the central nervous system, who were hospitalized at our department in years 2001-2012. RESULTS In our group three children were diagnosed with NF2. Two were released with a suspicion of that disease. Three patients had multiple meningiomas at the first presentation. The most common manifestation were focal neurological deficits (47%). Meningiomas were mostly located at the brain convexity (29%). Histological examination revealed the domination of fibrous type in our group (29%). Apart from surgical management a preoperative embolization of the tumors' vessels was implemented in two children. Another three children underwent postoperative radiotherapy (RTh), one received a chemotherapy (ChTh). CONCLUSION Meningiomas in children differ from their counterparts in adults. Due to common coexistence of pediatric meningiomas and neurofibromatosis type 2, this group of patients should be taken under strict control, because of high risk of tumor recurrence.
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Affiliation(s)
- Agnieszka Stanuszek
- Students' Research Group at the Department of Neurosurgery, University Children's Hospital, Jagiellonian University Medical College, Kraków, Poland.
| | - Paula Piątek
- Students' Research Group at the Department of Neurosurgery, University Children's Hospital, Jagiellonian University Medical College, Kraków, Poland.
| | - Stanisław Kwiatkowski
- Department of Neurosurgery, University Children's Hospital, Jagiellonian University Medical College, Kraków, Poland.
| | - Dariusz Adamek
- Department of Neuropathology, Chair of Pathomorphology, Jagiellonian University Medical College, Kraków, Poland.
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Kotecha RS, Jacoby P, Cole CH, Gottardo NG. Morbidity in survivors of child and adolescent meningioma. Cancer 2013; 119:4350-7. [PMID: 24052192 PMCID: PMC4209112 DOI: 10.1002/cncr.28366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/20/2013] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia; Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
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Management of pediatric intracranial meningiomas: an analysis of 31 cases and review of literature. Childs Nerv Syst 2013; 29:573-82. [PMID: 23292441 DOI: 10.1007/s00381-012-2010-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study is to understand the epidemiology, clinical features, behavior, and the prognostic factors that influence the outcome of intracranial meningiomas in children. METHODS Thirty-one patients with age less than 18 years who underwent surgery for intracranial meningiomas during the period of at 1988-2012 at Voluntary Health Services Hospital, Chennai, India were studied. These formed 3.7 % of the total 831 cases of intracranial meningiomas operated at the institute. RESULTS The study group included 22 (71 %) males and 9 (29 %) females. The mean age of presentation was 15 years, with the youngest being 9 months old. Two (6 %) had evidence of neurofibromatosis type 2 (NF2). The most common symptoms at presentation were seizures in 11 (35.5 %), weakness of limbs in 11 (35.5 %), and raised intracranial pressure in 10 (32 %). Convexity meningiomas were seen in 16 (51 %) and skull base in 15(49 %). Multiple meningiomas was seen in two (6 %) of the patients and intraventricular location was found in one patient (3 %). Two (6 %) had evidence of NF2. Gross total excision was achieved in 26 (83 %) and subtotal excision in 5 (17 %). WHO grade I was found in 20 (64 %) and higher grade was seen in 11 (36 %). The mean follow-up was 46.2 months. Recurrence was seen in 20 patients (64 %). In patients with higher grade or with recurrence resurgery and radiotherapy was given. Three (9 %) had multiple recurrences. On a mean follow-up of 46.2 months, 25 patients (81 %) were neurologically intact, 5 (16 %) were having moderated disability, and 1 (3 %) patient died. CONCLUSIONS Childhood meningiomas are uncommon lesions with a slight male predominance. They can have a varied clinical presentation. Higher grade is found more frequently compared with adults. Gross total resection is the goal and in higher grade meningiomas radiotherapy helps as a good adjuvant. Though the rate of recurrence is high, resurgery and radiotherapy gives a good outcome.
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Santos MV, Furlanetti L, Valera ET, Brassesco MS, Tone LG, de Oliveira RS. Pediatric meningiomas: a single-center experience with 15 consecutive cases and review of the literature. Childs Nerv Syst 2012; 28:1887-96. [PMID: 22669518 DOI: 10.1007/s00381-012-1823-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/23/2012] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Marcelo Volpon Santos
- Division of Pediatric Neurosurgery of the Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, 14049-900, Ribeirão Preto, Brazil
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Wang XQ, Jiang CC, Zhao L, Gong Y, Hu J, Chen H. Clinical features and treatment of World Health Organization grade II and III meningiomas in childhood: report of 23 cases. J Neurosurg Pediatr 2012; 10:423-33. [PMID: 22938082 DOI: 10.3171/2012.7.peds12179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECT High-grade meningiomas in childhood are rare, and their clinical features are unknown. The objective of this study was to determine the clinical characteristics and prognosis of childhood high-grade meningiomas. METHODS Twenty-three patients with childhood high-grade meningiomas were treated at the Huashan Hospital. Clinical data were collected, tumor samples were reexamined, and prognoses were attained through follow-up visits and telephone interviews. Survival probability was calculated using the Kaplan-Meier method. A 2-sided probability level of 0.05 was chosen for statistical significance. RESULTS The series included 18 males and 5 females (mean age 12.1 years). The most common symptoms were headache and vomiting (43%). Three patients had accompanying neurofibromatosis type II (NF2). The high-grade meningioma cases with NF2 had larger tumor diameters than those without NF2 (p = 0.010). The skull base was the most common tumor site (39%). Complete resections were achieved in 11 patients after their initial operations. Adjuvant radiation therapy was performed in 9 cases. Follow-up evaluations were performed for 20 patients (mean follow-up 70 months). Ten patients experienced recurrences, 2 patients had lung metastases, and 7 patients died of the recurrence. The extent of surgery was significantly related to progression-free survival (PFS; p = 0.038). A negative progesterone receptor combined with strongly positive Bcl-2 immunoreactivity was significantly related to PFS (p = 0.001) and overall survival (p = 0.002). The MIB-1 labeling index was significantly related to overall survival (p = 0.018), whereas postoperative radiation therapy was not significantly related to PFS (p = 0.087) and overall survival (p = 0.40). CONCLUSIONS Childhood high-grade meningioma is a rare tumor type. Childhood high-grade meningioma has a male predominance and the basilar region is the most common tumor location. Patients with these tumors have high recurrence and mortality rates. The extent of resection is an important prognosis factor. A negative progesterone receptor combined with a strongly positive Bcl-2 immunoreaction might predict cancer recurrence. The MIB-1 labeling index correlates with the prognosis, and an MIB-1 labeling index > 3% increases the risk of recurrence in childhood high-grade meningioma. More cases should be collected, and longer follow-up periods should be obtained, to evaluate the effects of postoperative radiation therapy in childhood high-grade meningioma.
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Affiliation(s)
- Xiao-Qiang Wang
- Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China
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Elbabaa SK, Gokden M, Crawford JR, Kesari S, Saad AG. Radiation-associated meningiomas in children: clinical, pathological, and cytogenetic characteristics with a critical review of the literature. J Neurosurg Pediatr 2012; 10:281-90. [PMID: 22900483 DOI: 10.3171/2012.7.peds1251] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Radiation-associated meningiomas (RAMs) arise after treatment with radiation to the cranium and are recognized as clinically separate from sporadic meningiomas. Compared with their sporadic counterparts, RAMs are often aggressive or malignant, likely to be multiple, and have a high recurrence rate. However, limited information exists about the clinical, pathological, and cytogenetic features of RAMs in pediatric patients. The authors report the findings in 9 children with meningiomas following therapeutic radiation to the cranium. In addition, they performed a critical review of the English language literature on pediatric RAMs. METHODS Medical files were searched for patients who demonstrated meningiomas after a history of radiation to the brain. Only those patients in whom a meningioma occurred before the age of 18 years were included in this study. Clinical and demographic data along with the MIB-1 labeling index and cytogenetic studies were evaluated. RESULTS The patients consisted of 5 males and 4 females with a median age of 5 years (range 2-10 years) at radiation therapy. The latency period was a median of 10 years after radiation therapy (range 6-13 years). The MIB-1 labeling index was a median of 6.6% (range 4%-10%). Five patients (55.6%) displayed multiple meningiomas at the first presentation. Histological types included clear cell meningioma in 1 patient, fibroblastic meningioma in 2, chordoid meningioma in 2, meningothelial meningioma in 7 (atypical in 2 cases), xanthomatous meningioma in 1, and chordoid meningioma in 1. Cytogenetic studies showed that the loss of 22q12.2 was the most common abnormality (3 patients), followed by complex cytogenetic abnormalities (2 patients) and rearrangements between chromosomes 1 and 12 (1 patient) and a 1p deletion (1 patient). CONCLUSIONS In contrast to RAMs occurring in adults, those in pediatric patients show an increased incidence of multiplicity on first presentation and unusual histological variants, some of which are described here for the first time. There was no difference in the MIB-1 labeling index in children with RAMs as compared with that in children with non-RAMs.
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Affiliation(s)
- Samer K Elbabaa
- Departments of Neurosurgery, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas 72202, USA
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Ramraje S, Kulkarni S, Choudhury B. Paediatric intraventricular meningiomas. A report of two cases. Australas Med J 2012; 5:126-9. [PMID: 22905053 DOI: 10.4066/amj.2012.993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Meningiomas are rare in children comprising less than 3% of paediatric brain tumours and only 1.5-1.8% of all intracranial neoplasms. Intraventricular meningiomas (IVM) account for 0.5-5% of all meningiomas. They arise in the ventricles from arachnoid cap cells contained within the choroid plexus, the tela choroidea, or the velum interpositum. Paediatric tumours also show an association with neurofibromatosis type 2 and previous radiation exposure.We present two cases of intraventricular meningiomas, both in children. The age and site of the lesion in the two cases are uncommon. Excision of the lesions caused a total subsidence of the symptoms with no reported recurrences.
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Affiliation(s)
- Sushma Ramraje
- Associate Professor, Department of Pathology, Grant Medical College, Mumbai-400008
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Okechi H, Albright AL. Intraventricular meningioma: case report and literature review. Pediatr Neurosurg 2012; 48:30-4. [PMID: 22922461 DOI: 10.1159/000341176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/11/2012] [Indexed: 11/19/2022]
Abstract
In this article we describe the clinical course of a child with an intraventricular meningioma and review the relevant literature. A 7-year-old girl with a several-month history of headaches had a CT scan that demonstrated a large, enhancing, intraventricular tumor. The tumor was completely excised via a superior parietal approach. Pathological examination revealed a pleomorphic meningioma. Postoperative scans demonstrated no residual tumor. Pediatric intraventricular tumors are rare. The surgical objective is complete resection, which appears to be associated with excellent outcomes.
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Paldino MJ, Faerber EN, Poussaint TY. Imaging tumors of the pediatric central nervous system. Radiol Clin North Am 2011; 49:589-616, v. [PMID: 21807164 DOI: 10.1016/j.rcl.2011.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary tumors of the central nervous system (CNS) are the second most common neoplasms in children and the leading cause of death in this patient population. The primary objective of this article is to describe the most common pediatric brain tumors and to offer an overview of their respective imaging features, primarily on magnetic resonance imaging. Precise anatomic characterization is essential for developing an appropriate differential diagnosis. Once equipped with this critical information, physicians should be better able to make firm diagnoses, leading to improved disease management and patient outcomes in the setting of CNS tumors of childhood.
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Affiliation(s)
- Michael J Paldino
- Division of Neuroradiology, Department of Radiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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Pinto PS, Huisman TAGM, Ahn E, Jordan LC, Burger P, Cohen KJ, Patay Z, Tekes A. Magnetic resonance imaging features of meningiomas in children and young adults: a retrospective analysis. J Neuroradiol 2011; 39:218-26. [PMID: 21840060 DOI: 10.1016/j.neurad.2011.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 04/29/2011] [Accepted: 06/18/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Meningiomas are rare in children and, unlike in adults, they have male predominance, unusual locations, cystic components and poorer clinical outcomes. The aims of our study were to: a) evaluate the MRI features of pediatric meningiomas; b) correlate ADC values of meningiomas with clinical and histopathological types; and c) correlate peritumoral edema with size and histopathological type of tumor. PATIENTS AND METHODS Radiological data from 24 patients (mean age: 14.3 years) with an imaging or histopathological diagnosis of meningioma, and presurgical MRI between 1995 and 2009 from two medical institutions, were reviewed. Meningiomas were clinically classified as spontaneously arising meningiomas (SAM), NF2-associated meningiomas (NF2-M) and radiation-induced meningiomas (RIM) and, histopathologically, according to the WHO classification system. The main MRI signal characteristics and enhancement were evaluated. ADC values were compared with histopathological type and clinical group. Tumor size and peritumoral edema were also assessed. RESULTS Thirty-four meningiomas (eight SAM, 13 NF2-M, 13 RIM) in 24 patients (12 male, 12 female) were evaluated. Unusual locations were frequently seen in SAM, including cases of intraventricular and intraparenchymal meningiomas. SAM were also always larger than either RIM or NF2-M. Cystic components were only found in SAM, and were not associated with high-grade tumors (WHO II and III). Mean ADC values were significantly different between SAM and NF2-M, but were not associated with histopathological type. Peritumoral edema correlated with tumor size, but did not differ significantly according to clinical group. CONCLUSION Pediatric SAM have unusual locations, larger size and cystic components, and are diagnosed at a younger age than NF2-M and RIM. NF2-M can have unusual locations such as, in particular, the craniocervical junction. Tumor ADC values did not help to predict tumor grade or clinical type. Peritumoral edema correlated with tumor size, but not with clinical group or histopathological grade.
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Affiliation(s)
- Pedro S Pinto
- Division of Pediatric Radiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, 600 North Wolfe Street Nelson Basement, 172, Baltimore, MD 21287-0842, USA
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A clinicopathological and neuroradiological study of paediatric meningioma from a single centre. J Clin Neurosci 2011; 18:1084-9. [DOI: 10.1016/j.jocn.2010.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
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Pediatric meningioma: current approaches and future direction. J Neurooncol 2011; 104:1-10. [DOI: 10.1007/s11060-010-0503-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/13/2010] [Indexed: 01/09/2023]
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Intracranial meningioma in children: Different from adult forms? A series of 21 cases. Neurochirurgie 2010; 56:309-14. [DOI: 10.1016/j.neuchi.2010.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 05/14/2010] [Indexed: 11/17/2022]
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Cleary C, Curtin D. Giant atypical intraventricular meningioma presenting with visual loss in a child. Ir J Med Sci 2010; 179:617-9. [DOI: 10.1007/s11845-010-0514-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/27/2010] [Indexed: 11/28/2022]
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Gao X, Zhang R, Mao Y, Wang Y. Childhood and juvenile meningiomas. Childs Nerv Syst 2009; 25:1571-80. [PMID: 19641924 DOI: 10.1007/s00381-009-0964-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 06/14/2009] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Xing Gao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fu Dan University, #12 Wulumuqi Zhong Road, Shanghai 200040, China
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