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Keymakh M, Benton JA, Fluss R, Alavi SAN, Martin AM, Chin S, Kobets AJ. Clear cell meningiomas-case presentation, review of radiographic identifiers, and treatment approaches. Childs Nerv Syst 2024; 40:1989-1996. [PMID: 38637336 PMCID: PMC11180007 DOI: 10.1007/s00381-024-06390-z] [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: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
Spinal clear cell meningiomas (CCMs) are a rare histological subtype of meningiomas that pose preoperative diagnostic challenges due to their radiographic similarities with other lesions. They are also more aggressive, exhibiting higher rates of recurrence, particularly in pediatric patients. Overcoming diagnostic challenges of these tumors can improve patient outcomes. In this report, we describe a case of a pediatric patient presenting with a lumbar CCM in whom we were able to obtain gross total resection. Our report reviews previously identified predictors of CCM recurrence, including the Ki-67 proliferation index, number of spinal segments involved, and hormonal influences related to age and sex. We describe the characteristic radiographic features that differentiate spinal CCMs from other tumors to improve pre-operative diagnosis. Furthermore, we provide our rationale for adjuvant therapy for pediatric patients to refine treatment protocols for these rare tumors.
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Affiliation(s)
- Margaret Keymakh
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA.
| | - Joshua A Benton
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Rose Fluss
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Seyed Ahmad Naseri Alavi
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Allison M Martin
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Steven Chin
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew J Kobets
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
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Liang Q, Ge P, Liu Y, Zhu X, Lu S, Pan C, Ji Z, Wang Q, Wang Y. Central nervous system clear cell meningioma: a systematic literature review. Neurosurg Rev 2024; 47:35. [PMID: 38183517 DOI: 10.1007/s10143-023-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
Clear cell meningiomas are a rare histological subtype of World Health Organization (WHO) grade II meningioma. Despite its relatively low frequency, clear cell meningioma has attracted considerable attention because of its unique pathological characteristics, clinical behavior, and challenging management considerations. The purpose of our systematic review is to provide clinicians with a better understanding of this rare disease. PubMed was searched for articles in the English language published from 1988 to 2023 June. The keywords were as follows: "clear cell meningioma," "clear cell" and "meningioma." We analyzed clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis to determine the factors influencing recurrence-free survival (RFS). Recurrence-free survival curves of related factors were calculated by the Kaplan‒Meier method. The log-rank test and Cox univariate analysis were adopted to assess the intergroup differences and seek significant factors influencing prognosis and recurrence. Fifty-seven papers met the eligibility criteria, including 207 cases of clear cell meningioma (CCM), which were confirmed by postoperative pathology. The fifty-seven articles involved 84 (40.6%) males and 123 (59.4%) females. The average age at diagnosis was 27.9 years (range, 14 months to 84 years). Among the symptoms observed, headache, neurologic deficit, and hearing loss were the most commonly reported clinical manifestations. Most tumors (47.8%) were located in the skull base region. Most tumors showed significant enhancement, and homogeneous enhancement was more common. A total of 152 (74.1%) patients underwent gross total resection (GTR), and 53 (25.9%) patients underwent subtotal resection (STR). During the follow-up, the tumor recurred in 80 (39.4%) patients. The log-rank test and the Cox univariate analysis revealed that tumor resection range (GTR vs. STR) and adjuvant treatment (YES vs. NO) were significant predictors of recurrence-free survival (RFS). Clear cell meningioma is a rare type of meningioma with challenging diagnosis and therapy. The prognosis of this disease is different from that of regular meningiomas. Recurrence remains a possibility even after total tumor resection. We found that the surgical resection range and adjuvant treatment affected the recurrence period. This finding provides significant guidance for the treatment of clear cell meningioma.
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Affiliation(s)
- Qi Liang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Pengfei Ge
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yanhua Liu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Xiaoxi Zhu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Shan Lu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Chengliang Pan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Zhilin Ji
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Qingxuan Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China.
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Okamon DJM, Coulibaly M, N’dri D. Cervical spinal meningioma mimicking an arachnoid cyst: A pediatric case report. Surg Neurol Int 2023; 14:441. [PMID: 38213462 PMCID: PMC10783675 DOI: 10.25259/sni_672_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
Background Meningiomas are rare tumors in children. Although magnetic resonance imaging (MRI) diagnosis is usually easy, its cystic form can wrongly suggest other diagnoses, such as an epidermoid or arachnoid cyst. We describe an unusual case of cervical cystic meningioma in a child. Case Description A 5-year-old patient was consulted for progressive weakness of all four limbs, making walking impossible. Neurological examination revealed cervical stiffness without meningeal signs and tetrapyramidal syndrome with incomplete tetraplegia. A cervical spine MRI showed a circumscribed intradural extramedullary lesion at the level of C2-C3, which led to a suspicion of a compressive arachnoid cyst. A gross total resection was performed through a posterior approach. During surgery, it was an extramedullary intradural cystic formation containing a clear liquid and a shell adherent to the Dura mater. Postoperative MRI shows satisfactory spinal cord decompression without evidence of residual tumor. The postoperative course was uneventful, with the resumption of independent walking on the 21st day. Histopathologic examination and immunohistochemistry revealed a grade I meningothelial meningioma according to the 2021 World Health Organization classification of tumors of the central nervous system. Conclusion Cystic meningiomas can sometimes suggest another diagnosis on imaging, especially since they are rare in children.
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