Pediatric Skull Base Meningiomas: Clinical Features and Surgical Outcomes

Trans-eyebrow supraorbital endoscope-assisted keyhole approach to suprasellar meningioma in pediatric patient: case report and literature review

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.

Open Approaches to the Anterior Skull Base in Children: Review of the Literature

Introduction  Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the "gold standard" for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective  This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods  Comprehensive literature review. Results  Extensive intracranial-intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion  Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a specific lesion in regard to its nature, location, and extent is of utmost importance.

Sporadic pediatric meningiomas: a neuroradiological and neuropathological study of 15 cases

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.

A comparison of clinicopathological features and surgical outcomes between pediatric skull base and non-skull base meningiomas

OBJECT

The purpose of this study is to analyze and compare the clinicopathological characteristics and surgical outcomes between skull base and non-skull base meningiomas in pediatric population.

METHODS

We retrospectively analyzed a total of 140 cases of pediatric meningiomas surgically treated in our department from January 2005 to July 2015 and compared the clinicopathological characteristics and surgical outcomes between skull base and non-skull base meningiomas.

RESULTS

Of all the pediatric meningiomas, 50 (35.8 %) were located at the skull base and 90 (64.2 %) were located at the non-skull base. Skull base and non-skull base meningiomas had a similar sex distribution (male/female = 1:1 in skull base meningiomas and male/female = 1.5:1 in non-skull base meningiomas) (P = 0.288) and high-grade meningioma occurrence rate (P = 0.569). In addition, the mean age of non-skull base meningiomas was 12.5 years which was younger than that of skull base meningiomas (14.2 years) (P = 0.019), and the preoperative tumor size was smaller in skull base (mean size = 4.7 cm in skull base meningiomas and mean size = 5.7 cm in non-skull base meningiomas) (P = 0.020). Gross total resection was achieved in 64 non-skull base patients (73.9 %) and 26 skull base patients (52 %) (P = 0.046). Patients with gross total resection had better progression free survival (PFS) than those with subtotal resection.

CONCLUSION

Pediatric skull base and non-skull base meningiomas are similar in sex distribution and high-grade meningioma occurrence rate. In comparison with non-skull base ones, pediatric skull base meningiomas occur at elder age and are smaller in size and they are more likely to be incompletely resected. Gross total resection and early treatment are recommended to prolong PFS of pediatric patients.