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Vitulli F, Spennato P, Di Costanzo M, Cinalli MA, Onorini N, Mirone G, Cinalli G. Hemostasis in a giant intraventricular tumor using a saline-cooled radiofrequency bipolar coagulator: technical note. Childs Nerv Syst 2023; 39:2181-2185. [PMID: 37330459 DOI: 10.1007/s00381-023-06027-7] [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: 05/16/2023] [Accepted: 06/10/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Meningiomas are relatively rare in children and tend to be intraventricular and cystic, with often malignant behavior. Complete excision is associated with the most favorable outcome; moreover, the size and extent of these lesions often make complete excision in one step impossible because of the risk of intraoperative death from uncontrollable hemorrhage. CASE PRESENTATION A 10-year-old girl was admitted for headache in the last 3 months and was found to have a giant left intraventricular lesion with a volume of 166.63 cm3, which caused hydrocephalus and significant mass effect. Very large draining veins were evident within the tumor, draining into the thalamostriates and internal cerebral veins. Cerebral angiography showed multiple feeders originating mainly from branches of the posterior left choroidal artery with distal afferents that could not be embolized. Therefore, a left parietal transcortical approach was chosen. Given the vascularity of the tumor, saline-cooled radiofrequency coagulation (Aquamantys®) was used to reduce blood loss intraoperatively. Gross total resection (GTR) was achieved with an estimated blood loss of 640 mL. Pathology analysis was consistent with WHO grade 1 transitional meningioma. Postoperatively, the patient was neurologically intact, and MRI confirmed complete resection. CONCLUSION Aquamantys® is a novel bipolar coagulation device that employs a new bipolar coagulation technique combining radiofrequency energy and saline to achieve hemostatic sealing by denaturing collagen fibers. This offers the possibility of achieving adequate hemostasis even in giant intraventricular tumors in infants to obtain GTR resection with minimal blood loss.
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Affiliation(s)
- Francesca Vitulli
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, n.6, 80129, Naples, Italy
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| | - Pietro Spennato
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, n.6, 80129, Naples, Italy.
| | - Marianna Di Costanzo
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, n.6, 80129, Naples, Italy
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| | - Maria Allegra Cinalli
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Nicola Onorini
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, n.6, 80129, Naples, Italy
| | - Giuseppe Mirone
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, n.6, 80129, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, n.6, 80129, Naples, Italy
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Thevandiran D, Nga V, Chang KTE, Ng LP, Seow WT, Low DCY, Yeo TT, Low SYY. Paediatric meningiomas in Singapore - Case series of a rare entity. J Clin Neurosci 2020; 73:62-66. [PMID: 32067824 DOI: 10.1016/j.jocn.2020.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/05/2020] [Indexed: 01/19/2023]
Abstract
Paediatric meningiomas are extremely rare. These tumours constitute only 2 to 3% of all childhood brain tumours. Despite similarities in histological features between PMs and their adult counterparts, there are important distinctions between them. In this case series, the authors describe their experience in paediatric meningiomas in Singapore's 2 children's hospitals from 1998 to 2018. The primary aim of this retrospective study is to evaluate the clinical, radiological and pathological characteristics, and associated outcomes of paediatric patients diagnosed with meningioma managed in our local institutions. Following that, the study's findings are secondary aims are corroborated with published literature. A total of 10 patients (4 males and 6 females) were identified for this study within the period of 01 January 1998 to 31 December 2018. Their ages ranged from 1 year old to 18 years old (median age 10.5 years old). Two of the patients had NF1 and NF2 respectively. There were 9 intracranial and 1 intraspinal paediatric meningiomas. Seven patients achieved gross total resection and 3 patients had subtotal resection. Eight patients did not have tumour recurrence or increase in size of tumour remnant during the course of their follow-up. In congruency with the literature, up to 40% of our patients had higher grade meningiomas and 55.6% had large tumour volumes more than 30 cm3. Owing to the paucity of knowledge for this unusual tumour, the authors emphasize the need for closer surveillance and in-depth genomic studies to identify novel therapies for this challenging condition.
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Affiliation(s)
- Dave Thevandiran
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Vincent Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore.
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Pandey SK, Mani SE, Sudhakar SV, Panwar J, Joseph BV, Rajshekhar V. Reliability of Imaging-Based Diagnosis of Lateral Ventricular Masses in Children. World Neurosurg 2019; 124:e693-e701. [PMID: 30660880 DOI: 10.1016/j.wneu.2018.12.196] [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: 07/18/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We studied the accuracy of the radiologic diagnosis of lateral ventricular masses in children (<20 years of age). METHODS In this retrospective study, data were collected from children with lateral ventricular masses managed in our unit between 2001 and 2016. There were 43 patients (26 boys and 17 girls; mean age, 12.1 years; range, 8 months to 20 years). Magnetic resonance imaging was available for 36 patients, whereas in 7 patients only a contrast-enhanced computed tomography scan was available. The images were read independently by 3 radiologists, who were blinded to the pathology. Two differential diagnoses were offered for each patient. The agreement between the 3 radiologists was calculated using the Fleiss κ statistic. RESULTS The common pathologic diagnoses were subependymal giant cell astrocytoma (SEGA) (20.9%), low-grade astrocytoma (16.3%), high-grade astrocytoma (9.3%), choroid plexus papilloma (9.3%), and meningioma (9.3%). The sensitivity, specificity, and accuracy of the radiologic diagnoses were 62%, 96.7%, and 94.2%, respectively. Low-grade tumors such as low-grade gliomas, SEGAs, choroid plexus papillomas, and meningiomas were diagnosed with a high level of accuracy. High-grade gliomas, choroid plexus carcinomas, and other malignant neoplasms were difficult to diagnose on imaging. Cavernous angiomas were also difficult to diagnose. There was only fair agreement between the 3 radiologists (Fleiss κ = 0.24). CONCLUSIONS The pathologic spectrum of lateral ventricular tumors in children is wide, and identifying the pathology on imaging is difficult for malignant tumors. Benign tumors such as SEGAs, low-grade astrocytomas, and choroid plexus papillomas are relatively easier to diagnose. There is significant interobserver variability in the radiologic diagnosis of these tumors.
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Affiliation(s)
- Sanjeev Kumar Pandey
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sunithi Elizabeth Mani
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sniya Valsa Sudhakar
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Jyoti Panwar
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Baylis Vivek Joseph
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
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Narayan DS, Traber GL, Figueira E, Pirbhai A, Landau K, Davis G, Crompton J, Selva D. Natural history of primary paediatric optic nerve sheath meningioma: case series and review. Br J Ophthalmol 2017; 102:1147-1153. [PMID: 29146762 DOI: 10.1136/bjophthalmol-2017-310672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To study the natural history, clinical and radiological characteristics of primary paediatric optic nerve sheath meningioma (PPONSM). METHODS Retrospective study of eight paediatric patients who were treated between 1994 and 2016 at the University Hospital Zurich, Switzerland and the Royal Adelaide Hospital, Australia. Clinical records and imaging studies were reviewed. RESULTS The mean age at presentation was 11 years (range: 6-17 years). There were six female patients and two male patients. 2/8 patients had associated neurofibromatosis type 2. Patients were followed up for 71-297 months (mean 156±70 months). 6/8 patients were observed through the course of their disease and 2/8 patients were treated with radiotherapy. 2/8 patients who were observed had minimal change in vision and did not experience tumour growth after long-term follow-up. CONCLUSIONS This is the largest PPONSM case series with long-term data on patients treated conservatively. We highlight that a small subset of these tumours are indolent and can be managed using observation alone.
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Affiliation(s)
- Daniel S Narayan
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Ghislaine L Traber
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Edwin Figueira
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Adnan Pirbhai
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Klara Landau
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Garry Davis
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - John Crompton
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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Begnami MD, Rushing EJ, Santi M, Quezado M. Evaluation of NF2 Gene Deletion in Pediatric Meningiomas Using Chromogenic In Situ Hybridization. Int J Surg Pathol 2016; 15:110-5. [PMID: 17478763 DOI: 10.1177/1066896906299128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Meningiomas are uncommon childhood tumors. They could be of significant size at presentation, which has been associated with difficult surgical excision, high recurrence rate, and possibly aggressive clinical behavior. Monosomy 22 is a common molecular event in this neoplasm. Additionally, losses on chromosomes 1,7,10, and 14 have been identified in clinically aggressive meningiomas. Using chromogenic in situ hybridization, we studied a group of pediatric meningiomas, including neurofibromatosis type II—associated, sporadic, and radiation-induced cases. We found NF2 gene deletion in about 72% of the cases, with corresponding absent or minimal merlin protein expression by immunohistochemistry. Our findings confirm that the NF2 gene plays a role in the tumorigenesis of pediatric meningiomas and that chromogenic in situ hybridization is an efficient, economic, and reliable method for routinely assessing NF2 gene deletion in formalin-fixed, paraffin-embedded tissues.
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Affiliation(s)
- Maria D Begnami
- Laboratory of Pathology, Surgical Pathology Section, National Cancer Institute, NIH, Bethesda, Maryland, USA
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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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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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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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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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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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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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Intracranial meningiomas of childhood and adolescence: report of 34 cases with follow-up. Childs Nerv Syst 2009; 25:1411-7. [PMID: 19636568 DOI: 10.1007/s00381-009-0949-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the characteristics of rare meningiomas occurring during childhood and adolescence specially demography, locations, radiological findings, pathological features, and outcome; 34 patients can be followed up and analyzed. METHODS Fifty-nine patients with meningiomas were treated during the period of 2000-2007 at the Department of Neurosurgery, Beijing Tiantan Hospital. Thirty-four cases which can be followed up were analyzed by retrospective method. Clinical presentation, anatomical distribution, radiological findings, clinical behavior, outcome, and follow-up are summarized. RESULTS All cases had been performed microsurgical treatment including 20 cases totally resection. Eleven cases have been achieved subtotal resection. Two patients have been performed biopsy because of giant tumor volume. One patient has been partially resected for internal carotid artery involved. The operative mortality is zero. The average follow-up period is 4 years long. There was recurrence in seven and metastasis in two. Adjuvant radiotherapy has been performed on residual, malignant, and recurrent tumors. Six patients are dead. CONCLUSIONS The sex predominance is not similar to that in adults. Increased ICP, decreased visual acuity, and seizure are the common presentation. There is a higher incidence of intraventricle and skull base region. Larger size and frequent abnormal tumor calcification and cyst appear not relative to pathological subtypes. The higher incidence of atypical histopathological features than adult is affirmative. The prognosis is good if the tumor can be totally removed and adjuvant radiotherapy not to be significant beneficial after incomplete excision.
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Traunecker H, Mallucci C, Grundy R, Pizer B, Saran F. Children's Cancer and Leukaemia Group (CCLG): guidelines for the management of intracranial meningioma in children and young people. Br J Neurosurg 2009; 22:13-25; discussion 24-5. [DOI: 10.1080/02688690701842208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Miranda P, Simal JA, Vila M, Hernández M, Menor F, Alvarez-Garijo JA. Posterior fossa clear cell meningioma without dural attachment in a child. Childs Nerv Syst 2009; 25:389-92. [PMID: 19030867 DOI: 10.1007/s00381-008-0757-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Meningiomas are relatively uncommon in childhood. They represent 1% to 2% of all intracranial tumours of infancy and childhood and 1.5% to 1.8% of all intracranial meningiomas. Occasionally, meningiomas may develop without dural attachment. Clear cell meningioma is a histological distinctive uncommon variant of meningioma that may behave aggressively with local recurrence and progression as well as cerebrospinal fluid-borne metastasis. Meningiomas near the craniocervical junction represent challenging tumours, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves and the vertebral artery. CASE REPORT In this study, the authors present a rare case of posterior fossa clear cell meningioma without dural attachment in a child with severe brainstem and cervical spinal cord displacement and discuss the clinical and radiological features as well as treatment considerations.
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Affiliation(s)
- Pablo Miranda
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Hospital Universitario Infantil La Fe, Avda Campanar s/n., 46009 Valencia, Spain.
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Gelabert-González M, García-Allut A, Bandín-Diéguez J, Serramito-García R, Martínez-Rumbo R. Meningiomas of the lateral ventricles. A review of 10 cases. Neurocirugia (Astur) 2008; 19:427-33. [PMID: 18936859 DOI: 10.1016/s1130-1473(08)70209-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraventricular meningiomas are rare tumours that represent about 2% of all intracranial meningiomas, and represent one of the most challenging problems in neurosurgery. They are located deep within the brain and often are sizable and highly vascular. We report on a series of 10 meningiomas of the lateral ventricles treated at our institution during the last 28 years. PATIENTS Ten patients (6 women, 4 men; mean age 41.6 yrs) were admitted to our medical center between 1978-2005 with meningioma of the lateral ventricles. Headache was the first symptom in 8 cases and ocular signs were present in 5 patients. RESULTS Seven tumours were located in the right ventricle (70%) ranging in size from 2-8 cm, with 7 tumours larger than 3 cm in diameter. Nine patients underwent surgery with total excision in 8 cases and subtotal in the other; the remaining patient only received radiosurgery. CONCLUSIONS Total resection is the gold standard for treatment which was possible in all but one of the cases undergoing surgery.
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Affiliation(s)
- M Gelabert-González
- Neurosurgical Service, Department of Surgery, Clinic Hospital of Santiago de Compostela, University of Santiago de Compostela, Spain
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Caroli E, Russillo M, Ferrante L. Intracranial meningiomas in children: report of 27 new cases and critical analysis of 440 cases reported in the literature. J Child Neurol 2006; 21:31-6. [PMID: 16551450 DOI: 10.1177/08830738060210010801] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We accumulated 440 cases of intracranial meningiomas in patients under 16 years of age, and another 27 personal. This review confirms the existence of specific clinical features of spontaneous and radiation-induced meningioma in children. In addition, we discuss various points that suggest a more aggressive behavior of meningiomas in children than in adults. (J Child Neurol 2006;21:31-36).
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Affiliation(s)
- Emanuela Caroli
- Department of Neurological Sciences, Division of Neurosurgery, University of Rome La Sapienza, Italy.
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18
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Tufan K, Dogulu F, Kurt G, Emmez H, Ceviker N, Baykaner MK. Intracranial meningiomas of childhood and adolescence. Pediatr Neurosurg 2005; 41:1-7. [PMID: 15886506 DOI: 10.1159/000084858] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 11/17/2004] [Indexed: 11/19/2022]
Abstract
Meningiomas are rare intracranial neoplasms in childhood and adolescence, representing 0.4-4.1% of the pediatric-age tumors and 1.5-1.8% of all intracranial meningiomas. The goal of this study was to determine epidemiology, clinical and radiological features, and long-term outcome of childhood and adolescence meningiomas. Patients operated for intracranial meningiomas of childhood and adolescence between 1983 and 2003 at Gazi University School of Medicine, Department of Neurosurgery, were evaluated retrospectively. This study presents 11 cases (6 male, 5 female), ranging in age from 14 months to 17 years. Age and sex distribution, presenting symptoms, neurological examination results, location of meningiomas, radiological and histopathological findings, and prognosis were reviewed. The results were compared with those reported in the existing literature. Atypical and malignant meningiomas seem to be more common in childhood and adolescence with respect to adult meningiomas. Tumor location, completeness of tumor removal, and pathological grade are the most important prognostic factors.
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Affiliation(s)
- Kadir Tufan
- Department of Neurosurgery, Gazi University Medical School, Ankara, Turkey.
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19
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Martín R, Vázquez-Barquero A, Pinto I, Figols J, Cerezal L, Canga A. [Cauda equina meningioma in a girl: presentation of a case and review of the literature]. Neurocirugia (Astur) 2002; 13:132-6. [PMID: 12058605 DOI: 10.1016/s1130-1473(02)70635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Meningiomas are unusual in childhood, and the intraspinal location is very uncommon. Those arising from lumbar dura matter are the most rare among spinal neoplasms of meningeal origin. We present the case of a 12-years-old girl with a cauda equina meningioma. As in previously reported cases, the initial complain was back pain with radicular irradiation. The girl had few neurological findings, with pyramidal signs of both lower limbs as single neurological impairment. She underwent surgical treatment through an open door laminoplasty and the tumour was completely removed without neurological deficit. After 2-year of follow-up she remains asymptomatic.
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Affiliation(s)
- R Martín
- Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Santander
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20
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Oliveira RSFD, Sales Filho R. Meningiomas múltiplos em um lactente: relato de caso e revisão da literatura. Radiol Bras 2001. [DOI: 10.1590/s0100-39842001000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho é apresentado um caso de meningiomas múltiplos em um lactente de cinco meses de idade, em que o diagnóstico se torna difícil pela apresentação da lesão dominante, de localização selar e supra-selar, com grande área cística na região frontal direita, e que tem grande interesse por sua raridade. Em seguida é apresentada uma revisão da literatura sobre o assunto.
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21
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Abstract
A variety of mass lesions can arise within or in proximity to the ventricular system in children. These lesions are relatively uncommon, and they present a unique diagnostic and surgical challenge. The differential diagnosis is determined by tumor location in the ventricular system, clinical presentation, age of the patient, and the imaging characteristics of the lesion. In this report the authors provide an introduction to and an overview of the most common pediatric supratentorial intraventricular tumors. The typical radiographic features of each tumor and location preference within the ventricular system are reviewed. Management and treatment considerations are discussed. Examination of tissue samples to obtain diagnosis is usually required for accurate treatment planning, and resection without adjuvant therapies is often curative. The critical management decision frequently involves determining which lesions are appropriate for surgical therapy. Care ful preoperative neuroimaging is extremely useful in planning surgery. Knowledge of the typical imaging characteristics of these tumors can help to determine the diagnosis with relative certainty when a tissue sample has not been obtained, because a small subset of these lesions can be managed expectantly.
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Affiliation(s)
- D Y Suh
- Department of Neurosurgery, Emory University School of Medicine, Children's Healthcare of Atlanta-Egleston, Atlanta, Georgia, USA
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22
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Abstract
Primary meningeal sarcomas are rare but highly aggressive tumors predominantly affecting children. The clinical course, imaging characteristics and histopathological features of meningeal sarcomas in two pediatric patients are presented. Furthermore, we critically discuss the new WHO classification of these entities comparing them to older descriptions. In a 6-year-old girl, a cranial computed tomography (CT) scan was performed, after a mild head trauma, showing a parieto-occipital hemorrhage. One month later, a circumscribed mass adhering to the meninges and with central areas of hemorrhage was evident on magnetic resonance imaging (MRI) scans. Brain biopsy revealed a polymorphocellular sarcoma originating from the leptomeninges and infiltrating the brain. In an 8-year-old girl, who presented with headaches and vomiting, several MRI-examinations were inconspicuous for nearly one year until the latest MR-scan revealed a diffuse contrast enhancement of the leptomeninges of the whole brain and spinal canal. After open biopsy, primary leptomeningeal sarcomatosis was diagnosed. Although CT and MRI did not allow a specific diagnosis in both cases the exact visualization of the extent of the tumor and/or meningeal involvement was possible. Since there are no specific imaging criteria to differentiate meningeal sarcoma from other solid brain tumors or from other tumoral or inflammatory meningioses brain biopsy is indispensable. In order to avoid misinterpretations and delays of therapy, early open brain biopsy or surgical resection of the lesion is necessary in cases of unclear brain masses, especially of unclear meningeal processes. Due to the low number of cases published so far, the biological behavior and clinical management of this tumor entity still awaits further investigation.
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Affiliation(s)
- A Büttner
- Institute of Legal Medicine, Ludwig-Maximilians-University, Munich, Germany.
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Heth JA, Kirby P, Menezes AH. Intraspinal familial clear cell meningioma in a mother and child. Case report. J Neurosurg 2000; 93:317-21. [PMID: 11012068 DOI: 10.3171/spi.2000.93.2.0317] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case of familial clear cell meningioma in which the proband is a child with an intraspinal tumor. The clear cell meningioma variant has recently been studied. The literature regarding clear cell meningioma is reviewed.
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Affiliation(s)
- J A Heth
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA
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25
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Bouvier C, Zattara-Canoni H, Daniel L, Gentet JC, Lena G, Figarella-Branger D. Cerebellar papillary meningioma in a 3-year-old boy: the usefulness of electron microscopy for diagnosis. Am J Surg Pathol 1999; 23:844-8. [PMID: 10403309 DOI: 10.1097/00000478-199907000-00014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report one case of papillary meningioma located in the posterior fossa in a 3-year-old boy. Despite a gross total resection, a major recurrence occurred 6 months later that was operated on. Eight months later, another recurrence was observed with intracranial metastases and dissemination throughout the cerebrospinal fluid. The tumor had a papillary architecture more obvious in the recurrence. Areas of necrosis were numerous. Tumor cells had large clear atypical nuclei. Many mitotic figures were seen and Ki-67 labeling index was high. The tumor cells were immunoreactive for vimentin and polysialylated neural cell adhesion molecule only, ruling out a diagnosis of ependymoma or medulloblastoma. Diagnosis of meningioma was done by electron microscopy, which showed interdigitating cytoplasmic processes and cell junctions. Cytogenetic study revealed unusual karyotypic abnormalities.
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Affiliation(s)
- C Bouvier
- Department of Pathology and Neuropathology, CHU Timone, Marseille, France
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26
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Abstract
Meningiomas are rare intracranial neoplasms in the pediatric population. Most of the reports concerning these tumors have stressed some distinguishing features comparable with the adult counterpart. Besides the lower incidence, the nearly equal sex distribution, the relatively common infratentorial location and the frequent development within the ventricular system have been emphasized. A poor prognosis of pediatric meningiomas has also been claimed by authors who have suggested that this could be owing to a possibly more aggressive behavior, accounting for the huge size that these tumors have usually reached at diagnosis, the difficult surgical excision, and the higher recurrence rate. The analysis of recent series challenges the concept that pediatric meningiomas do actually bear a worse prognosis than similar tumors occurring in older patients. Improved surgical techniques have in fact resulted in higher percentages of complete tumor removal. Better histological delineation has allowed the identification of highly aggressive meningeal neoplasms, which in the past were not differentiated properly, thus contributing to the apparent higher incidence of recurrent tumors in the pediatric population. When the studies are limited to the "classical" form of meningioma, it becomes apparent that pediatric meningiomas do not behave more aggressively than meningiomas in adult patients.
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