Pediatric Meningiomas- A Case Report and Review of the Literature

Abstract

Background: Pediatric meningiomas are relatively rare accounting for only 3% of intracranial neoplasms. As such most of the literature on pediatric meningiomas exists in the form of isolated case reports or as a case series with small patient numbers. Despite this scarcity of literature several important features distinguish pediatric meningiomas from those that occur in adults. These include unique risk factors; a male predominance; larger tumor sizes at presentation; unusual sites of occurrence including intraventricular and parenchymal; higher World Health Organization histological grades; more aggressive clinical behavior and an increased tendency for recurrence. We present a 12-year-old male patient whom presented to our unit with a left fronto-parietal convexity meningioma of an alarming size. Methods: A 12-year-old male patient presented to our unit with an eight-month history of a progressive headache complicated by a two-week history of vomiting. He also complained of progressive weakness of the right side of his body which had worsened to a point that he was no longer independently ambulant. General examination revealed craniomegaly with tortuous scalp veins. Neurological examination revealed a right upper motor neuron facial nerve palsy and a right hemiplegia of 2/5. Radiological investigation revealed an extremely large left fronto-parietal dural based space-occupying lesion which crossed the midline. Due to the adolescent’s progressive neurology he was taken to the operating room for emergency resection of the lesion. Gross total resection was achieved, and histopathological analysis confirmed the lesion to be a fibroblastic meningioma. Result: Post-operatively the patient demonstrated a complete resolution of his hemiplegia and at three weeks post operatively he was already independently ambulant with power 4/5 on the previously hemiplegic side. Conclusion: Despite the notorious features that characterize pediatric meningiomas, as well as an often-intimidating radiological appearance, adherence to standard Neurosurgical operating principles has the best chance of ensuring a successful outcome.