Pediatr Neurosurg. 2005 Jan-Feb;41(1):1-7.

Intracranial meningiomas of childhood and adolescence.

Tufan K, Dogulu F, Kurt G, Emmez H, Ceviker N, Baykaner MK. Source
Department of Neurosurgery, Gazi University Medical School, Ankara, Turkey. ktufan@gazi.edu.fr

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.

2013 Mar;155(3):407-13. doi: 10.1007/s00701-012-1611-y. Epub 2013 Jan 15.

Malignant potential of skull base versus non-skull base meningiomas: clinical series of 1,663 cases.
Cornelius JF, Slotty PJ, Steiger HJ, Hnggi D, Polivka M, George B. Source
Neurochirurgische Klinik, Universittsklinikum Dsseldorf, Heinrich-Heine-Universitt, Moorenstrasse 5, 40229, Dsseldorf, Germany.

Abstract
BACKGROUND: About 90 % of meningiomas are benign (WHO grade I), atypical and anaplastic variants exist (WHO grade II/III, 10 %). Tumour grade has important implications for management. Non-invasive diagnosis of tumour grade is still not feasible. The purpose of this survey was to analyse epidemiological risk factors such as sex, age and location for a higher grade (WHO grade II/III) meningioma in a large surgical series. METHODS: A retrospective study comprising 1,663 patients operated on for an intracranial meningioma in a single tertiary-care centre. The population was analysed for correlations including WHO grade, histological subtype, tumour localisation, patient age and gender. Additionally correlations between Ki67 index/WHO grade and localisation were analysed. RESULTS: A binary logistic regression analysis revealed non-skull base localisation (OR 1.779 [CI 1.069-2.960, p = 0.0027]) and age 65 years (OR 1.549 [CI 1.214-2.624, p = 0.012]) as significant risk factors for a higher WHO grade. Male gender showed a trend for a higher risk in (2) analysis. An analysis of the Ki67 index revealed an increased index for non-skull base localisation compared with skull base (p < 0.001). Correlation analysis of Ki67 distribution in WHO grade I meningiomas revealed higher Ki67 indices for non skull base localisation (p = 0.0024). CONCLUSIONS: Non-skull base localisation and age 65 years are independent risk factors for higher grade meningiomas. In other terms, the malignant potential of skull base meningiomas is low. This information is important when advising a patient about individual treatment options (observation, surgery or radio-surgery) and prognosis.

2009 Mar;151(3):239-44; discussion 244. doi: 10.1007/s00701-009-0206-8. Epub 2009 Feb 24.

Childhood and adolescent meningiomas: a report of 38 cases and review of literature.

Menon G, Nair S, Sudhir J, Rao BR, Mathew A, Bahuleyan B. Source
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India. gmr@sctimst.ac.in

Abstract
BACKGROUND: The aim is to study the clinical, radiological and pathological features of childhood and adolescent meningiomas and analyse outcome prognosticators. METHOD: A retrospective analysis of the case records of patients less than 20 years of age operated for a meningioma in our institute since 1982 was performed. The variables analysed included age, sex, presentation, associated neurofibromatosis (NF), imaging characteristics, extent of resection and histopathology. RESULTS: The study group included 20 males and 18 females with a mean age of 15.53 years. Eleven children (28.9%) had evidence of NF of whom three had NF2 with bilateral vestibular schwannomas. The common presenting symptoms were seizures (76.3%), raised intracranial tension (71%), and focal neurological deficits (39.4%). The location of the operated tumours were as follows: ten skull base (24.4%), ten falx/parasagittal (24.4%), eight spinal (19.5%), five convexity (12.2%), three posterior fossa (7.3%), three intraventricular (7.3%) and two optic nerve sheath (4.9%). Two children (4.9%) had cystic meningiomas. Grade I excision was achieved only in twenty tumours (48.8%). On histopathology, thirty (73.2%) were grade I, nine (21.9%) were grade II and two (4.9%) were grade III meningiomas. Seven tumours recurred of which six were located at the skull base. During the mean follow up period of 4.74 years, the majority, 32 (84.2%) had a good outcome and five (13.2%) had a poor outcome. One child (2.6%) expired due to post-operative sepsis. CONCLUSION: Childhood meningiomas are uncommon but not rare lesions with a marginal male predominance. Absence of large series with long follow up precludes any definite conclusions on the clinical course and outcome. Uniform observations made in different series including ours, include a higher incidence of the skull base location and tumours with atypical histopathology. Favourable prognostic factors include younger age (< than 10 years), superficial location, total excision and absence of neurofibromatosis. Location and extent of excision appear to be more important than histopathology grade in predicting outcome.

Pathologe. 1997 Sep;18(5):353-8.

[Meningioma. Classification and grading].

[Article in German]

Niedermayer I, Kolles H, Henn W, Zang KD, Steudel WI, Feiden W. Source

Abteilung fr Neuropathologie, Universittskliniken des Saarfandes, Homburg-Saar.

Abstract
Meningiomas account for the most frequent primary intracranial neoplasms in adults. In 1993, the socalled atypical meningioma has additionally been introduced in the revised edition of the WHO Classification of Tumors of the Central Nervous System and should characterize meningiomas with an increased propensity to recur. Since the given qualitative histological criteria apply both to the "atypical" and anaplastic meningioma, mere histological grading appears somewhat critical. Therefore, additional parameters were tested for their contribution to meningioma grading: First of all, we succeeded in defining 3 meningioma "grades" by calculating corresponding 95% confidence intervals for the morphometrically assessed Ki-67 indices of 160 meningiomas in total, the validity of which was proved by comparison with the "recurrence"-free intervals. Histologically, atypical meningiomas were distinguished by a "syncytial", poorly structured growth pattern and macronucleoli. Only occasionally, nuclear pleomorphism, necroses and mitotic figures were found. Cytogenetics revealed, in 50% of the "atypical" and anaplastic meningiomas, partial loss of the short arm of one chromosome 1 (1p-). Histochemically, we could demonstrate, that the tissue non-specific type of alkaline phosphatase (ALPL), which is coded on chromosome 1p, is a convenient recurrence- and progression-associated marker enzyme for meningiomas with 1p-loss (loss of enzyme activity in 30/39 of intermediate and 8/8 anaplastic meningiomas). We favor to address the WHO "atypical" meningioma as meningioma of the intermediate type, since the attribute "atypical" in the context of histological diagnoses is highly susceptible to misinterpretations.

Clinical Features and Treatment of Meningiomas in Children: Report of 12 Cases and Literature Review Liu Y. Li F. Zhu S. Liu M. Wu C. Pediatr Neurosurg 2008;44:112117 (DOI: 10.1159/000113112)

Abstract
Objective: To study the clinical characteristics and treatment of meningiomas in children.Methods: One hundred and sixty-six meningiomas in children, including 12 cases treated in Qilu hospital and 8 series reported in the literature, were analyzed retrospectively on sex, age distribution, presenting symptoms, signs, radiological and pathological findings, treatment and prognosis. Results: The ratio of boys and girls was 2.3:1. The age ranged from 0.5 to 15 years (mean 9.9 years). Cranial nerve disorder (28%) and signs of chronic increased intracranial pressure such as headaches (62%), vomiting (53%) and papilledema (55%) were the most common symptoms. The most common location was the cerebral convexity (41%), followed by ventricles (15%), saddle areas (8%), cerebellopontine angles (8%), brain intraparenchyma (5%), parasagittal regions (4%), etc. Homogeneous density was observed in 62.3% of all cases, calcification in 14.8%, cystic components in 21.3% and intratumoral hemorrhage in 1.6%. On average, the epithelial and fibroblastic types of meningiomas took up 55% of the case, while the amount of malignant or atypical meningiomas averaged 9%. Complete tumor excision was achieved in 74%, and postoperative mortality was 3.3%. Conclusions: Compared with meningiomas in adults, meningiomas in children occur predominantly in males with a lower incidence rate of epilepsy, and are frequently associated with multiple neurofibromatosis. Meningiomas in children have a poorer prognosis than those in adults. Degree of the first tumor resection, tumor location, pathological grade and association with neurofibromatosis are the most important factors influencing the patients prognoses.

Intracranial Meningiomas of Childhood and Adolescence Tufan K. Dogulu F. Kurt G. Emmez H. Ceviker N. Baykaner M.K. Pediatr Neurosurg 2005;41:17 (DOI: 10.1159/000084858)

Abstract
Meningiomas are rare intracranial neoplasms in childhood and adolescence, representing 0.44.1% of the pediatric-age tumors and 1.51.8% 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. More Information

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Characteristics of Intracranial Meningiomas in Childhood

Sano K. Wakai S. Ochiai C. Takakura K. Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan Childs Brain 1981;8:98106 (DOI:10.1159/000119971)

Abstract
18 cases of meningiomas in childhood below the age of 15 years at the onset of symptoms and signs were experienced in our clinic. They were studied as for the incidence, age and sex distributions, symptoms and signs at the onset, tumor locations, histological types, presence of cyst, dural attachments, and prognosis, in comparison with cases in adolescence (18 cases) and in adults (498 cases). Distinctive features in childhood meningiomas were: (1) relatively high incidence in the lateral ventricles (11.1%), (2) high incidence of cyst formation in the tumor (16.7%), and (3) of cases without any dural attachment (12.5%). These features were statistically significant as compared to adult cases (p<0.05). Features 1 and 2 were also true for adolescence cases. It was also revealed that male patients were predominent in childhood and adolescence (M:F= 10:8) in contrast to female predominance in adults (M: F = 1:1.6). The most frequent histological type was sarcomatous type (6 out of 18). It may be of interest that 3 cases of this malignant type have been alive for more than 10 years.

References

Author Contacts Keiji Sano, M.D, Department of Neurosurgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113 (Japan)

Article Information Published online: March 04, 2008 Number of Print Pages : 9

Publication Details Pediatric Neurosurgery Vol. 8, No. 2, Year 1981 (Cover Date: 1981) Journal Editor: Frim D.M. (Chicago, Ill.) ISSN: 10162291 (Print), eISSN: 14230305 (Online) For additional information: http://www.karger.com/PNE

Med Pregl. 2010 Mar-Apr;63(3-4):237-40.

[Morphological characteristics of meningiomas].

[Article in Serbian]

Grujici M, Vuckovi N, Vulekovi P. Source

Medicinski fakultet, Novi Sad. grujicic@uns.ac.rs

Abstract
INTRODUCTION: Meningiomas are common intracranial neoplasms which originate from the soft meninges, precisely from meningeal arachnoidal cells. The aim of this investigation was to establish the age and sex distribution of the examinees, localization, frequency and histological types of meningiomas. MATERIAL AND METHODS: The investigation was carried out in the period from January 2001 to June 2006. It included 490 consecutive patients of both sexes with diagnosed intracranial tumors and undergoing surgical treatment at the Neurosurgery Clinic of the Clinical Center of Vojvodina. The surgery samples were analyzed in the Laboratory of the Institute of Pathology and Histology of the Clinical Center of Vojvodina. Out of 490 patients with diagnosed intracranial tumors, 137 (27.96%) were diagnosed to have meningiomas. RESULTS: Meningiomas were more frequent in females (63%) than in males (37%) and they were most common in the 50-59 year age group (37.2%). The most common localization of meningiomas was the frontal region (36.5%). Meningiomas were more common on the left side (44.5%). In regard to other histological types of intracranial tumors, meningiomas were more frequent in females (36.3%). The most common histological type of meningiomas was transitional meningiomas (59.1%). The commonest histological types of meningiomas were benign meningiomas (93.4%). Malignant histological types of meningiomas were more common in males (83.3%), whereas benign histological types were more common in females (64.1%). CONCLUSION: A typical patient with meningiomas is a woman 50-59 years old. The tumor is located in the left frontal region. On histology it is benign, transitional type of meningiomas.

Brain Pathol. 2011 Nov;21(6):633-44. doi: 10.1111/j.1750-3639.2011.00491.x. Epub 2011 Jul 25.

French brain tumor database: 5-year histological results on 25 756 cases.

Rigau V, Zouaoui S, Mathieu-Daud H, Darlix A, Maran A, Trtarre B, Bessaoud F, Bauchet F, Attaoua R, Fabbro-Peray P, Fabbro M, Kerr C, Taillandier L, Duffau H, Figarella-Branger D, Costes V, Bauchet L; Socit Franaise de Neuropathologie (SFNP), Socit Franaise de Neurochirurgie (SFNC); Club de Neuro-Oncologie of the Socit Franaise de Neurochirurgie (CNO-SFNC); Association des Neuro-Oncologues dExpression Franaise (ANOCEF). Collaborators (716) Source
Department of Pathology, Centre Hospitalier Universitaire, Hpital Gui de Chauliac, Montpellier cedex, France. v-rigau@chu-montpellier.fr

Abstract
756 cases of newly diagnosed and histologically confirmed PCNST have been recorded. Histological diagnoses included glioma (48.9%), all other neuroepithelial tumors (5%), This work aimed to prospectively record all primary central nervous system tumor (PCNST) cases in France, for which histological diagnosis is available. The objectives were to (i) create a national registry and a network to perform epidemiological studies; (ii) implement clinical and basic research protocols; and (iii) harmonize the health care of patients affected by PCNST. For 5 years, 25meningioma (28.8%), nerve sheath tumors (8.4%), lymphoma (3.2%) and others (5.7%). Cryopreservation was reported for 6018 PCNST specimens. Tumor resections (R) were performed in 78% cases, while biopsies accounted for 22%. Median age (MA), sex, percentage R and number of cryopreserved tumors were detailed for each histology; for example, out of 6053 glioblastomas (MA 63 years, male 59.4%, R 62%, 1611 were cryopreserved), and out of 37 atypical teratoid/rhabdoid tumors (MA 2 years, male 56.8%, R 94%, 17 were cryopreserved). This database or databank dedicated to PCNST cases contains detailed data on clinical, histological and other characteristics, such as the inclusion of data on cryopreserved specimens that are not available in other European registries. Therefore, this is a valuable resource that can be used for planning future epidemiological and clinical research. 2011 The Authors; Brain Pathology 2011 International Society of Neuropathology.

A clinicopathological and neuroradiological study of paediatric meningioma from a single centre.

Jaiswal S, Vij M, Mehrotra A, Jaiswal AK, Srivastava AK, Behari S. Source
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow 226 014, Uttar Pradesh, India. sushilaj@sgpgi.ac.in

Abstract
Paediatric meningiomas are rare intracranial neoplasms representing 0.4% to 4.1% of tumours in paediatric patients and 1.5% to 1.8% of all intracranial meningiomas. The goal of this study was to determine the epidemiology, clinical presentation, radiological features, morphological spectrum and treatment outcome of paediatric meningiomas. All evaluable reports of meningioma in children from 1 January 1999 to 31 December 2009 were retrieved from the database of our Department of Pathology and were assessed retrospectively. This study describes 12 patients (nine males, three females; age range, 4-18 years; mean, 12.8 years). Their age and sex distribution, presenting symptoms, neurological findings, location, neuroradiological and histopathological findings were reviewed and the results were compared with published reports. Atypical and malignant meningiomas seem to be more common in childhood and adolescence than in adulthood. Copyright 2011 Elsevier Ltd. All rights reserved.

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J Neurosurg Spine. 2010 Jul;13(1):67-77. doi: 10.3171/2010.3.SPINE09430.

Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina.
Engelhard HH, Villano JL, Porter KR, Stewart AK, Barua M, Barker FG, Newton HB. Source
Departments of Neurosurgery, University of Illinois at Chicago Medical Center, Chicago, Illinois, USA. hengel@uic.edu

Abstract
OBJECT Patients having a primary tumor of the spinal cord, spinal meninges or cauda equina, are relatively rare. Neurosurgeons encounter and treat such patients, and need to be aware of their clinical presentation, tumor types, treatment options, and potential complications. The purpose of this paper is to report results from a series of 430 patients with primary intraspinal tumors, taken from a larger cohort of 9661 patients with primary tumors of the CNS. METHODS Extensive information on individuals diagnosed (in the year 2000) as having a primary CNS neoplasm was prospectively collected in a Patient Care Evaluation Study conducted by the Commission on Cancer of the American College of Surgeons. Data from US hospital cancer registries were submitted directly to the National Cancer Database. Intraspinal tumor cases were identified based on ICD-O-2 topography codes C70.1, C72.0, and C72.1. Analyses were performed using SPSS. RESULTS Patients with primary intraspinal tumors represented 4.5% of the CNS tumor group, and had a mean age of 49.3 years. Pain was the most common presenting symptom, while the most common tumor types weremeningioma (24.4%), ependymoma (23.7%), and schwannoma (21.2%). Resection, surgical biopsy, or both were performed in 89.3% of cases. Complications were low, but included neurological worsening (2.2%) and infection (1.6%). Radiation therapy and chemotherapy were administered to 20.3% and 5.6% of patients, respectively. CONCLUSIONS Data from this study are suitable for benchmarking, describing prevailing patterns of care, and generating additional hypotheses for future studies.