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.

Clear understanding of the normal anatomy will help in meticulous dissection and will result in reduced morbidity. Significant incidence of postoperative ataxia and mutism is seen with this approach in large tumors, and this can be avoided by staged dissection of the uvulotonsillar cleft.

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Primary bilateral thalamic lesions have characteristic neuroradiological properties and are distinct from unilateral thalamic tumours with bilateral progression. Almost all of these lesions on histology prove to be gliomas but decompressive surgery is seldom feasible. Surgical intervention is limited to biopsy and CSF diversion for hydrocephalus. Bilateral thalamic lesions remain unresponsive to adjuvant therapy and generally carry a poor prognosis.

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Aneurysmal bone cyst (ABC) of the skull is exceedingly rare. We report a unique case of an intradural ABC without bone involvement presenting with raised intracranial pressure. The patient was a 14-year-old boy who presented with headache, vomiting and right focal seizure. Imaging showed a large multicystic left frontal lesion without any evidence of bone involvement. The lesion adherent to an intact sphenoid wing dura was completely excised. The histopathology report was consistent with an ABC. This case represents the first report of an ABC without involvement of the skull bones or any evidence of dural erosion. The possible mechanism of origin at this unusual location is hypothesized.