Background. Irradiation, either alone or in association with other factors, is thought to play a role in the causation of intracranial meningioma. Methods. The authors report two 15‐year‐old patients with convexity meningiomas as a result of high‐dose irradiation received at a young age and review the English language literature reports of 13 pediatric patients with meningiomas after high‐dose irradiation. The clinical characteristics of the 15 patients are presented. Results. There were nine girls and six boys. The mean age at the time of irradiation was 2.5 years (2 months‐9 years), and the mean age at diagnosis of meningioma was 13 years (5–15.5 years). The mean radiation dose was 4154 cGy (1500–8000 cGy). In 11 of the 15 patients, the meningioma was located in the calvarial area. Only 1 of 15 had multiple tumors, and only two of the tumors were clearly malignant at diagnosis. In ten patients, gross total resection was recorded, and two patients underwent subtotal resection. Three died of recurrent/disseminated meningiomas. Conclusions. This study suggests that meningiomas after high‐dose radiation in children are mostly calvarial in location, rarely multiple, mostly benign in histologic type, and that complete removal is possible in most patients. The age at the time of radiation is young (mean age, 2.5 years) and the latent period is short (mean, 10.8 years). Although the clinical course of radiation‐induced meningiomas in childhood generally is benign, high doses of radiation at a young age are to be avoided, and other means of therapy should be used if possible.
Familial congenital spinal arachnoid cysts causing progressive paraplegia are reported in two adolescent siblings as part of a hereditary syndrome. The other features of this unusual dominantly inherited disorder include double rows of eyelashes, partial ectropion of the lower eyelids, and acquired late-onset lymphedema of the lower extremities. The siblings' mother, who had roentgenographic evidence of a similar intraspinal lesion, was free of neurological symptoms but had the other characteristic features. Surgical treatment of the arachnoid cysts improves the progressive paraplegia.
Background. The outlook of children with pineoblastoma treated with radiation therapy alone is extremely poor, but neoadjuvant chemotherapy has been tried only in a few cases of this rare childhood brain tumor with poor prognosis. Methods. Three consecutive children 3 to 7 years of age received neoadjuvant chemotherapy consisting of etoposide 100 mg/m2 days 1 to 3, cisplatin 100 mg/m2 day 1, and vincristine 1.5 mg/m2 day 1, repeated every 4 weeks. After four courses of chemotherapy, patients underwent craniospinal irradiation. The radiation doses to the primary site ranged from 5040 to 5440 cGy and craniospinal axis radiation dose was 2520 to 3060 cGy. Results. After chemotherapy, mild myelosuppression occurred in all three and mild to moderate bilateral high‐frequency sensorineural hearing loss occurred in two of the three patients. One patient remains in near complete resolution of the tumor at 2 years after diagnosis and another remains in CR for 5 years. One patient achieved PR for 5 months but eventually died of progressive tumor. Conclusions. This study suggests that the neoadjuvant chemotherapy as used here is effective and has acceptable toxicity.
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