Long-term outcomes of pediatric meningioma surgery: single center experience with 23 patients

Abstract

AIM: To evaluate the long-term outcomes and prognostic variables in a surgical cohort of pediatric meningiomas treated in a single institution. MATERIAL and METHODS: Medical records and follow-up notes of 23 pediatric patients aged <18 years (12 male and 11 female; mean age on presentation, 13.1 ± 4.4 years) harboring 27 meningiomas operated between 1994 and 01/2019 at Hacettepe University Ihsan Dogramaci Children's Hospital were evaluated. RESULTS: One patient had neurofibromatosis (NF) type 1, and five patients had NF2. Tumors were most commonly located in the convexity (n=6) and parasagittal or falcine (n=6). Gross total resection was performed in 70.4% of cases. WHO grade I tumors accounted for 56% of all cases, whereas high-grade meningiomas accounted for 44% (33% grade II, 11% grade III). The mean follow-up duration was 10.3 ± 7.7 years. Three patients (13%) died during follow-up, and 76.2% of the patients had favorable outcome (Glasgow Outcome Scale > 3) during the last follow-up assessment. Ten patients (43.5%) had relapse. In univariate analysis, low histological grade (p=0.030) and gross total resection (p=0.024) were associated with favorable outcome. The 10-year overall survival rate was 86%. CONCLUSION: Meningiomas in the pediatric age group are surgically treatable tumors with fairly good outcomes. However, relapses are common even for low-grade tumors; therefore, long-term surveillance and aggressive treatment are needed.

Quality of Life, Clinical, and Patient-Reported Outcomes after Pencil Beam Scanning Proton Therapy Delivered for Intracranial Grade WHO 1–2 Meningioma in Children and Adolescents

“…It should be noted that no resections lower than Simpson IV were achieved for our patients, in the context of challenging locations and voluminous tumors, 70% were WHO grade 2, 40% were recurrent tumors after upfront therapy, and 30% presented multiple tumors in the context of neurofibromatosis type 2. The extent of surgical resection, WHO grade 3, and neurofibromatosis type 2 have been associated with worse prognosis [ 6 , 9 , 46 , 47 , 48 ]. The meta-analysis conducted by Kotecha et al, which included a total of 677 children and adolescents with meningioma who underwent surgery, reported a significantly lower 5-year relapse-free survival (RFS) in patients with subtotal resection (STR, 46.0% vs. 85.8% after gross total resection, GTR) and WHO grade 3 tumors (40.7% vs. 81.2% in WHO grade 1) [ 8 ].…”

Pediatric meningiomas: A literature review and diagnostic update

“… 3 , 7 , 8 , 13–37 Neurofibromatosis type 2 is encountered in 21% of reported pediatric meningiomas, with multiple locations in the majority of cases. 3 , 7 , 8 , 13–37 Pediatric meningiomas have also been described in families with germline mutations in NF1 , 26 SMARCE1 , 38 BAP1 , 39 and SUFU 40 genes. The identification of clear cell meningioma may help detect germline loss of function mutations of the SMARCE1 gene and – through genetic counseling – also diagnose, parents with a family history of meningiomas/meningiomatosis.…”

“…Among these factors, a major clinical predictor of recurrence and overall survival in childhood meningiomas is based on the extent of surgical resection. 26 , 30 , 43 The feasibility/quality of resection may, however, be limited by the tumor location (particularly in the skull base) and the extent of invasion. The WHO CNS classification grade has been determined as the most prevalent histopathological predictor of recurrence.…”