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Meningiomas in childhood
1Section of Paediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Largo A. Gemelli, 8, I-00168 Rome, Italy
Insights
Pediatric meningiomas (tumors of the meninges) do not have a worse prognosis than adult meningiomas. Advances in surgical techniques and histological classification have improved outcomes for children with these rare brain tumors.
Area of Science:
- Neuro-oncology
- Pediatric Neurosurgery
Background:
- Meningiomas are rare intracranial neoplasms in children.
- Pediatric meningiomas were previously thought to have a poorer prognosis due to size, surgical difficulty, and recurrence rates.
Purpose of the Study:
- To challenge the concept of a worse prognosis for pediatric meningiomas compared to adult counterparts.
- To evaluate the impact of recent advancements on pediatric meningioma outcomes.
Main Methods:
- Analysis of recent case series on pediatric meningiomas.
- Comparison of outcomes between pediatric and adult meningioma patients.
- Review of histological classifications and surgical techniques.
Main Results:
- Improved surgical techniques lead to higher rates of complete tumor removal.
- Better histological delineation helps identify aggressive subtypes, clarifying past recurrence data.
- When limited to classical meningiomas, pediatric tumors show similar behavior to adult tumors.
Conclusions:
- Pediatric meningiomas do not inherently have a worse prognosis than adult meningiomas.
- Advancements in surgery and pathology have improved outcomes and understanding of these tumors.
- The concept of a poorer prognosis for pediatric meningiomas is challenged by current evidence.
Abstract:
Meningiomas are rare intracranial neoplasms in the pediatric population. Most of the reports concerning these tumors have stressed some distinguishing features comparable with the adult counterpart. Besides the lower incidence, the nearly equal sex distribution, the relatively common infratentorial location and the frequent development within the ventricular system have been emphasized. A poor prognosis of pediatric meningiomas has also been claimed by authors who have suggested that this could be owing to a possibly more aggressive behavior, accounting for the huge size that these tumors have usually reached at diagnosis, the difficult surgical excision, and the higher recurrence rate. The analysis of recent series challenges the concept that pediatric meningiomas do actually bear a worse prognosis than similar tumors occurring in older patients. Improved surgical techniques have in fact resulted in higher percentages of complete tumor removal. Better histological delineation has allowed the identification of highly aggressive meningeal neoplasms, which in the past were not differentiated properly, thus contributing to the apparent higher incidence of recurrent tumors in the pediatric population. When the studies are limited to the "classical" form of meningioma, it becomes apparent that pediatric meningiomas do not behave more aggressively than meningiomas in adult patients.