Brain-invasive meningioma in a 16-month-old boy

A previously well 16-month-old boy presented to Sydney Children's Hospital with generalised seizures. There was no history of neurofibromatosis and no family history. Imaging revealed a well-demarcated, frontal intracranial mass at the grey-white matter junction with surrounding oedema. At operation, the tumour was adherent to the underlying brain on its deep aspect but superficially connected to the dura. There was an associated peritumoural cyst. The tumour was biopsied for intra-operative frozen section opinion and excised in its entirety. The specimen consisted of a 25 x 25 x 17 mm nodule of firm cream tissue and separate fragments. Histologically, the tumour was a meningioma with frequent mitoses, necrosis and brain invasion. Optimal treatment, in view of the recurrence risk, includes complete excision and postoperative irradiation. The latter was deferred because of the young age. At follow-up at 26 months, the child was well and free of disease on MRI scan. Paediatric meningiomas are rare, with very few brain-invasive examples in reported series. In infants and young children, few meningiomas have been reported. There are several notable differences between meningiomas in children and adults. This report illustrates these differences.