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Published on: July 5, 2021
Meningiomas of the pediatric skull base: a review
1Division of Pediatric Neurosurgery, Norton Neuroscience Institute and Kosair Children's Hospital, Louisville, Kentucky, United States.
Abstract:
Pediatric skull base meningiomas are rare and complex clinical entities. Meningioma is a relatively uncommon brain tumor in children, and only ∼ 27% involve the skull base. Some evidence suggests that these tumors are more likely to be atypical or malignant in children than adults. The absence of female preponderance in pediatric meningiomas is reflected in the skull base subpopulation. Skull base meningiomas in children are most likely to be found in the anterior or middle fossa base, or involving the orbit and optic nerve sheath. Petroclival, suprasellar/parasellar, cerebellopontine angle, cavernous sinus, and foramen magnum tumors are very rare. Meningiomas constitute a small proportion of reported cases of pediatric skull base pathology, and they are entirely absent from many case series. Initial gross total resection is consistently associated with superior outcomes. Surgical approaches to the pediatric skull base must take additional factors into consideration including relatively smaller anatomy, immature dentition, incompletely aerated sinuses and air cells, and altered configurations of structures such as the pterional bony complex. Multidisciplinary expertise is essential to optimizing treatment outcomes.
Insights
Pediatric skull base meningiomas are rare brain tumors in children, often atypical or malignant. Achieving gross total resection is key for superior outcomes in managing these complex cases.
Area of Science:
- Pediatric neuro-oncology
- Skull base surgery
- Neurosurgery
Background:
- Pediatric skull base meningiomas are rare, accounting for only ~27% of pediatric meningiomas.
- These tumors may present with higher rates of atypical or malignant histology in children compared to adults.
- Unlike adult meningiomas, pediatric variants lack a female preponderance.
Purpose of the Study:
- To review the characteristics and management of pediatric skull base meningiomas.
- To highlight the unique challenges and considerations in surgical approaches for pediatric skull base tumors.
- To emphasize the importance of multidisciplinary care for optimizing treatment outcomes.
Main Methods:
- Review of existing literature on pediatric skull base meningiomas.
- Analysis of epidemiological and clinical features.
- Discussion of surgical techniques and outcomes.
Main Results:
- Most common locations include anterior and middle cranial fossae, orbit, and optic nerve sheath.
- Tumors in locations like petroclival, cerebellopontine angle, and foramen magnum are exceptionally rare.
- Gross total resection is consistently linked to better patient outcomes.
Conclusions:
- Pediatric skull base meningiomas require specialized multidisciplinary management.
- Surgical approaches must account for pediatric-specific anatomical and physiological differences.
- Early and complete tumor resection is crucial for improving prognosis in pediatric patients.
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