Pediatric meningioma and seizures: A scoping review

Pediatric meningiomas (PM) are rare tumors with unique clinical characteristics, including their association with seizures. This review aims to explore the available evidence regarding the nature of this association, the types of evidence available, and the gaps in our understanding.

We synthesized evidence from systemic literature search. We identified key clinical concepts including the frequency of seizures as a presenting feature, seizure outcomes following surgical treatment, the relationship between extent of resection and seizure freedom, the impact of histologic features or grade on seizure freedom, and the role of post-operative anti-seizure medications (ASMs). Two proportion z-tests were performed with a p < 0.05 significance threshold.

In our search, we found 824 pediatric meningioma cases, with 293 (35.6%) presenting with seizure(s) at the time of meningioma diagnosis. Varying information regarding tumor grade, recurrence, seizure outcomes, and use of ASM was available in all 293 patients. One hundred-thirteen cases had a listed meningioma grade, with 80 (70.8%) classified as grade I, 19 (16.8%) as grade II, and 14 (12.4%) as grade III. 12 of the 113 patients with graded tumors (10.6%) received post-operative ASMs. Post-operative seizure status was reported in 76 of these patients and 50 (65.8%) achieved seizure freedom. Twenty-one underwent subtotal resection and only 2 of 7 (28.6%) were known to have had seizure freedom.

Seizures are a recognized clinical feature in pediatric meningioma, occurring in approximately 36% of patients. They may present at diagnosis or emerge as a postoperative complication, with implications for long-term neurological outcomes. Surgical resection remains the standard of care for pediatric meningioma, and a greater extent of resection improves seizure outcomes. The role of post-resection ASMs and the relationship between seizures and molecular characteristics of pediatric meningioma warrants further investigation.