J Neurol Surg B Skull Base 2015; 76(01): 066-073
DOI: 10.1055/s-0034-1390012
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Meningiomas of the Pediatric Skull Base: A Review

William C. Gump
1   Division of Pediatric Neurosurgery, Norton Neuroscience Institute and Kosair Children's Hospital, Louisville, Kentucky, United States
› Author Affiliations
Further Information

Publication History

30 December 2013

14 June 2014

Publication Date:
21 September 2014 (online)

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.

 
  • References

  • 1 Auguste KI, Rutka JT. Meningiomas in children. In: DeMonte F, McDermott MW, Al-Mefty O, , eds. Al-Mefty's Meningiomas. 2nd ed. New York, NY: Thieme; 2011: 69-74
  • 2 Greene S, Nair N, Ojemann JG, Ellenbogen RG, Avellino AM. Meningiomas in children. Pediatr Neurosurg 2008; 44 (1) 9-13
  • 3 Tufan K, Dogulu F, Kurt G, Emmez H, Ceviker N, Baykaner MK. Intracranial meningiomas of childhood and adolescence. Pediatr Neurosurg 2005; 41 (1) 1-7
  • 4 Zhou P, Ma W, Yin S, Li Y, Jiang S. Three risk factors for WHO grade II and III meningiomas: a study of 1737 cases from a single center. Neurol India 2013; 61 (1) 40-44
  • 5 Rushing EJ, Olsen C, Mena H , et al. Central nervous system meningiomas in the first two decades of life: a clinicopathological analysis of 87 patients. J Neurosurg 2005; 103 (6, Suppl): 489-495
  • 6 Morrison AL, Rushing E. Pathology of meningiomas. In: DeMonte F, McDermott MW, Al-Mefty O, , eds. Al-Mefty's Meningiomas. 2nd ed. New York, NY: Thieme; 2011: 40-48
  • 7 Sakaki S, Nakagawa K, Kimura H, Ohue S. Intracranial meningiomas in infancy. Surg Neurol 1987; 28 (1) 51-57
  • 8 Spetzler RF, Sanai N. The quiet revolution: retractorless surgery for complex vascular and skull base lesions. J Neurosurg 2012; 116 (2) 291-300
  • 9 Brockmeyer D, Gruber DP, Haller J, Shelton C, Walker ML. Pediatric skull base surgery. 2. Experience and outcomes in 55 patients. Pediatr Neurosurg 2003; 38 (1) 9-15
  • 10 Demonte F, Moore BA, Chang DW. Skull base reconstruction in the pediatric patient. Skull Base 2007; 17 (1) 39-51
  • 11 Miller ML, Kaufman BA, Lew SM. Modified osteoplastic orbitozygomatic craniotomy in the pediatric population. Childs Nerv Syst 2008; 24 (7) 845-850
  • 12 Teo C, Dornhoffer J, Hanna E, Bower C. Application of skull base techniques to pediatric neurosurgery. Childs Nerv Syst 1999; 15 (2–3) 103-109
  • 13 Kotecha RS, Junckerstorff RC, Lee S, Cole CH, Gottardo NG. Pediatric meningioma: current approaches and future direction. J Neurooncol 2011; 104 (1) 1-10
  • 14 Burkhardt JK, Zinn PO, Graenicher M , et al. Predicting postoperative hydrocephalus in 227 patients with skull base meningioma. Neurosurg Focus 2011; 30 (5) E9
  • 15 Burkhardt JK, Neidert MC, Grotzer MA, Krayenbühl N, Bozinov O. Surgical resection of pediatric skull base meningiomas. Childs Nerv Syst 2013; 29 (1) 83-87
  • 16 Kotecha RS, Pascoe EM, Rushing EJ , et al. Meningiomas in children and adolescents: a meta-analysis of individual patient data. Lancet Oncol 2011; 12 (13) 1229-1239
  • 17 Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA. Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol 2009; 10 (3) 258-266
  • 18 Wisoff JH, Boyett JM, Berger MS , et al. Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group trial no. CCG-945. J Neurosurg 1998; 89 (1) 52-59
  • 19 Wolff JE, Sajedi M, Brant R, Coppes MJ, Egeler RM. Choroid plexus tumours. Br J Cancer 2002; 87 (10) 1086-1091
  • 20 Gottardo NG, Gajjar A. Current therapy for medulloblastoma. Curr Treat Options Neurol 2006; 8 (4) 319-334
  • 21 Zeltzer PM, Boyett JM, Finlay JL , et al. Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children's Cancer Group 921 randomized phase III study. J Clin Oncol 1999; 17 (3) 832-845
  • 22 Mathiesen T, Kihlström L, Karlsson B, Lindquist C. Potential complications following radiotherapy for meningiomas. Surg Neurol 2003; 60 (3) 193-198 ; discussion 199–200
  • 23 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (1) 22-39
  • 24 Traunecker H. Pitfalls in extrapolating adult data to rare paediatric diseases. Lancet Oncol 2011; 12 (13) 1180-1181
  • 25 Kallio M, Sankila R, Hakulinen T, Jääskeläinen J. Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 1992; 31 (1) 2-12
  • 26 Amirjamshidi A, Mehrazin M, Abbassioun K. Meningiomas of the central nervous system occurring below the age of 17: report of 24 cases not associated with neurofibromatosis and review of literature. Childs Nerv Syst 2000; 16 (7) 406-416
  • 27 Lakhdar F, Arkha Y, El Ouahabi A , et al. Intracranial meningioma in children: different from adult forms? A series of 21 cases. Neurochirurgie 2010; 56 (4) 309-314
  • 28 Menon G, Nair S, Sudhir J, Rao BRM, Mathew A, Bahuleyan B. Childhood and adolescent meningiomas: a report of 38 cases and review of literature. Acta Neurochir (Wien) 2009; 151 (3) 239-244 ; discussion 244
  • 29 Thuijs NB, Uitdehaag BMJ, Van Ouwerkerk WJR, van der Valk P, Vandertop WP, Peerdeman SM. Pediatric meningiomas in The Netherlands 1974-2010: a descriptive epidemiological case study. Childs Nerv Syst 2012; 28 (7) 1009-1015
  • 30 Wang XQ, Zeng XW, Zhang BY , et al. Spinal meningioma in childhood: clinical features and treatment. Childs Nerv Syst 2012; 28 (1) 129-136
  • 31 George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: a series of 40 cases. Surg Neurol 1997; 47 (4) 371-379
  • 32 Fan MC, Zhang X, Wang QL , et al. Malignant meningioma of the cerebellopontine angle in a 2-year-old girl: a case report and literature review. Chin J Cancer 2013; 32 (7) 415-417
  • 33 Pencalet P, Sainte-Rose C, Lellouch-Tubiana A , et al. Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 1998; 88 (3) 521-528
  • 34 Dunn IF, Al-Mefty O. Radiation-induced and multiple meningiomas. In: DeMonte F, McDermott MW, Al-Mefty O, , eds. Al-Mefty's Meningiomas. 2nd ed. New York, NY: Thieme; 2011: 81-87
  • 35 Pettorini BL, Park YS, Caldarelli M, Massimi L, Tamburrini G, Di Rocco C. Radiation-induced brain tumours after central nervous system irradiation in childhood: a review. Childs Nerv Syst 2008; 24 (7) 793-805
  • 36 Broniscer A, Ke W, Fuller CE, Wu J, Gajjar A, Kun LE. Second neoplasms in pediatric patients with primary central nervous system tumors: the St. Jude Children's Research Hospital experience. Cancer 2004; 100 (10) 2246-2252
  • 37 Gil Z, Patel SG, Cantu G , et al; International Collaborative Study Group. Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 2009; 31 (3) 308-317
  • 38 Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC. Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 2013; 11 (3) 227-241
  • 39 Lang DA, Neil-Dwyer G, Evans BT, Honeybul S. Craniofacial access in children. Acta Neurochir (Wien) 1998; 140 (1) 33-40
  • 40 Klimo Jr P, Browd SR, Pravdenkova S, Couldwell WT, Walker ML, Al-Mefty O. The posterior petrosal approach: technique and applications in pediatric neurosurgery. J Neurosurg Pediatr 2009; 4 (4) 353-362
  • 41 Gil Z, Constantini S, Spektor S , et al. Skull base approaches in the pediatric population. Head Neck 2005; 27 (8) 682-689
  • 42 Hayhurst C, Williams D, Yousaf J, Richardson D, Pizer B, Mallucci C. Skull base surgery for tumors in children: long-term clinical and functional outcome. J Neurosurg Pediatr 2013; 11 (5) 496-503
  • 43 Mandonnet E, Kolb F, Tran Ba Huy P, George B. Spectrum of skull base tumors in children and adolescents: a series of 42 patients and review of the literature. Childs Nerv Syst 2008; 24 (6) 699-706
  • 44 Tsai MH, Wong AM-C, Jaing T-H, Wang H-S, Hsueh C, Wu C-T. Treatment of cerebellopontine angle tumors in children: a single institution's experience. J Pediatr Hematol Oncol 2009; 31 (11) 832-834
  • 45 Phi JH, Wang K-C, Kim I-O , et al. Tumors in the cerebellopontine angle in children: warning of a high probability of malignancy. J Neurooncol 2013; 112 (3) 383-391
  • 46 Zúccaro G, Sosa F. Cerebellopontine angle lesions in children. Childs Nerv Syst 2007; 23 (2) 177-183
  • 47 Hanbali F, Tabrizi P, Lang FF, DeMonte F. Tumors of the skull base in children and adolescents. J Neurosurg 2004; 100 (2, Suppl Pediatrics): 169-178
  • 48 Alshail E, Rutka JT, Drake JM , et al. Utility of frameless stereotaxy in the resection of skull base and basal cerebral lesions in children. Skull Base Surg 1998; 8 (1) 29-38
  • 49 Gross ND, Ganly I, Patel SG, Bilsky MH, Shah JP, Kraus DH. Results of anterior skull base surgery in pediatric and young adult patients. Skull Base 2010; 20 (2) 75-81
  • 50 Lewark TM, Allen GC, Chowdhury K, Chan KH. Le Fort I osteotomy and skull base tumors: a pediatric experience. Arch Otolaryngol Head Neck Surg 2000; 126 (8) 1004-1008
  • 51 Kassam A, Thomas AJ, Snyderman C , et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, Suppl): 75-86
  • 52 Munson PD, Moore EJ. Pediatric endoscopic skull base surgery. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (6) 571-576
  • 53 Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA. Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurg Focus 2011; 30 (5) E2
  • 54 Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA. Surgical nuances for removal of olfactory groove meningiomas using the endoscopic endonasal transcribriform approach. Neurosurg Focus 2011; 30 (5) E3
  • 55 Van Gompel JJ, Frank G, Pasquini E, Zoli M, Hoover J, Lanzino G. Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta-analysis of the literature. Neurosurg Focus 2011; 30 (5) E15
  • 56 Tsai EC, Santoreneos S, Rutka JT. Tumors of the skull base in children: review of tumor types and management strategies. Neurosurg Focus 2002; 12 (5) e1
  • 57 Wang HH, Luo CB, Guo WY , et al. Preoperative embolization of hypervascular pediatric brain tumors: evaluation of technical safety and outcome. Childs Nerv Syst 2013; 29 (11) 2043-2049
  • 58 Eskridge JM, McAuliffe W, Harris B, Kim DK, Scott J, Winn HR. Preoperative endovascular embolization of craniospinal hemangioblastomas. AJNR Am J Neuroradiol 1996; 17 (3) 525-531
  • 59 Haliasos N, Brew S, Robertson F, Hayward R, Thompson D, Chakraborty A. Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery?. Childs Nerv Syst 2013; 29 (1) 65-70
  • 60 Tampieri D, Leblanc R, TerBrugge K. Preoperative embolization of brain and spinal hemangioblastomas. Neurosurgery 1993; 33 (3) 502-505 ; discussion 505
  • 61 Kennedy JD, Haines SJ. Review of skull base surgery approaches: with special reference to pediatric patients. J Neurooncol 1994; 20 (3) 291-312
  • 62 Cass SP, Sekhar LN, Pomeranz S, Hirsch BE, Snyderman CH. Excision of petroclival tumors by a total petrosectomy approach. Am J Otol 1994; 15 (4) 474-484
  • 63 Megerian CA, Chiocca EA, McKenna MJ, Harsh IV GF, Ojemann RG. The subtemporal-transpetrous approach for excision of petroclival tumors. Am J Otol 1996; 17 (5) 773-779
  • 64 Slater PW, Welling DB, Goodman JH, Miner ME. Middle fossa transpetrosal approach for petroclival and brainstem tumors. Laryngoscope 1998; 108 (9) 1408-1412
  • 65 al-Mefty O, Anand VK. Zygomatic approach to skull-base lesions. J Neurosurg 1990; 73 (5) 668-673
  • 66 Lippman CR, Jallo GI, Feghali JG, Jimenez E, Epstein F. Aneurysmal bone cyst of the temporal bone. Pediatr Neurosurg 1999; 31 (4) 219-223
  • 67 Mazzoni A, Calabrese V, Danesi G. A modified retrosigmoid approach for direct exposure of the fundus of the internal auditory canal for hearing preservation in acoustic neuroma surgery. Am J Otol 2000; 21 (1) 98-109
  • 68 Kirazli T, Oner K, Ovül L, Bilgen C, Ogüt F. Petrosal presigmoid approach to the petro-clival and anterior cerebellopontine region (extended retrolabyrinthine, transtentorial approach). Rev Laryngol Otol Rhinol (Bord) 2001; 122 (3) 187-190
  • 69 Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 1992; 76 (4) 588-599
  • 70 Kawahara N, Sasaki T, Nibu K , et al. Dumbbell type jugular foramen meningioma extending both into the posterior cranial fossa and into the parapharyngeal space: report of 2 cases with vascular reconstruction. Acta Neurochir (Wien) 1998; 140 (4) 323-330 ; discussion 330–331