| 4 | Clinical and pathological features of intracranial meningiomas in children:A retrospective analysis显示文摘BACKGROUND: The attack of meningiomas has sex and age differences. Previous studies indicated that children and adult patients had different clinical and pathological features. Due to the limitation of conditions and technique of diagnosis and treatment, some clinical and pathological features of meningiomas in children should be further recognized. OBJECTIVE: To summarize the clinical and pathological features in 15 children with intracranial meningiomas. DESIGN: A retrospective case analysis. SETTING: The hospitals which the first author had been working in. PARTICIPANTS: Fifteen children with intracranial meningiomas were selected from the hospitals the first author had been working in from June 1996 to June 2006. There were 9 boys and 6 girls, aged 1.8-15 years, with an average of 9.8 years. The duration from attack to diagnosis was 1 month to 2.5 years, with an average of 13 months. Inclusive criteria: ① Clinically diagnosed, operated and confirmed pathologically; ② ≤ 15 years; ③ The children and their relatives were all informed and agree with the detection. METHODS: The clinical manifestations, imaging data, preoperative diagnosis and misdiagnosis, site and size of tumor, operative treatment and pathological data were retrospectively summarized. Thirteen of 15 children with intracranial meningiomas were followed up by means of reexamination for 1-8 years, and the postoperative recurrence were observed. MAIN OUTCOME MEASURES: Clinical manifestations, imaging data, preoperative diagnosis and misdiagnosis, site and size of tumor, operative treatment, pathological data, recurrence conditions of 1 to 8 years follow-up. RESULTS: Thirteen of the 15 children with intracranial meningiomas were involved in the analysis of results, and 2 lost to the follow-up. ① The main clinical manifestations at diagnosis were headache in 11 cases (73%, 11/15), vomiting in 8 cases (53%, 8/15), papilledema in 9 cases (60%, 9/15), hypopsia in 6 cases (40%, 6/15), epilepsy in 5 cases (33%, 5/15), hemiplegia in 4 cases (27%, 4/15), cranial nerve damage in 4 cases (27%, 4/15), instability of gait and incoordination in 2 cases, conscious disturbance in 3 cases, nystagmus in 2 cases and lump under scalp in 1 case. ② Imaging examination: Most of tumor CT plain scans were slightly high-density imaging, most enhanced scanning appeared well-distributed enhancement and clear boundary. MRI examination observed the tumor appeared equal or long T1 or longer T2 abnormal mixed singles with clear boundary. Two cases had cystic lesion of tumor and 8 cases had peritumor edema. Digital substraction angiography (DSA) observed that there obvious tumor staining and displacement of corresponding brain vessels due to compression in 2 cases. ③ Preoperative misdiagnosis: Six children (40%, 6/15) were misdiagnosed to have other diseases due to the untypical symptoms, including diseases of gastrointestinal tract in 3 cases, eye diseases in 2 cases, and encephalitis in 1 case. Most cases were diagnosed after CT or MRI scanning. ④ Sites and sizes of tumors: Tumor located at supratentorial parts in 13 cases (87%, 13/15), including cerebral convexity in 7 cases (46.7%, 7/15), intraventricle in 2 cases (13.3%, 2/15), cerebral parenchyma in 2 cases (13.3%, 2/15), parafalx and parasagittal sinus in 2 cases respectively. Tumor located at infratentorial part in 2 cases (13.3%, 2/15), which at cerebellar hemisphere and cerebellopontine angle respectively. The maximal diameter of tumor was 1.3-8.0 cm with an average of 4.6 cm. ⑤ Pathological types: The pathological examination reported that the meningioma was benign in 11 cases (73.3%, 11/15) and malignant in 4 cases (26.7%, 4/15). Among the benign meningiomas, it was syncytial in 5 cases, fibrous in 4 cases, and transitional in 2 cases. ⑥ Treatments: All the menigiomas of children were resected, and 14 cases (93.3%, 14/15) had the tumor resected totally (Simpson grades Ⅰ-Ⅲ), including Simpson grade Ⅰ resection in 7 cases, grade Ⅱ in 4 cases, and grade Ⅲ in 3 cases. One case only underwent subtotal resection (Simpson Ⅳ), this case had invasive medial sphenoid ridge-diaphragma sellae meningiomas, the tumor grew towards cavernous sinus and anterior skull base, and wrapped ipsilateral internal carotid artery and optic nerve. No one died postoperatively. ⑦ Follow up and recurrence: Of the 15 children with meningiomas, 13 cases were followed up, 4 cases (31%, 4/13) recurred, including 1 case recurred at 1 year, which was malignant meningioma, another 3 cases recurred at 3.5, 5.5 and 7 years after operation respectively, which were benign meningiomas. CONCLUSION: Meningiomas in children, most of which are benign, mostly locate at supratentorial part, have higher incidence rate in boys than in girls, higher recurrence rate, untypical symptoms, and easy to be misdiagnosed. The tumors grow rapidly with shorter disease course. | Kun Yang Lisheng He Linsun Dai Jian Chen Zhixiong Lin | 2006 | Neural Regeneration Research2006，1，6： | 0 |
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