<%server.execute "isdev.asp"%> Giant pediatric intraventricular meningioma: Case report and review of literature Munjal S, Vats A, Kumar J, Srivastava A, Mehta VS - J Pediatr Neurosci
home : about us : ahead of print : current issue : archives search instructions : subscriptionLogin 
Users online: 1272      Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
  Table of Contents    
CASE REPORT
Year : 2016  |  Volume : 11  |  Issue : 3  |  Page : 219-222
 

Giant pediatric intraventricular meningioma: Case report and review of literature


Department of Neurosurgery, Paras Hospital, Gurgaon, Haryana, India

Date of Web Publication3-Nov-2016

Correspondence Address:
Satyashiva Munjal
Department of Neurosurgery, Paras Hospital, Sushant Lok, Sector 43, Gurgaon - 122 002, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.193353

Rights and Permissions

 

   Abstract 

Intraventricular meningiomas are rare in the pediatric population. These tumors are often large in size and aggressive in behavior when they occur in children. The management of these tumors is a surgical challenge.


Keywords: Intraventricular, meningioma, pediatric


How to cite this article:
Munjal S, Vats A, Kumar J, Srivastava A, Mehta VS. Giant pediatric intraventricular meningioma: Case report and review of literature. J Pediatr Neurosci 2016;11:219-22

How to cite this URL:
Munjal S, Vats A, Kumar J, Srivastava A, Mehta VS. Giant pediatric intraventricular meningioma: Case report and review of literature. J Pediatr Neurosci [serial online] 2016 [cited 2021 Apr 21];11:219-22. Available from: https://www.pediatricneurosciences.com/text.asp?2016/11/3/219/193353



   Introduction Top


Intracranial meningiomas are rare in children. They form about 0.5%–5% of central nervous system (CNS) tumors in the pediatric age group.[1] The management of these tumors is challenging as they are usually large at presentation. Here, we present a case of a 7-year-old female child with a large intraventricular meningioma who presented to us features of raised intracranial pressure. We also reviewed literature for pediatric intraventricular meningiomas.


   Case Report Top


A 7-year-old female child born of a nonconsanguineous marriage presented to us with headache for the last 20 days, which was insidious in onset, dull aching type, and frontal in location to begin with but progressively worsened in severity over the next few days. It used to be worse in the early morning and was associated with vomiting. The vomiting used to relieve headache. She gave no history of loss of consciousness, seizures, diminution of vision, diplopia, facial asymmetry, difficulty in hearing, change in voice, nasal regurgitation of fluids, or difficulty in swallowing. The patient's antenatal and perinatal period was uneventful, and she had achieved normal developmental milestones. She also had an elder sibling who was developmentally normal to age according to parents. The child was conscious, alert, and playful. She had an enlarged head. Papilledema was present on fundus examination. She had no other neurological deficits and there were no neurocutaneous markers. A contrast-enhanced magnetic resonance imaging of the brain [Figure 1] revealed large lobulated lesion of size 6.4 cm × 6.3 cm × 8.3 cm which was hypointense on T1, hyperintense on T2, intensely enhancing within the body of the left lateral ventricle causing dilatation of lateral ventricle, causing significant mass effect. Based on radiology, a differential diagnosis of choroid plexus papilloma and intraventricular meningioma was considered. The patient was taken for surgery after informed consent and neuronavigation guided posterior temporal craniotomy flap was raised. Durotomy was done in C-shaped fashion and reflected anteroinferiorly. Navigation guided corticectomy was done in middle temporal gyrus to approach the tumour in left trigonal area. Tumor was completely intraventricular and extended from the left temporal horn to the atrium and body of the left lateral ventricle. It was highly vascular but variable in consistency, i.e. soft at certain areas and firm to hard in others. Gross total excision was done and a ventricular drain was placed. The duration of surgery was 9 h. Intraoperative blood loss was 3000 ml, but there were no episodes of bradycardia, hypotension, desaturation, or hypothermia. The patient was extubated and had no neurological deficits in the postoperative period. Postoperative noncontrast computed tomography of the head [Figure 2] done revealed no residual tumor. The ventricular drain was removed on the second postoperative day. Histopathology report [Figure 3] revealed a moderately cellular tumor composed of sheets and whorls of round to oval cells with moderate amount of eosinophilic cytoplasm with mild nuclear atypia suggestive of Grade 1 meningioma. The MIB index was 2%.
Figure 1: (a) T1 sagittal, (b) T2 axial, (c) T2 coronal, (d) contrast axial, (e) contrast coronal, (f) contrast sagittal

Click here to view
Figure 2: Postoperative noncontrast computed tomography of the head showed no residual tumor

Click here to view
Figure 3: Histopathology showed a moderately cellular tumor composed of sheets of cells with eosinophilic cytoplasm with mild nuclear atypia

Click here to view



   Discussion Top


Meningiomas in children tend to occur in the latter part of the first decade or early second decade.[2] They form about 0.5%–5% of CNS tumors in them.[1] This is much less as compared to adults where they are about 30% of the total, of which only 3%–4% are intraventricular.[3] In children, however, a much larger proportion (10%–15%) are intraventricular and usually occur in the trigone of the lateral ventricles.[3] In another sharp contrast with the adults, meningiomas in the pediatric population are more common in males.[1],[4] This is probably due to the absence of effect of sex hormone on steroid receptors. A significantly higher proportion (up to 40%) of these tumors is associated with neurofibromatosis.[2],[3] The patients with neurofibromatosis are more likely to present with multiple tumors.[2] Prior radiation exposure, especially in cases of childhood, leukemia has been reported to predispose to development of meningiomas.[3]

As in our case, the usual presentation is with symptoms of raised intracranial pressure.[5],[6] Neurological deficits or lateralizing signs are usually absent due to intraventricular location. Some patients may present with seizures which are mostly generalized type.[2] Overall, the incidence of seizures is reported to be lower than that of adults.[2]

Pediatric meningiomas are usually large at presentation. As previously mentioned, this is probably due to the fact that these tumors produce no or minimal symptoms in children. They also exhibit a higher frequency of cystic change as compared to their adult counterparts.[1],[2] Due to derivation from leptomeningeal rests lodged in parenchyma, choroid plexus, tela choroidea, or velum interpositum, these tumors lack dural attachment and are more likely to be intraparenchymal or intraventricular in children.[5],[6] A differential diagnosis of choroid plexus papilloma, ependymoma, primitive neuroectodermal tumor, teratoma, or cavernoma must be considered in these cases.

Operating on these large tumors, especially in children, is challenging more so with their peculiar location such as in intraventricular location, in the skull base, or in the Sylvian fissure.[2] Surgical trajectory to tumors within the atrium requires consideration of the location of the optic radiation which lies lateral and inferior to atrium. These tumors may even derive their blood supply from internal carotid artery or its branches which make embolization hazardous and of questionable benefit.[2] About 10% of patients succumb to perioperative complications due to excessive blood loss during surgery, meningitis, or neurological deficits due to venous infarcts.[2]

Pediatric meningiomas frequently demonstrate brain invasion. They are aggressive tumors with 40%–60% of these being Grade 2 or 3. 1p and 14q deletion have also been reported and are associated with increased recurrence.[6]

Radiation therapy is indicated for residual lesions, high-grade tumors, or recurrent tumors. Radical tumor excision with adjuvant radiotherapy improves the recurrence-free survival in children with malignant meningiomas.[2]

Overall prognosis is poor as compared to adults. Outcomes for intraventricular meningiomas have not been reported separately. Subtotal resection is associated with a worse outcome. Outcome is also poor in tumors with higher grade, lesions that demonstrate cortical invasion and in patients with neurofibromatosis.

Reported cases of pediatric intraventricular meningioma are tabulated in [Table 1].
Table 1: Reported cases of pediatric intraventricular meningiomas

Click here to view



   Conclusion Top


Pediatric intraventricular tumors are rare tumors. The management of these tumors is challenging because of their large size at presentation, peculiar location, and aggressive behavior.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[16]

 
   References Top

1.
Li J, Mzimbiri JM, Zhao J, Zhang Z, Liao X, Liu J. Surviving the largest atypical parasagittal meningioma in a 2-year-old child: A case report and a brief review of the literature. World Neurosurg 2016;87:662.e1-6.  Back to cited text no. 1
    
2.
Ravindranath K, Vasudevan MC, Pande A, Symss N. Management of pediatric intracranial meningiomas: An analysis of 31 cases and review of literature. Childs Nerv Syst 2013;29:573-82.  Back to cited text no. 2
    
3.
Okechi H, Albright AL. Intraventricular meningioma: Case report and literature review. Pediatr Neurosurg 2012;48:30-4.  Back to cited text no. 3
    
4.
Larrew T, Eskandari R. Pediatric intraparenchymal meningioma: Case report and comparative review. Pediatr Neurosurg 2016;51:83-6.  Back to cited text no. 4
    
5.
Moiyadi AV, Shetty P. Giant velum interpositum meningioma in a child. Indian J Med Paediatr Oncol 2012;33:173-5.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Ramraje S, Kulkarni S, Choudhury B. Paediatric intraventricular meningiomas. A report of two cases. Australas Med J 2012;5:126-9.  Back to cited text no. 6
    
7.
Nambiar A, Pillai A, Parmar C, Panikar D. Intraventricular chordoid meningioma in a child: Fever of unknown origin, clinical course, and response to treatment. J Neurosurg Pediatr 2012;10:478-81.  Back to cited text no. 7
    
8.
Heppner F. Meningiomas of the third ventricle in children; Review of the literature and report of two cases with uneventful recovery after surgery. Acta Psychiatr Neurol Scand 1955;30:471-81.  Back to cited text no. 8
    
9.
Byard RW, Bourne AJ, Clark B, Hanieh A. Clinicopathological and radiological features of two cases of intraventricular meningioma in childhood. Pediatr Neurosci 1989;15:260-4.  Back to cited text no. 9
    
10.
Huang PP, Doyle WK, Abbott IR. Atypical meningioma of the third ventricle in a 6-year-old boy. Neurosurgery 1993;33:312-5.  Back to cited text no. 10
    
11.
Song KS, Park SH, Cho BK, Wang KC, Phi JH, Kim SK. Third ventricular chordoid meningioma in a child. J Neurosurg Pediatr 2008;2:269-72.  Back to cited text no. 11
    
12.
Dulai MS, Khan AM, Edwards MS, Vogel H. Intraventricular metaplastic meningioma in a child: Case report and review of the literature. Neuropathology 2009;29:708-12.  Back to cited text no. 12
    
13.
Orakdogen M, Somay H, Berkman Z, Aker F. Intraventricular meningioma in childhood. J Ist Faculty Med 2009;72:58-60.  Back to cited text no. 13
    
14.
Ciurea AV, Vapor I, Tascu A. Intraventricular meningioma in a 4-year-old child: Case presentation. Rom Neurosurg 2011;3:306-9.  Back to cited text no. 14
    
15.
Kwee LE, van Veelen-Vincent ML, Michiels EM, Kros JM, Dammers R. The importance of microsurgery in childhood meningioma: A case report. Childs Nerv Syst 2015;31:161-5.  Back to cited text no. 15
    
16.
Zheng S, You C, Ju Y. Recurrent atypical giant meningioma in the third ventricle of a child. Neuropsychiatry Neuropsychol 2016;11:35-8.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (960 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1661    
    Printed28    
    Emailed0    
    PDF Downloaded78    
    Comments [Add]    

Recommend this journal