Liu Hai, Luo Wei, Li Jiaxin, Yang Jun, Xu Yulun
Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
Department of Neurosurgery, Beijing Neurosurgical Institute, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
Childs Nerv Syst. 2017 May;33(5):777-786. doi: 10.1007/s00381-017-3362-9. Epub 2017 Feb 28.
Pediatric infratentorial meningiomas are extremely rare. In this article, we present a series of 19 cases operated at our institution in the last 8 years.
During the 8-year period from January 2008 to December 2015, we encountered 21 cases suffered from infratentorial meningiomas. Two patients were excluded. The clinical profiles, radiological features, surgical procedures, intraoperative findings, and outcomes were extracted from the patient records and neuroimaging data.
The 19 cases with pediatric infratentorial meningiomas account for about 12.8% of all pediatric intracranial meningiomas. The age distribution of the patients ranged from 7 to 18 years. There were 9 male and 10 female patients. Cranial nerve defects were the first common signs and symptoms found in most cases (n = 14). One meningioma localized in cerebellum, one originated in jugular foramen. Meningioma involving internal auditory canal was only seen in one of the six patients with CPA meningioma. One tumor was totally ossified. In all, total resection was achieved in 14 patients, subtotal resection in 5 patients. Gamma knife was used for the recurrent and subtotally resected tumors. Conventional radiotherapy was applied for high-grade meningiomas (WHO grade II and WHO grade III).
Pediatric infratentorial meningiomas are different from supratentorial ones in many aspects, such as onset age, gender ratio, and neuroradiological characteristics. Surgical excision is challenging. According to the locations of tumors, different surgical approaches would be chosen to maximally resect the lesions without damage to brain stem and cranial nerves. Gamma knife and conventional radiotherapy could be used as postoperative adjuvant therapies. Long-term clinical follow-up and serial imaging are recommended.
小儿幕下脑膜瘤极为罕见。在本文中，我们呈现了过去8年在我院接受手术的一系列19例病例。
在2008年1月至2015年12月的8年期间，我们共收治21例幕下脑膜瘤患者。排除2例患者。从患者病历和神经影像数据中提取临床资料、放射学特征、手术过程、术中发现及结果。
19例小儿幕下脑膜瘤约占所有小儿颅内脑膜瘤的12.8%。患者年龄分布为7至18岁。男性9例，女性10例。多数病例（n = 14）最早出现的常见体征和症状为脑神经缺损。1例脑膜瘤位于小脑，1例起源于颈静脉孔。6例CPA脑膜瘤患者中仅1例累及内耳道。1例肿瘤完全骨化。总体而言，14例患者实现全切，5例患者次全切除。对复发及次全切除的肿瘤使用了伽玛刀。对高级别脑膜瘤（WHO二级和WHO三级）采用了常规放疗。
小儿幕下脑膜瘤在发病年龄、性别比例及神经放射学特征等许多方面与幕上脑膜瘤不同。手术切除具有挑战性。根据肿瘤位置，将选择不同的手术入路以在不损伤脑干和脑神经的情况下最大程度切除病变。伽玛刀和常规放疗可作为术后辅助治疗。建议进行长期临床随访及系列影像学检查。
