Pediatric meningioma and seizures: a single-center cohort study.
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OBJECTIVE: Pediatric meningiomas are rare but often present clinically with seizures. Despite this, seizure outcomes and perioperative seizure management strategies remain underreported in the pediatric population. This paper aims to characterize seizure presentation, evaluate anti-seizure medication (ASM) use, and assess seizure outcomes following surgical resection in children with meningiomas. METHODS: We conducted a retrospective chart review of pediatric patients (< 18 years) who were diagnosed with meningioma at Vanderbilt University Medical Center between 2014 and 2024. For surgically treated patients, the diagnosis was histologically confirmed following resection. For patients managed conservatively, the diagnosis was presumed radiographically based on characteristic dural-based morphology, homogeneous enhancement, and absence of alternative differential considerations on MRI. These presumed lesions demonstrated long-term radiographic stability on serial imaging, supporting the diagnosis of meningioma. Data on seizure presentation, anti-seizure medication (ASM) use, tumor features, extent of resection (EOR), and seizure outcomes were extracted; seizure outcomes were evaluated using the Engel classification. RESULTS: Sixteen patients were included (median age 15 years), of whom six (37.5%) presented with seizures. Gross total resection (GTR) was achieved in 11 of 12 surgically treated patients (91.7%) and in all six patients (100%) with seizures. All six patients were started on ASMs pre-operatively; however, medication and duration of treatment varied. At a median follow-up of 3.5 years, four patients (66.7%) achieved Engel Class IA outcomes, with two weaned off ASM(s) without seizure recurrence. One patient each (16.7%) was classified as Engel IVC and IVB. Notably, seizures were observed in both patients with neurofibromatosis type 2 (100%), the single patient with radiation-induced meningiomas (100%), and those harboring rare molecular alterations. ASM regimens varied, underscoring the lack of standardized management protocols in this population. CONCLUSIONS: Seizures are a common clinical presentation in pediatric meningioma. While GTR appears beneficial for seizure control, ASM management remains heterogeneous. These findings support the need for consensus-based perioperative seizure management guidelines and further multicenter studies to clarify the relationship between tumor biology, treatment approaches, and long-term neurologic outcomes.