Pediatric Meningiomas: Clinicopathological Spectrum, Long-Term Outcomes, and Recurrence Predictors.
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INTRODUCTION: Pediatric meningiomas are rare tumors with clinical and biological features distinct from adult meningiomas. This study reviews 20-year experience of managing pediatric meningiomas at a tertiary referral center, focusing on their clinical characteristics, pathological features, treatment outcomes, and prognostic factors. METHODS: A retrospective analysis of 47 pediatric patients (<18 years) diagnosed with meningiomas between January 2005 and December 2024 was performed. Data on demographics, clinical presentation, radiological features, tumor location, histopathology, extent of resection, adjuvant therapy, and outcomes were collected. Recurrence rate and event-free survival were analyzed using Kaplan-Meier estimates, and predictors of recurrence were assessed with univariate and multivariate analyses. RESULTS: Pediatric cases accounted for 3.9% of all meningiomas treated during the study period (47/1,194). The median age was 13 years (IQR, 10-15), with a slight female predominance (55.3%). Neurofibromatosis was present in 21% of patients. Most tumors were supratentorial (76.6%), and 19% were intraventricular. The mean tumor volume in the series was 61.4 ± 75.2 cm3. High-grade meningiomas (WHO grade II and III) comprised 61.7% of cases. Gross total resection was achieved in 82.9%, and 53.2% received adjuvant radiotherapy. At a median follow-up of 41 months (IQR, 20-74 months), recurrence occurred in 21.3% of patients. On multivariate analysis, higher MIB-1 labeling index and longer follow-up duration were independent predictors of recurrence. CONCLUSION: Pediatric meningiomas, though rare, often display aggressive histopathology and a high risk of recurrence despite gross total resection. Multivariate analysis identified the MIB-1 labeling index and longer follow-up duration as independent predictors of recurrence, highlighting the importance of proliferative activity and extended surveillance in long-term disease control. These findings underscore the importance of biomarker-driven risk stratification and ongoing post-treatment monitoring in pediatric meningioma management.