Meningioma+(child)


 * **Epidemiolgy:** || Meningioma’s in children are very rare about 1.5% and second of all diagnosed tumors. Gender does plays a role where females are more likely to develop were males are three times likely to be diagnosed with malignant meningioma, which may so a relationship to specific hormones (estrogen, progesterone) and diagnosis. ||
 * **Etiology:** || The main link to meningioma that is agreed upon although there are other studies being done is the role of radiation exposure in high doses to children. There is also a result of low dose radiation exposure as well but this has more of an impact on the older population. A relationship to specific hormones receptors (estrogen, progesterone) and diagnosis in females is being evaluated currently. ||
 * **Signs & Symptoms:** || While each child may experience symptoms differently, some of the most common include: seizures, hemiparesis (weakness on one side of the body), visual disturbance, difficulty finding words. Meningiomas may also have no obvious symptoms and may be discovered through diagnostic scans obtained for other reasons[6]. The symptoms of meningioma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis[6]. ||
 * **Diagnostic Procedures:** || Diagnostic procedures for meningioma may include[6]:

Computerized tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body[6]. CT scans are more detailed than general x-rays[6].

Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body[6].

Magnetic resonance spectroscopy (MRS) - a test done along with MRI that can detect the presence of particular compounds within sample tissue that can identify tissue as normal or tumor, and may be able to distinguish between different types of brain tumors. It may also be able to tell if the tumor is glial (originating in connective tissue)or neuronal (originating in a neuron, or nerve cell)[6].

|| || **__Grade I:__** Benign Meningioma __**Grade II:**__ Atypical Meningioma __**Grade III:**__ Malignant (Anaplastic) Meningioma || Brain: Whole 4500 cGy, 2/3 5000 cGy, 1/3 6000 cGy Ear (acute serous otitis: Whole 3000 cGy, 2/3 3000 cGy, 1/3 3000 cGy Ear (chronic serous otitis: Whole 5500 cGy, 2/3 5800 cGy, 1/3 6000 cGy Lens: Whole 1000 cGy Optic chiasm: Whole 5000 cGy Optic nerve: Whole 5000 cGy Retina: Whole 4500 cGy [3] || 2. Lenhard RE, Osteen R, Gansler T. //The American Cancer Society’s Clinical Oncology//. Williston, VT: Blackwell Publishing, Inc; 2001. 3. RadiationOncology/Toxicity/Emami. Available at: []. Accessed June 25, 2012. 4. Hystopathology of Meningiomas.Available at: __[].__ Accessed June 27, 2012 5. Brain Cancer Overview [], Accessed June 28 2012. 6. Meningioma. Boston Children Hospital. 2011. Available at: []. Accessed on: June 28, 2012. 7. Meningioma. National Brain Tumor Society. Available at: []. Accessed June 25, 2012. 8. Tumor grade. National Cancer Institute. Available at: []. Accessed on June 25, 2012. 9. Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. ||
 * **Histology:** || Meningiomas and malignant meningiomas are considered tumors meningothelial (or arachnoidal) cells by the World Health Organization. [1] The world Health Organization has set a grading system for many subtypes of memingiomas which classifies them based on their behavior. The more aggressive and higher tendancy to recur, the higher the grade of the tumor. [5]
 * **Lymph node drainage:** || There are no true lymphatic pathways from the brain.[4] ||
 * **Metastatic spread:** || Primary brain tumors very rarely spread outside of the cranial cavity and are more likely to invade other areas of the brain. Brain metastases are spread from other areas of the body to the brain and are not associated with a primary brain lesion. [5] ||
 * **Grading:** || The World Health Organization (WHO) classification divides Meningiomas into three grades: [7]
 * **Staging:** || Staging refers to the extent and severity of the cancer. [8] There is no formal staging for pediatric Meningioma. ||
 * **Radiation side effects:** || Some of the effects of Radiation Therapy (RT) on a Meningioma (depending on the area of RT) are: [9]
 * Nausea and vomiting
 * Radiation dermatitis
 * Alopecia
 * Otitis externa or serious otitis media
 * High tone hearing loss, and sometimes vestibular damage
 * Mucositis and esophagitis
 * Fatigue
 * 6-12 weeks after RT neurologic deterioration may occur (usually responds to steroids)
 * The most serious late reaction is radiation necrosis (may appear 6 months- peaks at 3 years after RT)
 * Retinopathy or cataracts
 * Decrease in visual sharpness, field changes, or blindness
 * Hormone deficiency
 * Neuropsychological changes (decreased learning ability, short-term memory deficits, and problem solving is difficult) ||
 * **Prognosis:** || Children who have a complete resection and the typical benign histology have a good prognosis. The prognosis for these cases is similar to adults. [1] ||
 * **Treatments:** || Surgery is the treatment of choice. If a tumor is only partially resected, or resection is not possible, radiation therapy can be used. However, given the significant side effects of radiation on the developing brain, especially in children under three, reoperation is a preferred strategy in some reports. [2] ||
 * **TD 5/5:** || Brainstem: Whole 5000 cGy, 2/3 5300 cGy, 1/3 6000 cGy
 * **References:** || 1. Mehta N, Bhagwati S, Parulekar G. Meningiomas in children: A study of 18 cases. //J Pediatr Neurosci//. 2009;4(2):61-65.

Back to Week 6