Complications of Therapy for Supratentorial Meningiomas in Children

Surgery

Complications of surgery for meningioma are largely dependent on tumor size and location as well as local invasion, patient size, and preexisting neurological deficits. With improved technology, the surgical mortality rate has decreased to approximately 3%. Morbidity, to some extent, is a factor of the aggressiveness of the operation. Many centers now favor less aggressive attempts at gross total resection if the consequence will be significant morbidity to surrounding vessels or nerves.

  • Blood loss: Large lesions can be a significant source of blood loss, especially in small children.
  • Neurological deficits: Careful preoperative planning with adjuvant studies such as fMRI can help to define the risk of surgery. As pediatric meningiomas are more likely to be intraventricular or in the parenchyma than are adult lesions, these planning studies may be of greater benefit in children.
  • Seizures: Patients with meningiomas have a propensity to seizures after surgery, and prophylactic anticonvulsants are a reasonable option for cortical lesions.

Radiation

Standard risks of radiation therapy apply, including damage to vascular structures and nerves.

  • Moya-moya diseae: 3.5% of children exposed to cranial irradiation have a chance of developing moyamoya disease later in life (10).
  • Induction of secondary tumors or vascular lesions: Injury from radiation can result in the formation of secondary tumors such as cavernous malformations (8). Since many meningiomas may be in patients with NF2, who already have a high propensity for tumor development, the risk of secondary tumors from radiation is magnified. Therefore, the use of radiation for these patients must be carefully considered.