Intraoperative Anatomical Findings in Pediatric Clear Cell Meningioma of the Lumbar Spine: Case Report and Literature Review

Abstract

Clear cell meningioma (CCM) is a WHO classification Grade II meningioma. It is a very rare disease, of which only 41 cases of spinal cord CCM in children have been reported to date. CCMs sometimes do not have the "dural attachment" that is usually found in meningiomas, and our understanding of the origin of CCMs is therefore controversial. We hereby present a case of pediatric CCM of the lumbar spine, in which we examined intraoperatively, the detailed anatomical location of the tumor. The case is a 10-year-old boy, who presented to our hospital with a 2-month history of lower back and bilateral lower extremity pain upon waking, which gradually worsened. Lumbar spine CT and MRI revealed an intradural extramedullary tumor at the L3 vertebral level, and surgery was performed to remove it. The tumor was in close contact with the dura mater, and also in contact with the cauda equina via the arachnoid. The tumor was likely located primarily between the dura mater and arachnoid. The pathological diagnosis was CCM, with an MIB-1 index of less than 1%. His back pain and bilateral lower extremity pain improved after surgery, and he was discharged from our hospital. Postoperative radiation therapy was not performed. Based on this case, we suggest that intraoperative examination of the anatomical location of these tumors and accumulation of relevant experience are important to elucidate the embryological mechanisms of this rare disease.

Clear cell meningiomas—case presentation, review of radiographic identifiers, and treatment approaches

“…Zhang et al achieved GTR in 91.7% of patients with spinal CCMs, which exhibited a 20.8% rate of recurrence in comparison to 57.1% for subtotal resection [ 14 ]. Several other studies have come to similar conclusions, establishing the significance of extent of resection to postoperative outcomes [ 15 – 17 ].…”

“…The decision to offer pediatric patients with CCMs adjuvant radiotherapy requires balancing the increased risk of recurrence for younger patients with increased risk of side effects from radiotherapy treatments. In children, radiation has been shown to induce myelopathy, organ damage, and vertebral radiation necrosis with spinal cord dislocation [ 15 , 17 ]. The choice to administer adjuvant therapies should be guided by the tumor’s specific characteristics including grade, histological features and location, and the patient’s overall health.…”

“…If there is no evidence for recurrence on the immediate postoperative scan and the delayed 3-month study, we support continued conservative therapy with serial imaging. Imaging every 3–6 months is suggested for pediatric patients with spinal CCMs for the first several years after the operation, after which the interval can be increased to annually [ 17 , 26 ]. Our patient underwent a follow-up MRI 3 months post-surgery and showed no sign of recurrent disease.…”

Pituitary Adenoma Coexistent with Sellar Clear Cell Meningioma Unattached to the Dura: Case Report and Treatment Considerations

“…The results of this literature review are shown in Tables 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 and 2 . 31 32 33 34 35 36 37 …”

“…The results of this literature review are shown in ►Tables 1-1-30 and 2. [31][32][33][34][35][36][37]…”