儿童脑膜瘤的临床特征与治疗

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目的探讨儿童脑膜瘤的特性和诊疗进展，为治疗提供新的视点。方法回顾性分析清华大学玉泉医院神经外科2014年1月—2022年4月收治的9例经手术病理证实为脑膜瘤患儿的临床资料。结果患儿最常见的临床症状是偏瘫、呕吐。所有患儿术前均行头颅CT、MRI检查，脑组织标本均经病理诊断，其中包括2例内皮型脑膜瘤，2例纤维型脑膜瘤，1例砂粒型脑膜瘤，1例血管瘤型脑膜瘤，1例横纹肌样脑膜瘤，1例间变型脑膜瘤，1例非典型脑膜瘤。9例患者中7例全切除，2例次全切除（其中Simpson Ⅰ级2例，Ⅱ级3例，Ⅲ级2例，Ⅳ级2例），术后无手术相关偏瘫或其他肢体功能障碍，无术后颅内血肿。到目前为止，其中2例复发，且均为WHO Ⅲ级脑膜瘤。结论相比于成人，儿童脑膜瘤发病率低，可能与放射治疗和神经纤维瘤病2型关系密切，病理恶性度高，手术全切除是治疗儿童脑膜瘤的首选方法，对于3岁以上未能全切患儿应当考虑术后放疗，可延长生存期、降低肿瘤复发率。

Objective To explore the characteristics, diagnosis and treatment progress of meningioma in children, and provide a new perspective for treatment. Methods The clinical data of 9 children with meningioma confirmed by pathology admitted to the Department of Neurosurgery, Yuquan Hospital, Tsinghua University from January 2014 to April 2022 were analyzed retrospectively. Results The most common clinical symptoms of children were hemiplegia and vomiting. The pathological diagnoses were 2 meningothelials, 2 fibrous, 1 psammomatous, 1 angiomatous, 1 rhabdoid, 1 anaplastic meningiomas and 1 atypical meningioma. Of the 9 patients, total resection was performed in 7, and subtotal resection was performed in 2(2 of Simpson grade Ⅰ, 3 of Simpson grade Ⅱ, 2 of Simpson grade Ⅲ and 2 of Simpson grade Ⅳ). There were no surgical related hemiplegia or other limb dysfunction after surgery, and no intracranial hematoma after surgery. Up to now, 2 of the 9 children had relapsed which were grade Ⅲ meningiomas. Conclusions Compared with adults, the incidence rate of meningiomas in children is low, which may be closely related to radiotherapy and neurofibromatosis type 2, and the pathological malignancy is high. Total surgical resection is the first choice for the treatment of meningiomas in children. Postoperative radiotherapy should be considered for children over 3 years old who fail to complete surgical resection, so as to prolong their survival and reduce the recurrence rate of tumors.