Adjuvant Therapies for Supratentorial Meningiomas in Children

Surgery is the mainstay of treatment. If complete surgical excision is possible, adjuvant therapy is not necessary. Factors that limit excision include deep location, very large size, and adherence to vital vessels and nerves. In general, an attempt at gross total excision should be made, even if it necessitates a second procedure, as long as the risk of morbidity to the child is not significant.

Chemotherapy

• No proven efficacy: No current medical therapy is as standard accepted for meningioma. Meningioma remains a disease best treated by surgery and radiation therapy. Hydroxyurea has been used as salvage therapy in adults, but no such series exists for children. Antiprogesterone treatment has not been actively used in children.

Radiation

• Used for residual or high-grade tumors: Radiation therapy is generally considered for incompletely resected or high-grade meningioma. A previously resected meningioma that recurs often responds best to reoperation but also may be a candidate for radiation. Types of radiation will depend on tumor size and location, but for those lesions in sensitive locations along nerves or vessels, highly focused radiation will likely offer a superior safety/efficacy profile.