Presentation of Supratentorial Meningiomas in Children

Symptoms

• Elevated ICP: The most common symptoms are related to increased ICP, as these tumors can become very large in children prior to presentation. In order of frequency this can cause headache, nausea and vomiting, and a visual disorder or papilledema.
• Seizures: Although less likely than headaches or nausea, seizures are a frequent manifestation of meningiomas.
• Location-specific symptoms: Other, less common symptoms that are related to the tumor’s location can also occur. These include, in order of their frequency, cranial nerve dysfunction, motor disturbance or a scalp mass.

Time for evolution

• Subacute: In most series, the average duration of symptoms is about 10 months.

Evaluation at Presentation

• See EVALUATION

Intervention

Stabilization

• Rare for child to present emergently or to require stabilization: The presentation of children with meningiomas is generally in a subacute fashion, and the need for urgent management prior to surgery will be rare.
• ICP management: Standard management of ICP should be considered for a patient in extremis.  Management would include intubation, mannitol, steroids for tumor edema, and, if hydrocephalus is present, consideration of drain placement. 

Preparation for definitive intervention, nonemergent

• Risks dependent on tumor location: Specifics of management of a child presenting with mild symptoms due to a meningioma should be based on the location of the mass and its local effects on the brain. Patients with meningiomas are prone to seizures; and if the lesion is near the cortical surface, administration of antiepileptics should be considered.
• Embolization: Depending on tumor size and location, embolization can be considered.

Admission orders

• Crossmatch and seizure protection: Pre-operative admission orders should include type and crossmatch for at least two units of blood, as these tumors are vascular and could bleed during surgery. Patients who present with seizures require orders for anticonvulsants. The remainder of the pre-operative orders would be the same as for patients other tumors.