Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2264  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (1,062 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

  In this Article
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    PDF Downloaded53    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


Table of Contents    
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 1351-1354

Pediatric intraparenchymal meningioma: A review of literature

1 Department of Neurosurgery, All India Institute of medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of medical Sciences, New Delhi, India

Date of Web Publication11-Nov-2016

Correspondence Address:
Ramesh S Doddamani
Department of Neurosurgery, All India Institute of medical Sciences, New Delhi
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.193795

Rights and Permissions

How to cite this article:
Dash C, Kumar A, Doddamani RS, Rajeshwari M, Sharma MC, Sharma BS. Pediatric intraparenchymal meningioma: A review of literature. Neurol India 2016;64:1351-4

How to cite this URL:
Dash C, Kumar A, Doddamani RS, Rajeshwari M, Sharma MC, Sharma BS. Pediatric intraparenchymal meningioma: A review of literature. Neurol India [serial online] 2016 [cited 2022 Jan 27];64:1351-4. Available from: https://www.neurologyindia.com/text.asp?2016/64/6/1351/193795


Meningiomas are rare tumors in the pediatric population accounting for approximately 1 to 2% of all intracranial neoplasms in this age group.[1] An intraparenchymal meningioma, which consists of a meningioma without a dural tail and is surrounded by the normal brain parenchyma is very rare, with very few case reports available in the literature.[2] We report one such case and present a pertinent literature review.

A 16-year-old male child presented with a history of multiple seizures. The last seizure occurred 4 months back, and the patient was seizure free after starting oral phenytoin tablets. Patient had no neurological deficits on examination.

Magnetic resonance imaging (MRI) revealed a tumor, which was hypointense on T1-weighted image (T1WI), iso to hypointense on T2WI, present in the right cingulate and superior frontal gyrus. There were areas of blooming on susceptibility weighted imaging (SWI), which corresponded to the areas of calcification on noncontrast computed tomography (CT) scan of the head. A heterogenous enhancement was seen on post-contrast scan [Figure 1]. Considering the radiology, a preoperative diagnosis of oligodendroglioma was made.
Figure 1: (a) Non-contrast computed tomography (NCCT) of the head showing the tumor in the right medial frontal lobe with calcification. (b) T1-weighted image (T1WI) axial section showing the hypointense tumor within the cortex. (c) T2WI axial section showing the hypointense tumor in close proximity to the anterior cerebral artery without any perilesional edema. (d and e) Contrast enhanced images, axial and coronal section, showing the heterogeneous enhancement in the tumor. (f) Susceptibility weighted imaging showing blooming in areas corresponding to the calcified areas on plain CT scan of the head

Click here to view

The patient underwent a right frontal craniotomy, an interhemispheric approach, and excision of the tumor. The tumor was present in the right medial frontal lobe surrounded by normal brain parenchyma. Resection of the overlying cortex was done to approach the tumor. The superficial part of the tumor was firm and fibrous, and calcification was present in the deeper portion of the tumor. A branch of the anterior cerebral artery (ACA), which was adjacent to the tumor, was injured during the surgical dissection, as there was a very poor plane of cleavage between the tumor and the vessel; the injured vessel was secured with ligaclips. Circumferential dissection around rest of the tumor did not reveal any attachment to the dura. The part of the tumor that was densely adherent to the tumor was left behind to preserve the vessel.

The histopathological examination revealed a transitional meningioma infiltrating into the surrounding brain parenchyma. There was no necrosis, pleomorphism, or appreciable mitotic activity [Figure 2]a and [Figure 2]b. Dura was not present in any of the sections. Tumor cells were immunopositive for epithelial membrane antigen [Figure 2]c. MIB1 labelling index was low [Figure 2]d. Patient had an uneventful recovery in the postoperative period and was discharged in a stable condition. At a 3-month follow up, the patient was doing well with no deficits. A follow up contrast-enhanced MRI of the brain is awaited.
Figure 2: Photomicrograph showing features of a transitional meningioma with focal psammomatous calcification (a, haematoxylin and eosin [H and E], ×100). Tumor is infiltrating into the adjacent cortex (b, H and E, ×200). Tumor cells are immunopositive for epithelial membrane antigen (c, immunohistochemistry [IHC] staining, ×200). MIB1 labelling index is low (d, IHC, ×400)

Click here to view

Meningiomas arise from meningothelial cells and are generally dural based.[3] The term 'intraparenchymal meningioma' is used for tumors that arise within the brain tissue and are not dural based. The key feature on neuroimaging is the absence of the dural tail. It is postulated that intraparenchymal meningiomas arise from the arachnoid cells of the perforating vessels as they enter the surface of the brain or sulci.[4],[5] The sylvian fissure, the intraventricular location, and the pineal region are the common sites where a meningioma may arise without a dural tail.[4],[6] A total of 33 cases of intraparenchymal meningiomas have been reported in the literature, and pediatric meningiomas account for 19 of these cases [7],[8],[9] [Table 1]. The most common symptom noticed in the literature review is seizure, as occurred in our case. In contrast to the female predilection noted for adult meningiomas, no such association for intraparenchymal meningioma has been noticed in the literature review. Various characteristics such as cyst formation, presence of peritumoral edema, and absence of dural attachment may cause a confusion in the diagnosis based on neuroimaging alone in the preoperative period.[5] Challenges in this case were the fibrous nature of the tumor and the calcified nature of the deeper portion of the tumor, which made debulking of the tumor and attempts to collapse its walls into the tumor cavity and away from the brain, difficult. In addition, the poor plane of cleavage between the tumor and vessel made separation of the tumor from vessel adventitia difficult and resulted in iatrogenic injury to the vessel. Characeteristics of all pediatric meningiomas are summarized in [Table 1] (however, primary sylvian fissure meningiomas and meningiomas secondary to underlying meningiomatosis have been excluded). Intraparenchymal meningioma in the pediatric population is a rare entity. Meningiomas should not be branded as “extra-axial lesions” and a diagnosis of an intraparenchymal meningioma should also be kept in mind for an intra-axial lesion in the pediatric population. This has implications in the surgical management as well as in prognostication of such patients.
Table 1: Cases of pediatric intraparenchymal meningioma available in literature

Click here to view

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.[19]

 » References Top

Davidson GS, Hope JK. Meningeal tumors of childhood. Cancer 1989;63:1205-10.  Back to cited text no. 1
Karadereler S, Aker F, Berkman Z. Intraparenchymal meningioma in a child. Case report and review of the literature. J Neurosurg 2004;101:112-5.  Back to cited text no. 2
Riemenschneider MJ, Perry A, Reifenberger G. Histological classification and molecular genetics of meningiomas. Lancet Neurol 2006;5:1045-54.  Back to cited text no. 3
Wada T, Suzuki M, Beppu T, Arai H, Yoshida Y, Ogawa A, et al. A case of subcortical meningioma. Acta Neurochir 2000;142:209-13.  Back to cited text no. 4
Mamourian AC, Lewandowski AE, Towfighi J. Cystic intraparenchymal meningioma in a child: Case report. AJNR Am J Neuroradiol 1991;12:366-7.  Back to cited text no. 5
Okamoto S, Handa H, Yamashita J, Tokuriki Y. Deep Sylvian meningiomas. Surg Neurol 1985;23:303-8.  Back to cited text no. 6
Nayil K, Makhdoomi R, Malik R, Ramzan A. Intraparenchymal anaplastic meningioma in a child: A rare entity. Asian J Neurosurg 2015;10:111-3.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Reynolds MR, Boland MR, Arias EJ, Farrell M, Javadpour M, Caird J. Intraparenchymal meningioma within the basal ganglia of a child: A case report. Br J Neurosurg 2016;30:360-2.  Back to cited text no. 8
Larrew T, Eskandari R. Pediatric intraparenchymal meningioma: Case report and comparative review. Pediatr Neurosurg 2016;51:83-6.  Back to cited text no. 9
Drake JM, Hendrick EB, Becker LE, Chuang SH, Hoffman HJ, Humphreys RP. Intracranial meningiomas in children. Pediatr Neurosci 1985;12:134-9.  Back to cited text no. 10
Morimoto M, Aoki H, Sadamitsu N, Nakashima R. Cystic meningioma-report of two cases. No Shinkei Geka 1976;4:805-9.  Back to cited text no. 11
Legius E, Vles JS, Casaer P, Plets C, Dom R. Intraparenchymal meningioma in a 14-month-old infant: Case report. Brain Dev 1985;7:622-4.  Back to cited text no. 12
Schroeder BA, Samaraweera RN, Starshak RJ, Oechler HW. Intraparenchymal meningioma in a child: CT and MR findings. J Comput Assist Tomogr 1987;11:192-3.  Back to cited text no. 13
Kimura H, Nakagawa K, Sakaki S, Matsuoka K. Intracranial meningioma of an infant: A case report. No Shinkei Geka 1987;15:663-8.  Back to cited text no. 14
Sakaki S, Nakagawa K, Kimura H, Ohue S. Intracranial meningiomas in infancy. Surg Neurol 1987;28:51-7.  Back to cited text no. 15
Kohama I, Sohma T, Nunomura K, Igarashi K, Ishikawa A. Intraparenchymal meningioma in an infant--Case report. Neurol Med Chir 1996;36:598-601.  Back to cited text no. 16
Teo JG, Goh KY, Rosenblum MK, Muszynski CA, Epstein FJ. Intraparenchymal clear cell meningioma of the brainstem in a 2-year-old child. Case report and literature review. Pediatr Neurosurg 1998;28:27-30.  Back to cited text no. 17
Zhang J, Chi L, Meng B, Li F, Zhu SG. Meningioma without dural attachment: Case report, classification, and review of the literature. Surg Neurol 2007;67:535-9.  Back to cited text no. 18
Shimbo D, Kato T, Takeda M, Ikeda H. Intraparenchymal meningioma in a child. Neurol Med Chir 2011;51:793-7.  Back to cited text no. 19


  [Figure 1], [Figure 2]

  [Table 1]

This article has been cited by
1 Primary Intraparenchymal Meningiomas: A Case Report and a Systematic Review
Vladimir Papic, Nebojsa Lasica, Bojan Jelaca, Nada Vuckovic, Dusko Kozic, Djula Djilvesi, Miroslav Fimic, Jagos Golubovic, Filip Pajicic, Petar Vulekovic
World Neurosurgery. 2021; 153: 52
[Pubmed] | [DOI]
2 Sylvian Fissure Meningioma in Childhood: Report of 3 Cases and Review of the Literature
Abbas Amirjamshidi, Mahmoud Reza  Khalatbari, Kazem Abbasioun, Babak Ghasemi
Pediatric Neurosurgery. 2019; 54(4): 270
[Pubmed] | [DOI]


Print this article  Email this article
Online since 20th March '04
Published by Wolters Kluwer - Medknow