Resection of a Giant Atypical Pediatric Meningioma Encasing the Cerebral Arterial Tree: 2-Dimensional Operative Video

Pediatricmeningiomas are rare tumors that comprise less than 5% of intracranial neoplasms in the pediatric population. These tumors have amore aggressive course, higher recurrence rate, and higher histological grade than in adults.1-3 They require radical resection for longer control. At the skull base, particularly when they reach a giant size, they encase the cerebral vessels creating a formidable challenge for safe resection. According to their origin, however, the arachnoidal rearrangement resulting from the tumor growth pattern can maintain an arachnoidal plane that permits safe dissection despite the full encasement of these vessels,4-6 as in this case. Skull base approaches provide wide multiaxial exposure for fine microsurgical dissection under high magnification.7 We demonstrate the surgical nuances of radical resection of a giant tuberculum sellae meningioma that involved the entire circle of the Willis vessels. The patient is a 13-year-old adolescent boy who presented with seizures and complete blindness. He underwent radical resection through a one and a half supraorbital craniotomy in the year 2000 with excellent clinical outcome. Histological evaluation and chromosomal analysis revealed an atypical meningioma (World Health Organization grade II) with a copy loss on chromosomes 14 and 22. A small residual was treated with Gamma Knife (Elekta) stereotactic radiosurgery. The patient's guardian consented to surgery and the publication of his images. Images at 1:31, 1:49, and 2:01 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, (C) LWW, 1998.