A Giant Atypical Meningioma in a 12-year-old Male: A Case Report and Review of Literature

Abstract

Background: Paediatric meningiomas are rare, accounting for only 0.5%–5% of childhood CNS tumors, and differ biologically from adult cases. Giant atypical meningiomas in children are exceptionally uncommon, with limited data on their management in resource-limited settings. Methods: We report a case of a 12-year-old male who presented with a 2-year history of progressive left-sided weakness, associated with headaches and generalized onset tonic-clonic seizures. The patient had no underlying medical or genetic disorders like neurofibromatosis and had no history of radiation exposure. Neurological examination revealed left hemiparesis (power 2/5) with preserved consciousness (GCS 15). Results: The MRI brain showed an approximately 102 by 81.8 mm minimally enhancing, extra-axial, dural-based mass in the right convexity with attendant compression and buckling of the right frontal, parietal, and temporal lobes. Following pre-operative evaluation, a fronto-temporo-parietal craniotomy was done with Simpson 1 resection of the brain tumour. Postoperatively, the patient exhibited marked clinical improvement, with resolution of seizures and headaches, as well as improvement in muscle power. MRI done after 3 months showed no signs of residual disease. Histology revealed morphologic features consistent with atypical meningioma, WHO Grade 2.  Conclusion: This case underscores the need for increased awareness of paediatric meningiomas in atypical demographics and settings. Successful gross total resection can yield excellent outcomes, even in resource-constrained settings, though long-term surveillance remains critical given their higher recurrence potential.