Primary intraosseous meningioma in a child: an unusual case report and literature review.
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Primary intraosseous meningiomas (PIOMs) are rare extradural meningiomas, originating within the skull, and accounting for approximately 2% of all meningiomas. These tumors are exceptionally uncommon in children, since the majority occurs in adults between 20 and 60 years old. Few cases have been reported in the literature, focusing on clinical findings, surgery, and outcomes in younger people. We report a case of a 9-year-old female with progressive painful frontal skull bossing, without neurological symptoms. Magnetic resonance imaging (MRI) diagnosed an osteolytic lesion in the right paramedian frontal bone. Surgery achieved gross total resection of the lesion, characterized by a clear cleavage plane from the surrounding bone with no dural involvement but infiltrating the upper wall of the frontal sinus. The skull defect was repaired with a three-dimensional (3D) custom-made titanium cranioplasty that provided an excellent aesthetic outcome. Histology revealed a primary intraosseous meningioma. Surgical resection is the cornerstone of PIOM treatment, offering high rates of gross total resection with low morbidity and no reported mortality. Our approach confirms the feasibility of complete resection along with cranial reconstructive techniques to optimize functional and aesthetic outcomes. We compare our findings with the limited literature data on pediatric PIOMs, discussing surgical strategies and outcomes in terms of disease control and aesthetic results. This case highlights the unique challenges of diagnosis and management of PIOMs in children, emphasizing the importance of radical removal along with excellent cosmetic results.