Distinct clinical characteristics and prognostic factors of pediatric meningiomas in a 10-year cohort of 198 patients.
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Pediatric meningiomas are rare, with poorly characterized clinical profiles and prognostic factors. This study aimed to characterize their clinical features, outcomes, and predictors of tumor recurrence. A retrospective analysis of 198 pediatric (< 18 years old) meningioma patients (2014-2023) from Beijing Tiantan Hospital was performed. Clinical, radiological and pathological characteristics were collected and analyzed. Log-rank test and multivariate Cox proportional hazards regression analysis were used to identify independent prognostic factors for recurrence. Males comprised 52.02% of the total cohort. Preoperative imaging misdiagnosis was frequent, with 90 patients (45.45%) not diagnosed with meningioma. The skull base was the most common tumor site (70 cases, 35.35%), followed by intraventricular locations (31 cases, 15.66%). Notably, parenchymal meningiomas accounted for 9.60% of cases (19 cases). Focal neurological deficits were most common initial symptoms (75 cases, 37.88%), followed by intracranial hypertension (53 cases, 26.77%) and seizure-related symptoms (31 cases, 15.66%). Gross total resection was achieved in 75.76% patients. High-grade (WHO grade 2-3) tumors accounted for 43.43% but showed no significant association with recurrence (P = 0.688). The 5-year PFS rate was 83.26%, 10-year PFS rate was 73.38%; the 5-year OS rate was 96.91%, and 10-year OS rate was 89.06%. Multivariate Cox analysis identified age < 14 years (P = 0.024), partial resection (P = 0.026), and prior recurrence (P = 0.012) as independent factors for recurrence. Pediatric meningiomas display a distinct clinical profile characterized by frequent imaging misdiagnosis, high proportion of intraventricular/parenchymal location, and elevated high-grade pathology. Younger age (< 14 years), partial resection, and recurrence history are key independent prognostic factors for recurrence. Clinical trial number: not applicable.