title: Malignant disseminated chordoid meningioma in a 12-year-old child: a role for early cranial and spinal radiation treatment after subtotal resection.
abstract: METHODS
  We present a case of a chordoid meningioma, a tumour sub-type which comprises less than 0.5% of all meningiomas. The patient, a 12-year-old Somalian girl with a history of having had a craniotomy for a brain tumour in her native country 11 months previously, presented with seizures. Imaging revealed an isolated left frontal tumour, which at the time was felt to be a residual mass. She underwent a macroscopically complete resection of this tumour. Histology revealed it to be a grade 2 chordoid meningioma. Recurrence with additional local meningeal lesions was detected on follow-up magnetic resonance imaging (MRI) at 2 months post surgery. These were resected and she was treated with adjuvant cranial radiation treatment that resulted in non-progression of the cranial tumour on imaging 6 and 12 months post surgery. However, at 12 months post initial presentation, she re-presented with disseminated spinal disease refractory to salvage radiation treatment and succumbed to her illness.
  
  
  RESULTS
  This is the first reported case of cranial radiation treatment being used to treat sub-totally resected recurrent chordoid meningioma. Whilst intra-cranial control of the tumour was achieved with this management, it did not prevent spinal progression. The authors advise a high-surveillance management strategy when treating these lesions and to employ cranial and spinal radiation treatment at the first sign of disease progression.
authors.affiliation: Department of Neurosurgery, Neuropathology and Neuro-oncology, Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Liverpool, UK.
authors.forename: Dhanya
authors.initials: D
authors.lastname: Mullassery
authors.forename: Donncha F
authors.initials: DF
authors.lastname: O'Brien
authors.forename: Dawn
authors.initials: D
authors.lastname: Williams
authors.forename: Daniel
authors.initials: D
authors.lastname: Crooks
authors.forename: Conor
authors.initials: C
authors.lastname: Mallucci
authors.forename: Barry
authors.initials: B
authors.lastname: Pizer
authors.forename: Nicky
authors.initials: N
authors.lastname: Thorp
authors.forename: Heather
authors.initials: H
authors.lastname: McDowell
mesh_terms: D002648:Child; D016545:Choroid Plexus Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D016634:Radiosurgery; D014057:Tomography, X-Ray Computed / Q000379:methods