Cognitive function assessment and comparison on lateral ventricular tumors resection by the frontal transcortical approach and anterior transcallosal approach respectively in children.

Currently, there are few studies on cognitive impairment caused by neurosurgery, and there have been no studies on cognitive impairment after resection of lateral ventricular tumors in children. Previously, our research team has reported that the frontal transcortical approach can impair cognitive function. In this study, we explored which functions would be damaged by the transcallosal approach and compared the cognitive function changes caused by the two surgical approaches, so as to provide a theoretical basis for the selection of pre-operative surgical approaches. The authors prospectively collected pediatric patients with lateral ventricular tumors who had undergone surgical resection through the frontal transcortical approach and anterior transcallosal approach in Beijing Tiantan Hospital from November 2012 to May 2017. The inclusion criteria according to the Children Wechsler Scale requirements and clinical performance were formulated. Wechsler Intelligence Scale for Children®-fourth edition: Chinese version (WISC-IV) was adopted for general intelligence and cognitive function assessment in the study. In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the pre-operative period and 6-month follow-up in post-operation. A total of 30 patients were enrolled. Gross total resection was achieved in all patients, and no severe post-operative complications were observed. The frontal transcortical approach was applied in 19 patients, and the transcallosal approach was conducted for 11 patients. Compared with the pre-operative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV in post-operation. In patients accepting lateral ventricular tumors resection through the anterior transcallosal approach, the total IQ was declined to M = 84.82, SD = 8.072 from M = 93.27, SD = 6.635 within the 6-month convalescence. The data of working memory (t = - 2.990, p = 0.002) and total IQ (t = - 2.205, p = 0.028) pre- and post-operative showed statistical significance. But in the comparison of two surgical approaches, it was found that IQ had no statistical difference in WISC-IV tasks data. Previous studies suggest that the frontal transcortical approach impair perceptual reasoning, processing speed, and IQ, while this study indicates that the anterior transcallosal approach impairs patients' working memory and IQ. Both approaches make equal damage to IQ. Through comparing the two surgical approaches, it can be known that the anterior transcallosal approach cannot replace the frontal transcortical approach. The protection of cognitive function should be considered as one of the bases for neurosurgeons to select the operative approach before the operation. However, in an actual situation, the specific approach should be carefully selected by comprehensive consideration.

Clinical features and long-term outcomes of pediatric intraventricular meningiomas: data from a single neurosurgical center.

The purpose of this study is to investigate the clinical characteristics and long-term outcomes of pediatric patients with intraventricular meningioma. We retrospectively analyzed a total of 30 pediatric patients with intraventricular meningiomas who were surgically treated at our department between January 2005 and June 2016 and analyzed their clinical characteristics and surgical outcomes. Among the 160 pediatric patients with intracranial meningioma, 33 (20.6%) had intraventricular lesions. However, only 30 patients had complete demographic and clinical data. A male predilection (male/female = 1.5:1) was observed, and the mean age of our patient cohort was 12.6 years. The lateral ventricle was the most common lesion site (88.6%). In addition, the most common initial symptom was headache or dizziness, and the average interval from symptom onset to admission was 19.17 months (0.25-72 months). Twenty-six patients (86.7%) achieved a Simpson grade of I. Based on the WHO classification, 28 (93.3%) meningiomas were classified as grade I, and the remaining two cases were grades II and III. During the follow-up period (0.67-10.08 years), 3 patients experienced tumor recurrence (15, 18, and 83 months, respectively), and 1 patient died of recurrence. Pediatric and adult intraventricular meningiomas present similar clinical characteristics and surgical outcomes; however, intraventricular meningiomas compose a higher percentage of pediatric meningiomas and have a male predilection. Compared with general pediatric meningiomas, pediatric intraventricular meningiomas tend to have higher incidence of benign subtypes. They are also more likely to be completely resected and have lower recurrence and mortality rates.

Risk factors for neurological deficits after surgical treatment of brain arteriovenous malformations supplied by deep perforating arteries.

The treatment of brain arteriovenous malformations supplied by deep perforating arteries (PA) (P-BAVM) remains challenging. The aims of this study were to determine the outcomes after surgical treatment in patients with P-BAVMs and to identify the risk factors associated with postoperative neurological deficits. We retrospectively reviewed the medical charts and imaging records of 228 consecutive patients with BAVMs who underwent microsurgical resection of their BAVMs at Beijing Tiantan Hospital between September 2012 and March 2016. Patients were included if the BAVMs were totally or partially supplied by PA. All patients had undergone preoperative diffusion tensor imaging (DTI), MRI, 3D time-of-flight MRA (3D TOF-MRA) and digital subtraction angiography (DSA) followed by resection. Both functional and angioarchitectural factors were analysed with respect to the postoperative neurological deficits, including motor deficits, visual field deficits and aphasia. Statistical analysis was performed using the statistical package SPSS (version 20.0.0, IBM Corp.). Fifty-nine patients with P-BAVMs were enrolled. Radical obliteration was achieved in all P-BAVMs according to postoperative DSA. Forty-five (76.3%) patients obtained neurological deficits 1 week after surgery. At a mean follow-up of 14.7 ± 9.4 (3-30) months after surgery, 34 patients (57.6%) had long-term neurological deficits. Multivariable logistic regression analyses showed that a shorter lesion-to-eloquent fibre tracts distance (LFD) was an independent risk factor for short- (P = 0.014) and long-term (P = 0.013) neurological deficits. The cut-off point of LFD for long-term neurological deficits was 5.20 mm. The predominant supply of the PA (P = 0.008) was an independent risk factor for long-term neurological deficits. This study identified a high risk of surgical morbidity for P-BAVMs. The predominant supply of the PA and a shorter LFD are crucial risk factors for postoperative neurological deficits in patients with P-BAVMs.

A comparison of clinicopathological features and surgical outcomes between pediatric skull base and non-skull base meningiomas.

OBJECT: The purpose of this study is to analyze and compare the clinicopathological characteristics and surgical outcomes between skull base and non-skull base meningiomas in pediatric population. METHODS: We retrospectively analyzed a total of 140 cases of pediatric meningiomas surgically treated in our department from January 2005 to July 2015 and compared the clinicopathological characteristics and surgical outcomes between skull base and non-skull base meningiomas. RESULTS: Of all the pediatric meningiomas, 50 (35.8 %) were located at the skull base and 90 (64.2 %) were located at the non-skull base. Skull base and non-skull base meningiomas had a similar sex distribution (male/female = 1:1 in skull base meningiomas and male/female = 1.5:1 in non-skull base meningiomas) (P = 0.288) and high-grade meningioma occurrence rate (P = 0.569). In addition, the mean age of non-skull base meningiomas was 12.5 years which was younger than that of skull base meningiomas (14.2 years) (P = 0.019), and the preoperative tumor size was smaller in skull base (mean size = 4.7 cm in skull base meningiomas and mean size = 5.7 cm in non-skull base meningiomas) (P = 0.020). Gross total resection was achieved in 64 non-skull base patients (73.9 %) and 26 skull base patients (52 %) (P = 0.046). Patients with gross total resection had better progression free survival (PFS) than those with subtotal resection. CONCLUSION: Pediatric skull base and non-skull base meningiomas are similar in sex distribution and high-grade meningioma occurrence rate. In comparison with non-skull base ones, pediatric skull base meningiomas occur at elder age and are smaller in size and they are more likely to be incompletely resected. Gross total resection and early treatment are recommended to prolong PFS of pediatric patients.

Pediatric intracranial clear cell meningioma: a clinicopathological study of seven cases and literature review.

BACKGROUND: In this study, we reported seven cases of pediatric intracranial clear cell meningiomas (CCMs) in our institution and reviewed the relevant literature to investigate the clinicopathological characteristics, treatment options, and prognosis of these rare tumors. METHODS: From January 2005 to June 2016, we retrospectively reviewed seven pediatric intracranial CCMs in terms of their clinical data, preoperative MRI features, and prognosis. Moreover, a critical review of the English language literature was also conducted. RESULTS: The patients consisted of two males and five females with a median age of 10.5 years (range 6-15 years) at initial surgery. Petroclival and cerebellopontine angle area was the most common location site (5/7). Accordingly, the most common initial manifestation was hearing loss (3/7), and the mean interval from onset of symptoms to admission was 6.8 months (1.5-24 months). Gross total resection was achieved in five patients. Of the six tumors with immunohistochemical records, MIB-1 labeling index varied from 3 to 20 % (mean 8.1 %). During the follow-up period (mean 76.9 months, range 16-180 months), four patients had experienced tumor recurrences and three patients died due to recurrences. CONCLUSIONS: Pediatric intracranial CCMs have a tendency to recur. There is a significant relationship between MIB-1 labeling index and recurrence. Gross total resection is recommended; if not available, adjuvant radiotherapy should be used to reduce the recurrent rate. In addition, postoperative MRI follow-up should be monitored at an interval time after resection.

Multi-omics analysis of intertumoral heterogeneity within medulloblastoma uncharted-pathway subtypes.

Medulloblastoma is a common pediatric malignant brain tumor. There were four consensus molecular subgroups (WNT, SHH, Group3 and Group4). Group 3 and Group 4 tumors exhibited a great degree of transcriptional overlap, and were neither derived from exact pathway aberration. We investigated transcriptional and chromatin accessibility of medulloblastoma by multi-omics single-cell analysis. Our work identified inter- and intra-tumoral heterogeneity within the Group 3, Group 4 and Group 3/4 intermediate subgroups. Unsupervised cluster of each tumor identified 9 cell clusters with transcriptional profiles and 6 cell clusters with chromatin accessibility profiles. OTX2 had the highest activity and expression level across the clusters in a special cluster based on open chromatin single-cell profilings. We identified multiple genes as a significant targeted gene within the OTX2 target genes, which made sense in prognosis. We analyzed the copy-number-variations which presented with expected subgroup distribution from transcriptional and chromatin accessibility profiles. Collectively, these data provide novel insights into Group 3 and Group 4 medulloblastoma and provide a potential therapeutic target.

Infantile and Noninfantile Desmoplastic Astrocytoma and Ganglioglioma: Only Different Age of Onset?

OBJECTIVE: The purpose of this study was to investigate clinical, pathological, and prognostic discrepancies between infantile and noninfantile desmoplastic astrocytoma/ganglioglioma patients. METHODS: From January 2012 to December 2019, we retrospectively reviewed patients aged <18 years who underwent craniotomies at Beijing Tiantan Hospital. Patients diagnosed with desmoplastic infantile astrocytoma and ganglioglioma (DIA/DIG) were included. RESULTS: The group consisted of 9 infantile patients and 8 noninfantile patients. The mean age of onset was 30.11 months in infantile patients and 103.75 months in noninfantile patients. Comparing with infantile patients, noninfantile patients had a mild female predominance (P = 0.335). The most common presentation in noninfantile patients was seizure (n = 4, 50%), whereas abnormal head circumference (n = 3, 33.3%) was the most common presentation in the infantile group. All cases showed a ki-67 index <2%. Preoperative tumor volume in infantile patients (213.98 cm3) was larger than that in noninfantile patients (21.99 cm3) (P = 0.043). Gross total resection was achieved in 5 (55.6%) infantile patients and 6 (75%) noninfantile patients (P = 0.62). All patients are alive by last follow-up visit, and 1 infantile patient recurred 8 months postoperative. CONCLUSIONS: Infantile and noninfantile patients with DIA/DIGs share similar clinical and histopathological features. Compared with infantile patients, noninfantile patients tend to have different symptom predominance. Lesions in noninfantile patients are prone to present with different cystic-solid patterns and smaller volume. Patients with DIA/DIGs have favorable prognosis regardless of extent of resection.

Measurement of lateral ventricle volume of normal infant based on magnetic resonance imaging.

BACKGROUND: Many neurophysiological diseases during infancy stage are associated with the morphology and size of the lateral ventricle. This research aims to measure the normal value range of lateral ventricle volume of normal infant and thus provide basic data for clinical treatment. METHOD: By retrospective analysis of magnetic resonance inspection (MRI) cranial image of 165 infants in the Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, the infants were divided into four groups according to their age, including the first group (1~3 month, n = 12), the second group (4~6 month, n = 33), the third group (7~9 month, n = 51), and the fourth group (10~12 month, n = 69). On Neurosoft image workstation, it can measure the sectional area of the lateral ventricle volume at each layer of axis T2W image and calculate the lateral ventricle volume using the Cavalieri method. Moreover, the correlations between lateral ventricle volume and gender, side difference, and month age were analyzed. RESULTS: 95% confidence interval of total bilateral ventricle volume of normal infant: 11920.22~14,266.28 mm3 for male infant and 9922.22~12,263.17 mm3 for female infant; 95% confidence interval of left side ventricle volume: 6254.72~7546.94 mm3 for male infant and 5206.03~6479.99 mm3 for female infant; 95% confidence interval of right side ventricle volume: 5041.56~6743.29 mm3 for male infant and 4695.00~5804.40 mm3 for female infant. The lateral ventricle volume of the male infant was normally larger than that of the female infant (p < 0.05). For both male and female infants, the left side ventricle volume was larger than the right ventricle volume (p < 0.01). There was no significant difference in lateral ventricle volume between infants over 3 months old. CONCLUSION: The normal value range of lateral ventricle volume of the infant can be obtained via referring MRI image. The lateral ventricle volume of infant varies upon gender and ventricle side.

Spetzler-Martin grade IV and V arteriovenous malformations: Treatment outcomes and risk factors for negative outcomes after surgical resection.

OBJECTIVE: Microsurgical resection may be recommended for high grade brain arteriovenous malformations (BAVMs) (HBAVMs) in individualized patients. Careful case selection is necessary to minimize postoperative complications. The aim of this study was to determine the surgical outcomes in patients with HBAVMs and to identify their risk factors associated with postoperative negative outcomes. PATIENTS AND METHODS: We retrospectively studied 53 consecutive patients with HBAVMs. All patients had undergone preoperative diffusion tensor imaging (DTI), MRI, 3D time-of-flight MRA (3D TOF-MRA) and digital subtraction angiography (DSA) followed by resection. White matter (WM) eloquent fibre tracts, including the corticospinal tract (CST), optic radiation (OR) and arcuate fasciculus (AF), were tract. Both functional, angioarchitectural and operative factors were analyzed with respect to the surgical outcomes. RESULTS: Nineteen (35.8%) patients suffered from negative surgical outcomes (MRS > 2) one week after surgery. At the last clinic visit, 10 patients (18.9%) suffered from negative surgical outcomes. Diffuse nidus (P = 0.018), Perforating arteries (PA) supplying (P = 0.009) and CST involving (P = 0.001) were independent risk factors for negative short-term outcomes. PA supplying (P = 0.039), CST involving (P = 0.026) and postoperative intracranial haemorrhage (ICH) (P = 0.014) were independent risk factors for negative long-term neurological outcomes. Larger nidus size (P = 0.024) was predictor of postoperative ICH. The cut-off point was 6.8 cm. CONCLUSIONS: This study identified that diffuse nidus, PA supplying and CST involving are risk factors for negative short-term outcomes in patients with HBAVMs. PA supplying, CST involving and postoperative ICH are risk factors for negative long-term outcomes. Larger nidus size was risk factor for postoperative ICH.

Brain Arteriovenous Malformations Supplied by the Anterior Choroidal Artery: Treatment Outcomes and Risk Factors for Worsened Muscle Strength After Surgical Resection.

OBJECTIVE: The treatment of brain arteriovenous malformations (BAVMs) supplied by the anterior choroidal artery (AChA), or aBAVMs, remains challenging. The aim of this study was to determine the surgical outcomes and risk factors for worsened muscle strength (MS) after surgery in patients with aBAVMs. METHODS: We retrospectively reviewed 266 consecutive patients with BAVMs who underwent microsurgical resection of their BAVMs between September 2012 and June 2016. Patients were included if the BAVMs were entirely or partially supplied by the AChA. All patients had undergone preoperative diffusion tensor imaging, magnetic resonance imaging, 3-dimensional time-of-flight magnetic resonance angiography, and digital subtraction angiography followed by resection. Both functional and angioarchitectural factors were analyzed with respect to the change in MS. RESULTS: We identified 29 patients with aBAVMs who underwent surgical resection of the nidus. Radical resection was achieved in all patients. Thirteen (44.8%) patients suffered from postoperative short-term and 11 (37.9%) suffered from long-term MS deterioration. A shorter lesion-to-corticospinal tract distance (LCD) (P = 0.004) was significantly associated with postoperative short-term worsened MS. Shorter LCD (P = 0.018) and nidus supplied by cisternal segment of AChA (P = 0.026) were independent risk factors for the long-term MS worsening. The amplitudes and potential changes of intraoperative motor-evoked potential monitoring were consistent with the surgical outcomes. CONCLUSIONS: Surgical treatment of aBAVMs can cause a high incidence of MS deficits. Niduses supplied by cisternal segment of AChA and shorter LCD were crucial risk factors for postoperative MS worsening. Motor-evoked potential monitoring was an effective intraoperative technique to predict postoperative MS deficits.

Brain Arteriovenous Malformations Located in Language Area: Surgical Outcomes and Risk Factors for Postoperative Language Deficits.

OBJECTIVE: Case selection for surgical treatment of language-area brain arteriovenous malformations (L-BAVMs) remains difficult. This study aimed to determine the surgical outcomes and risk factors for postoperative language deficits (LDs) in patients with L-BAVMs. METHODS: Patients with L-BAVMs who underwent microsurgical resection between September 2012 and June 2016 were reviewed. All patients had undergone preoperative functional magnetic resonance imaging and diffusion tensor imaging. Both functional and angioarchitectural factors were analyzed regarding the postoperative LD. Functional factors included the eloquence involved, the side of blood-oxygenation level-dependent signal activation and the white-matter fibers (anterior segment, long segment [LS], and posterior segment of arcuate fasciculus, and the inferior fronto-occipital fasciculus) involved. RESULTS: Sixty-nine patients with L-BAVMs were reviewed. Postoperative short- and long-term LD was found in 32 (46.4%) and 14 (20.3%) patients, respectively. Twelve of the 14 patients with Geschwind's territory L-BAVMs (85.7%) had short-term LD, compared with 10 (34.5%) in Wernicke's and 10 (38.5%) in Broca's area. LS involvement (P = 0.001) and larger nidus size (P = 0.017) were independent risk factors for the short-term LD. Meanwhile, nidus size (P = 0.007), preoperative LD (P = 0.008), and LS involvement (P = 0.028) were independent risk factors for long-term LD. CONCLUSIONS: L-BAVMs located in Geschwind's territory can cause a high incidence of LD. LS involvement and larger nidus size are risk factors for postoperative short- and long-term LD, and preoperative LD is a risk factor for postoperative, long-term LD.

Brain Arteriovenous Malformations Located in Premotor Cortex: Surgical Outcomes and Risk Factors for Postoperative Neurologic Deficits.

OBJECTIVE: The premotor cortex (PMC) is known to have a dual role in movement and language processing. Nevertheless, surgical outcomes of brain arteriovenous malformations located in PMC (PMC-BAVMs) have not been well defined. The aim of this study was to determine surgical outcomes and risk factors for neurologic deficits (NDs) after surgery in patients with PMC-BAVMs. METHODS: We retrospectively reviewed patients with PMC-BAVMs who underwent surgical resection of the nidus. All patients had undergone preoperative functional magnetic resonance imaging, diffusion tensor imaging, magnetic resonance imaging, three-dimensional time-of-flight magnetic resonance angiography, and digital subtraction angiography. Functional and angioarchitectural factors were analyzed with respect to postoperative NDs. Function-related fiber tracts, corticospinal tract, and dominant arcuate fasciculus were tracked. Lesion-to-fiber distance was measured. RESULTS: We identified 36 patients with PMC-BAVMs. Radical resection was achieved in all patients. Four patients (11.1%) presented with limb-kinetic apraxia and bradykinesia. Short-term NDs developed in 12 (33.3%) patients, among which 6 developed aphasias and 7 developed muscle weakness. A shorter lesion-to-eloquent fiber distance (P = 0.012) and larger nidus size (P = 0.048) were significantly associated with short-term NDs. Long-term NDs occurred in 5 patients. Larger nidus size was significantly associated (P = 0.015) with long-term NDs. CONCLUSIONS: Varying degrees of motor and language deficits can be induced immediately after resection of PMC-BAVMs. Permanent and long-term severe motor or language deficits are rare. Shorter lesion-to-eloquent fiber distance is a risk factor for short-term NDs. Larger nidus size is a risk factor for short-term and long-term NDs.

Pediatric Skull Base Meningiomas: Clinical Features and Surgical Outcomes.

The purpose of this study is to investigate the clinical, pathological, and prognostic characteristics of pediatric skull base meningiomas. A retrospective analysis of 44 pediatric skull base patients younger than 18 years who underwent surgery at Beijing Tiantan Hospital was performed. The study group included 20 males and 24 females. Multiple lesions were seen in 8 patients. WHO grade I was found in 28 patients and higher grade was seen in 16 patients. Recurrence or progression occurred in 10 patients after the initial operation. The overall survival rate in the follow-up period for the entire cohort was 89.7%. The authors found no sex predominance in pediatric skull base meningiomas. In addition, this lesion was more often seen in their second decades. In contrast to skull base meningiomas in adult patients, pediatric skull base meningiomas had a higher incidence of nonbenign histopathological variants and a higher rate of recurrence.

Differential long non­coding RNA and mRNA expression in differentiated human glioblastoma stem cells.

Differentiation of glioblastoma stem cells (GSCs) may lead to inhibition of their self­renewing ability and tumorigenic potential, as well as increasing their sensitivity to treatment. The critical role of long non­coding RNAs (lncRNAs) in numerous biological processes has been revealed. However, the involvement of lncRNAs in GSC differentiation remains to be elucidated. In the present study, GSCs were isolated from patient samples and differentiation was induced. Using a high­throughput microarray, the present study identified a profile of 1,545 lncRNAs and 2,729 mRNAs that differed between GSCs and their non­differentiated counterparts. To ascertain the association between the altered lncRNAs and mRNAs, a co­expression network was constructed in which 1,087 lncRNAs and 1,928 mRNAs altered upon GSC differentiation formed a total of 19,642 lncRNA­mRNA pairs. Based on the co­expression network, the lncRNA functions were additionally predicted by a cis­ or trans­ targeting program. Furthermore, three pairs of lncRNAs and their nearby target mRNAs were selected [ENSG00000261924.1­regulatory associated protein of MTOR complex 1, ENSG00000235427.1­caveolin 1 and Tax1 binding protein 3 (TAX1BP3)­purinergic receptor P2X 5 (P2RX5)­TAX1BP3] and their expression levels were validated by reverse transcription­quantitative polymerase chain reaction. The altered lncRNAs were also regulated by various pluripotency transcription factors (POU domain, class 3, transcription factor, sex determining region Y­box 2, spalt­like transcription factor 2 and oligodendrocyte lineage transcription factor 2). In conclusion, the results of the present study revealed that lncRNAs may function in GSC differentiation by regulating their target mRNAs, and a set of lncRNAs were identified as candidates for further study concerning the future treatment of GSCs.

Prediction of High-Grade Pediatric Meningiomas: Magnetic Resonance Imaging Features Based on T1-Weighted, T2-Weighted, and Contrast-Enhanced T1-Weighted Images.

BACKGROUND: Prediction of high-grade meningiomas before surgery is essential to determine optimal treatment strategies; however, the relationship between radiologic features and malignancy of meningiomas in pediatric patients has not been clearly demonstrated. The aim of this study was to identify preoperative magnetic resonance imaging features that are significantly correlated with high risk of high-grade pediatric meningiomas. METHODS: We retrospectively reviewed preoperative magnetic resonance imaging features and histopathologic diagnosis according to the 2007 World Health Organization classification system for intracranial tumors of 79 pediatric meningiomas from 2005 to 2015. World Health Organization grade II and III meningiomas were defined as high-grade meningiomas. The relationship between the radiologic findings and incidence of high-grade meningiomas was assessed initially with univariate analysis and then corrected by multivariate analysis. RESULTS: According to univariate analysis, heterogeneous tumor enhancement, an unclear tumor-brain interface, tumor cyst, type of dural attachment, lateral location, positive capsular enhancement, and irregular shape of tumor were strong predictive factors for high-grade meningiomas. When corrected by multivariate analysis, an unclear tumor-brain interface (P < 0.001; odds ratio = 10.4; 95% confidence interval, 3.0-37.0), lateral location (P = 0.014; odds ratio = 4.9; 95% confidence interval, 1.4-17.6), and narrow base (P = 0.001; odds ratio = 8.3; 95% confidence interval, 2.5-27.1) were strong independent predictive factors for high-grade meningiomas. CONCLUSIONS: In pediatric patients, meningiomas with an unclear tumor-brain interface, lateral location, and narrow base on preoperative magnetic resonance imaging are more likely to be high-grade meningiomas. Our results may be helpful in decision making regarding therapeutic strategies for pediatric patients with meningiomas.