Recurrent pediatric cervical World Health Organization grade II meningioma with foraminal extension and vertebral artery displacement: A case report and literature review

Background: Pediatric spinal meningiomas are rare, particularly cervical intradural extramedullary World Health Organization (WHO) grade II tumors with foraminal extension. These lesions present unique surgical and management challenges due to their aggressive behavior, high recurrence rates, and proximity to critical neurovascular structures. Case Description: A 9-year-old female presented with a 9-month history of headache, progressive limb weakness (i.e., most pronounced in the right upper extremity), and gait instability. The magnetic resonance (MR) revealed a C2-C6 cervical intradural extramedullary mass causing significant spinal cord compression. She underwent a laminoplasty with near-total tumor resection i.e., leaving a small amount of residual tumor to avoid neurological injury. The histopathology confirmed a WHO grade II meningioma. Postoperatively, she received adjuvant radiotherapy. At 21-month follow-up, the MR demonstrated tumor recurrence with foraminal extension and vertebral artery displacement, causing renewed cord compression. Following additional tumor resection/decompression, she remained ambulatory, but with persistent right upper-limb weakness. Conclusion: Recurrent pediatric cervical WHO grade II meningiomas can demonstrate locally aggressive behavior. Optimal management requires maximal safe resection, utilization of adjuvant radiotherapy for subtotal resections, and long-term surveillance to monitor for recurrence and guide further management.