Pediatric intracranial high-grade solitary fibrous tumor/hemangiopericytoma with drop metastasis to cervicodorsal spine: a rare case report.

Background: Intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is extremely rare in children, accounting for fewer than 10% of all SFT/HPCs and significantly fewer primary central nervous system tumors. Pediatric SFT/HPCs of high-grade are particularly aggressive, having a high frequency of recurrence and late metastasis, though spinal "drop" metastases remain, nevertheless, very rare. Case Presentation: We discuss the case of an 11-year-old girl patient with a 2-year history of recurrent generalized tonic-clonic seizures, worsening headache, vomiting, and acute-onset bilateral visual loss. MRI showed a large frontoparietal mass on the right side, for which neuronavigation-guided craniotomy with gross total resection was performed. Histopathological examination revealed a high-grade (Grade III) SFT/HPC with a high Ki-67 index and characteristic "staghorn" vascular pattern. Postoperatively, the child developed a pseudomeningocele, which was subsequently followed by new neurological deficits. MRI of the cervicothoracic spine revealed a posterior epidural lesion at C7-T1, indicative of early drop metastasis. Referral for further surgery and oncology management was advised, although treatment was refused due to cost. Clinical Discussion: Pediatric intracranial SFT/HPCs are very uncommon, and such instances have usually been described in isolation. Metastases have a tendency to occur many years following initial treatment, making early spinal dissemination within our patient a rare and ominous occurrence. This case also illustrates pseudomeningocele as a complication, thus highlighting the significance of close follow-up and employment of individualized therapy protocols for postoperative management in children with high-grade disease. Conclusion: This case points out the virulent biological behavior of pediatric intracranial SFT/HPC and the propensity for early postoperative complications, including unusual early drop metastases. It stresses the need for close monitoring, personalized multidisciplinary management, and early consideration of new neurologic symptoms in children with high-grade intracranial neoplasms. Our publication adds to the limited pediatric literature and highlights the therapeutic challenge faced in resource-poor environments.