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J Neurol Surg A Cent Eur Neurosurg 2012; 73(05): 330-333
DOI: 10.1055/s-0032-1304222
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cervical Extradural “En-Plaque” Meningioma

Giuseppe Mariniello
1   Dipartimento di Scienze Neurologiche, Cattedra di Neurochirurgia, Università degli Studi di Napoli “Federico II,” Napoli, Italy
,
Francesco Briganti
2   Dipartimento di Scienze Neurologiche, Servizio di Neuroradiologia, Università degli Studi di Napoli “Federico II,” Napoli, Italy
,
Maria Laura Del Basso De Caro
3   Dipartimento di Scienze Biomorfologiche e Funzionali, Sezione di Anatomia Patologica e Citopatologia, Università degli Studi di Napoli “Federico II,” Napoli, Italy
,
Francesco Maiuri
1   Dipartimento di Scienze Neurologiche, Cattedra di Neurochirurgia, Università degli Studi di Napoli “Federico II,” Napoli, Italy
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Publication History

09 August 2011

16 November 2011

Publication Date:
09 July 2012 (online)

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Abstract

Objective Spinal meningiomas with concurrent extradural localization and “en-plaque” growth are exceptional, with only five reported cases in the literature. We report another case and discuss the peculiar diagnostic and surgical features of this very unusual pattern of growth.

Case report A 74-year-old woman was observed because of a rapidly progressive tetraparesis, more marked in the left arm. Magnetic resonance imaging depicted an inhomogeneously enhancing tumor of the cervical spine, extending from C4 to T1, with diffuse dural enhancement and extension into the left brachial plexus roots. At operation by laminotomy from C4 to C7 a firm posterior extradural tumor arising from the dura was resected; however, the diffusely infiltrated dura could not be removed. Histology was in favor of a transitional meningioma (WHO I). Postoperatively, irradiation to the operative field with 50 Gy was performed. At follow-up, 18 months after surgery, clinical improvement to moderate tetraparesis was evidenced.

Conclusions Spinal extradural “en-plaque” meningiomas have been mainly reported in women and at the cervical region, and show extension to many spinal levels as well as diffuse dural infiltration. Preoperatively, they may be differentiated from spinal metastases and lymphomas because of the presence of a “dural tail” sign and calcifications. The surgical resection is mainly limited to the posterior and lateral extradural tumor component, whereas the whole invaded dura is very difficult to resect, mainly in cases with circumferential infiltration. This results in a high rate of tumor recurrence.

Keywords

spinal meningioma - en-plaque meningioma - magnetic resonance imaging - spine
 

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