Spinal en plaque meningiomas: a contemporary experience

Area of Science:

• Neurosurgery
• Spinal Oncology
• Neuropathology

Background:

• Spinal en plaque meningiomas are rare dural tumors characterized by their diffuse, flattened growth pattern along the spinal cord.
• These lesions present unique surgical challenges due to their infiltrative nature and frequent association with spinal arachnoiditis, complicating dissection and increasing the risk of neurological injury.

Observation:

• This study reviewed seven cases of spinal en plaque meningiomas and conducted a literature search to analyze all reported cases.
• Microsurgery was the primary treatment modality, with complete tumor resection achieved in three patients and subtotal resection in four.
• One patient experienced permanent neurological worsening postoperatively.

Findings:

• Spinal en plaque meningiomas exhibit a poorer prognosis compared to classic meningiomas regarding definitive surgical cure.
• High rates of recurrence and postoperative arachnoiditis contribute to the less favorable outcomes.
• Complete tumor removal is feasible only when a distinct cleavage plane between the tumor and the arachnoid mater is present.

Implications:

• Surgical strategies for spinal en plaque meningiomas must carefully consider the risk of arachnoiditis and recurrence.
• Careful patient selection and surgical technique are crucial to optimize outcomes and minimize neurological deficits.
• Further research into adjuvant therapies or novel surgical approaches may be warranted to improve the prognosis of these challenging tumors.