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Spinal en plaque meningiomas: a contemporary experience
Emanuela Caroli1, Michele Acqui, Raffaelino Roperto
1Department of Neurological Sciences and Neurosurgery, Policlinico S. Andrea, University of Rome La Sapienza, Rome, Italy. manucarol2000@yahoo.it
Objective:
Spinal en plaque meningiomas are rare and challenging lesions because of their tendency to induce spinal arachnoiditis. The surgical treatment of this type of meningioma is more complex than that of classic meningioma.
Methods:
We report seven cases of spinal en plaque meningiomas and review all the cases reported in the literature accessible to us by a MEDLINE search.
Results:
All patients underwent microsurgery. Complete tumor removal was achieved in three patients. Subtotal removal was performed in four patients. A permanent neurological worsening was observed in one patient.
Conclusion:
Spinal meningiomas en plaque bear a prognosis poorer than that of classic meningiomas with regard to the possibility of a definitive surgical cure because recurrence or postoperative arachnoiditis occurs frequently. Total surgical removal should be attempted only when a clear plane of cleavage between tumor and arachnoid exists.
Insights
Spinal en plaque meningiomas are rare tumors that often cause arachnoiditis, making surgical treatment difficult. These tumors have a poorer prognosis than classic meningiomas due to frequent recurrence and postoperative complications.
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.