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Intraoperative Ultrasound in Spinal Surgery

Intraoperative Ultrasound in Spinal Surgery

Published on: August 17, 2022

Cervical extradural "en-plaque" meningioma.

Giuseppe Mariniello¹, Francesco Briganti, Maria Laura Del Basso De Caro

¹Dipartimento di Scienze Neurologiche, Cattedra di Neurochirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy. giumarin@unina.it

Journal of Neurological Surgery. Part A, Central European Neurosurgery

|July 11, 2012

Summary

This case report details an exceptionally rare spinal extradural en-plaque meningioma. Complete resection is challenging due to diffuse dural infiltration, often leading to recurrence.

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Area of Science:

Neurosurgery
Oncology
Pathology

Background:

Spinal meningiomas are typically intradural tumors.
Extradural and "en-plaque" meningiomas are exceptionally rare, with limited literature.
This presentation focuses on a unique case of spinal meningioma with concurrent extradural and "en-plaque" growth.

Observation:

A 74-year-old woman presented with rapidly progressive tetraparesis.
MRI revealed an inhomogeneously enhancing cervical spine tumor (C4-T1) with diffuse dural enhancement and brachial plexus involvement.
Surgical resection of the extradural component was performed, but complete dural removal was not feasible.

Findings:

Histological analysis confirmed a transitional meningioma (WHO Grade I).
The tumor exhibited diffuse dural infiltration and extension along multiple spinal levels.
Postoperative radiotherapy was administered, resulting in clinical improvement at 18 months.

Implications:

Spinal extradural "en-plaque" meningiomas predominantly affect women, often in the cervical region, and present with extensive dural infiltration.
Preoperative differentiation from metastases or lymphomas may be aided by the "dural tail" sign and calcifications.
The difficulty in achieving complete resection of infiltrated dura contributes to a high recurrence rate, necessitating careful surgical planning and adjuvant therapies.