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Updated: May 20, 2026
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
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.
Insights
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.
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.
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