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Totally extradural spinal en plaque meningiomas - Diagnostic dilemmas and treatment strategies
Amey Savardekar1, Debarshi Chatterjee1, Debajyoti Chatterjee2
1Department of Neurosurgery, Post Graduate Institute of Medical education and Research, Chandigarh, India.
Background:
Meningiomas are the second most common intraspinal tumors, constituting ~25% of all intraspinal tumors; however, in the context of extradural spinal lesions, the diagnosis of meningioma is an uncommon one. Purely extradural spinal meningiomas, especially of the en plaque variety, frequently mimic metastatic disease and may result in inadequate therapy.
Case Description:
We report two cases of totally extradural en-plaque meningiomas of the spine, one each in the cervical and dorsal spine. We present the significant diagnostic dilemmas posed by these cases and discuss the pathogenesis, treatment strategies, and long-term behavior of these uncommon lesions.
Conclusion:
Attention needs to be drawn to this dangerous preoperative and intraoperative misinterpretation. Intraoperative histopathology support for correct identification, gross total resection at surgery, inclusion of a durotomy to rule out intradural extension, and long-term follow-up are cornerstones for successful management of totally extradural en plaque spinal meningiomas.
Insights
Extradural spinal meningiomas, particularly en plaque types, can mimic metastatic disease, leading to misdiagnosis. Early identification and complete surgical resection are crucial for successful management of these rare tumors.
Area of Science:
- Neurosurgery
- Spinal Oncology
Background:
- Meningiomas are common intraspinal tumors, but purely extradural variants are rare.
- Extradural spinal meningiomas, especially en plaque types, often mimic metastatic disease, complicating diagnosis and treatment.
Observation:
- This report details two cases of totally extradural en-plaque meningiomas in the cervical and dorsal spine.
- These cases highlight significant diagnostic challenges, including preoperative and intraoperative misinterpretations.
Findings:
- Purely extradural en plaque spinal meningiomas present unique diagnostic dilemmas.
- Successful management relies on accurate intraoperative histopathology, gross total resection, and consideration of durotomy.
Implications:
- Increased awareness is needed to prevent misdiagnosis of extradural spinal meningiomas.
- Comprehensive surgical strategies and long-term follow-up are essential for optimal patient outcomes.
