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Surgical limitations in convexity meningiomas en-plaque: Is radical resection necessary?
Amy Yao1, Christopher A Sarkiss1, James Lee1
1Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, One Gustave L. Levy Place, Box 1136, New York, NY 10029, USA.
Abstract:
Meningiomas-en-plaque (MEP) comprise 2.5% of all meningiomas. While they typically arise in the sphenoid wing, convexity MEP are comparatively rare and are often confused with meningeal sarcoidosis, osteoma, tuberculoma, or fibrous dysplasia, with very little information published in the literature. We conducted a literature review on PubMed of English-only articles using a keyword search. All studies that described reports of convexity MEP were reviewed for patient demographics, presenting symptoms, radiological reports, surgical management, recurrence rates, histopathological presentation, post-operative complications, and follow-up. This resulted in 12 papers comprising 22 cases of convexity MEP. Seventeen (77%) of the 22 patients were female with an average age of 53.2years. Intitial presenting symptoms included headache in 12/20 (60%), hemiparesis in 5/20 (25%), and visual symptoms in 1/20 (5%). Of the 14 patients who underwent surgical resection, only four were reported as gross total resection. Twelve reports had associated pathology reports, with all 12 tumors graded as World Health Organization Grade I. Convexity MEP, while rare, present a challenge with regard to correct diagnosis and subsequent resection. The easier accessibility of these meningiomas predicts higher surgical success rates and incidence of total resection, though care must be taken to ensure gross total removal of tumor, dural attachments, and any overlying hyperostotic bone. Though hyperostosis is frequently observed with this variant of meningioma, it is neither exclusive nor wholly indicative of MEP. Due to its rarity in both clinical practice and the literature, further studies are warranted to identify modern imaging means to correctly diagnose this condition.
Insights
Meningiomas-en-plaque (MEP) on the brain convexity are rare and often misdiagnosed. Early diagnosis and complete surgical resection are key for better outcomes in these challenging meningioma cases.
Area of Science:
- Neurosurgery
- Neuropathology
- Radiology
Background:
- Meningiomas-en-plaque (MEP) represent 2.5% of all meningiomas.
- Convexity MEP are rare, often misdiagnosed as other conditions like sarcoidosis or fibrous dysplasia.
- Limited literature exists on convexity MEP, highlighting a diagnostic and management gap.
Purpose of the Study:
- To review the existing literature on convexity MEP.
- To analyze patient demographics, clinical presentation, radiological findings, and surgical outcomes.
- To identify challenges in diagnosis and management of this rare tumor type.
Main Methods:
- A comprehensive literature review was conducted on PubMed using English-only articles.
- Studies reporting convexity MEP were analyzed for various clinical and pathological parameters.
- Data extraction focused on demographics, symptoms, imaging, surgery, histopathology, and follow-up.
Main Results:
- The review identified 12 papers with 22 convexity MEP cases.
- The majority of patients (77%) were female, with an average age of 53.2 years.
- Headache (60%) was the most common symptom; only 4/14 gross total resections were reported, with all tumors WHO Grade I.
Conclusions:
- Convexity MEP pose diagnostic and surgical challenges due to their rarity.
- While accessible, complete resection requires careful attention to dural and bony involvement.
- Further research is needed to improve diagnostic accuracy using modern imaging techniques.
