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Non-brain-exposure Exoscopic and Endoscopic Volume Reduction Surgery for Benign Meningioma En Plaque in an Elderly
Yutaro Fuse1, Tadashi Watanabe2, Kazunori Shintai3
1Department of Neurosurgery, Handa City Hospital, Handa, Aichi, Japan.
Abstract:
Meningioma en plaque (MEP) often needs invasive surgery to resect totally because of its widespread proliferation along the dura mater. We report a minimally invasive surgical technique for non-brain-exposure exoscopic and endoscopic volume reduction in an elderly patient with MEP. An 83-year-old woman presented with gait disturbance and cognitive dysfunction that had progressed over 6 months. Magnetic resonance imaging (MRI) revealed a large MEP on the right frontal lobe with peritumoral edema. On confirming the benign nature of the tumor (WHO grade 1) by biopsy, the main feeders and tumor were transarterially embolized. Volume reduction surgery was performed under the assistance of an exoscope and an endoscope while being careful not to expose and damage the cortex. Her symptoms completely resolved postoperatively. This surgical technique without exposing the brain may be a treatment choice for elderly patients with benign symptomatic convexity MEP.
Insights
Minimally invasive surgery using exoscopic and endoscopic techniques can effectively reduce volume in elderly patients with meningioma en plaque (MEP). This approach avoids brain exposure and leads to complete symptom resolution.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Meningioma en plaque (MEP) is a dural-based tumor that often requires extensive surgical resection due to its diffuse growth pattern.
- Traditional surgical approaches for MEP can be invasive and carry risks, particularly in elderly patients.
Observation:
- An 83-year-old female patient presented with progressive gait disturbance and cognitive dysfunction.
- MRI revealed a large right frontal lobe MEP with peritumoral edema.
- Biopsy confirmed a benign (WHO grade 1) tumor.
Findings:
- A minimally invasive surgical technique involving exoscopic and endoscopic volume reduction was performed without cortical exposure.
- Preoperative transarterial embolization of tumor feeders was conducted.
- The patient experienced complete resolution of symptoms postoperatively.
Implications:
- This non-brain-exposure surgical technique may offer a viable treatment option for elderly patients with symptomatic, benign convexity MEP.
- Minimally invasive approaches can potentially reduce surgical morbidity in vulnerable patient populations.
- Further research into exoscopic and endoscopic techniques for dural tumors is warranted.
