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Published on: July 5, 2021
Primary Extracranial Meningiomas of the Head and Neck
Giuseppe Emmanuele Umana1, Gianluca Scalia2, Atul Vats3
1Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95125 Catania, Italy.
Abstract:
Meningiomas represent the most common benign histological tumor of the central nervous system. Usually, meningiomas are intracranial, showing a typical dural tail sign on brain MRI with Gadolinium, but occasionally they can infiltrate the skull or be sited extracranially. We present a systematic review of the literature on extracranial meningiomas of the head and neck, along with an emblematic case of primary extracranial meningioma (PEM), which provides further insights into PEM management. A literature search according to the PRISMA statement was conducted from 1979 to June 2021 using PubMed, Web of Science, Google Scholar, and Scopus databases, searching for relevant Mesh terms (primary extracranial meningioma) AND (head OR neck). Data for all patients were recorded when available, including age, sex, localization, histological grading, treatment, possible recurrence, and outcome. A total of 83 published studies were identified through PubMed, Google Scholar, and Scopus databases, together with additional references list searches from 1979 to date. A total of 49 papers were excluded, and 34 manuscripts were considered for this systematic review, including 213 patients. We also reported a case of a 45-year-old male with an extracranial neck psammomatous meningioma with sizes of 4 cm × 3 cm × 2 cm. Furthermore, whole-body 68Ga-DOTATOC PET/CT was performed, excluding tumor spread to other areas. Surgical resection of the tumor was accomplished, as well as skin flap reconstruction, obtaining radical removal and satisfying wound healing. PEMs could suggest an infiltrative and aggressive behavior, which has never found a histopathological correlation with a malignancy (low Ki-67, <5%). Whole-body 68Ga-DOTATOC PET/CT should be considered in the patient's global assessment. Surgical removal is a resolutive treatment, and the examination of frozen sections can confirm the benignity of the lesion, reducing the extension of the removal of healthy tissue surrounding the tumor.
Insights
Extracranial meningiomas of the head and neck are rare but can behave aggressively. Surgical resection is the definitive treatment, with frozen section examination aiding in benign confirmation and minimizing tissue removal.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Meningiomas are typically intracranial tumors.
- Extracranial meningiomas (EMs) of the head and neck are uncommon.
- EMs can infiltrate surrounding tissues.
Purpose of the Study:
- To systematically review literature on head and neck EMs.
- To present a case of primary extracranial meningioma (PEM).
- To provide insights into PEM management.
Main Methods:
- Systematic literature search (PubMed, Web of Science, Google Scholar, Scopus) from 1979-2021.
- PRISMA statement guidelines followed.
- Case report of a 45-year-old male with neck meningioma.
Main Results:
- 34 studies and 213 patients included in the review.
- PEMs may exhibit infiltrative behavior without malignancy (low Ki-67).
- Whole-body 68Ga-DOTATOC PET/CT useful for assessment; surgical resection curative.
Conclusions:
- PEMs require careful management due to potential aggressive behavior.
- Surgical resection is the primary treatment for EMs.
- Frozen section analysis helps confirm benignity and guide surgical extent.
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