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Published on: February 29, 2020
Meningioma En Plaque Associated with Cerebrospinal Fluid Rhinorrhea: A Systematic Review of the Literature with Case
Moataz D Abouammo1, Mohammad Bilal Alsavaf2, Chandrima Biswas3
1Department of Otorhinolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Background:
Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of a patient with MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of the literature.
Methods:
Following PRISMA guidelines, a systematic search was conducted in PubMed and Embase databases. Keywords and standardized index terms related to MEP were used. The search was performed without restriction on the publication date. Screening, data extraction, and quality assessment were carried out. Data on demographics, clinical presentations, management modalities, and treatment outcomes were analyzed.
Results:
The search yielded 487 titles, with 36 studies eligible for inclusion. A total of 530 patients with MEP were reported, with a mean age of 50.1 ± 11.62 years. Proptosis was the most common symptom (95%), followed by visual impairment (57.3%), orbital pain (38.3%), ophthalmoplegia (28.6%), and headache (23%). Our patient represented the only case of a patient with a spontaneous CSF leak. Surgical resection was performed in 85%, adjuvant radiotherapy in 15.7%, and 1 patient received primary radiotherapy, and 8 patients were closely followed up with no intervention.
Conclusions:
MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, sparing the patient from surgical complications, especially for skull base areas that are difficult to access.
Insights
Meningioma en plaque (MEP) rarely presents with cerebrospinal fluid (CSF) rhinorrhea. This rare presentation requires careful diagnosis and management, with conservative options considered for select cases.
Area of Science:
- Neurosurgery
- Oncology
- Ophthalmology
Background:
- Meningiomas are common benign intracranial tumors, with meningioma en plaque (MEP) being a rare subtype (2.5%).
- MEP typically affects the spheno-orbital region, causing proptosis, visual decline, and orbital pain.
- This study highlights a unique MEP case with spontaneous cerebrospinal fluid (CSF) rhinorrhea.
Purpose of the Study:
- To present a unique case of meningioma en plaque (MEP) with spontaneous CSF rhinorrhea.
- To conduct a systematic literature review on MEP, focusing on clinical presentations and management.
Main Methods:
- Systematic literature search conducted in PubMed and Embase following PRISMA guidelines.
- Data extraction and analysis of demographics, clinical presentations, management, and outcomes from eligible studies.
- Inclusion of a unique case of MEP with spontaneous CSF rhinorrhea.
Main Results:
- Systematic review identified 530 patients with MEP across 36 studies.
- Proptosis (95%) and visual impairment (57.3%) were the most frequent symptoms.
- The presented case was the only one with spontaneous CSF leak; surgical resection was common (85%).
Conclusions:
- MEP with spontaneous CSF rhinorrhea is exceptionally rare, presenting diagnostic and therapeutic challenges.
- Conservative management may be suitable for selected MEP cases, avoiding surgical risks.
- Careful consideration of treatment options is crucial, especially for complex skull base locations.
