En Plaque Meningiomas: A Narrative Review

Meningiomas in Rubinstein-Taybi syndrome: A case report and comprehensive review

Rubinstein-Taybi syndrome (RTS) is a congenital disorder with characteristic clinical manifestations. In the vast majority of cases, it is caused by mutations of the gene encoding the transcriptional co-activator cAMP-response element binding protein (CBP)-binding protein (CREBBP). It has been thought to be a tumor predisposition syndrome as RTS patients have an increased risk of developing tumors including meningiomas. However, RTS-associated meningiomas are rarely reported. We report a unique RTS-associated meningioma in which an oncogenic CREBBP mutation is identified. We also comprehensively review the reported RTS-associated meningiomas, from epidemiology and pathogenesis to clinicopathological characteristics and treatment. All RTS patients with meningiomas are female and have the exclusive mutations of CREBBP. In population-based studies RTS-associated meningiomas seem to develop at younger ages. Their pathogenesis may be driven by the CREBBP/CBP alterations resulting in aberrant signal transduction in the CBP-mediated signaling pathways. Meningiomas in RTS patients have common clinicopathological characteristics including comorbidity with other tumors, radiologically intra-osseous growth, and uncommon histopathology such as ossifying and secretory features. Given the genetic nature and rarity of RTS-associated meningiomas, further investigation of their characteristics may define molecular targets for improved therapeutic options for RTS patients.

[En plaque convexity hyperostotic meningioma: 69 cases from a singlecenter]

BACKGROUND

To date, 16 cases of en plaque hyperostotic meningioma of the convexity have been described. There are no clinical guidelines for the treatment of such patients.

OBJECTIVE

To study the factors influencing the results of surgical treatment of en plaque convexity hyperostotic meningioma, to formulate the appropriate decision-making algorithm.

MATERIAL AND METHODS

A retrospective total group of 69 patients with en plaque convexity hyperostotic meningioma who underwent surgery at Burdenko Neurosurgical Center between 2014 and 2023. We analyzed clinical manifestations, tactics and results of surgery and radiotherapy using statistical methods.

RESULTS AND DISCUSSION

Total resection of small local non-infiltrative hyperostotic meningioma not involving the superior sagittal sinus did not cause neurological deterioration. In case of spread infiltrative hyperostotic meningiomas, the best results (including regression of intracranial hypertension in all cases) were obtained after non-radical surgeries (resection of hyperostosis without wide excision of the dura or even without dura opening). Extent of resection of involved dura and intracranial tumor did not affect relapse-free survival. Additional morbidity at discharge from the clinic was 35%, after ≥6 months - 16%. The most common (27.5%) complication was pseudomeningocele. Redo surgery rate for pseudomeningocele - 7%, hematomas - 7%, wound infection - 6%. There were no mortality in the series. Radiotherapy increased relapse-free survival without statistical confirmation.

CONCLUSION

Total resection provides optimal results in patients with small convexity hyperostotic meningioma and no brain invasion. Resection of hyperostosis and expansive cranioplasty are preferable for large and giant convexity hyperostotic meningioma involving venous sinuses and / or the brain.

Surgical insights into meningiomas en plaque: A rare case of frontal tumor resection and its clinical implications

INTRODUCTION

Meningiomas en Plaque (MEP) represents a rare subtype, typically affecting females and seen in the fifth decade of life, with proptosis as a common presenting symptom, posing both diagnostic and surgical challenges.

CASE PRESENTATION

A 55-year-old right-handed male presented with right hemiplegia, headache, vomiting, and frequent seizures. Neurological examination showed reduced visual acuity and right-sided exophthalmos. MRI revealed a large, enhancing extra-axial dural-based lesion in the left frontal hemisphere, prompting surgical intervention. A bicoronal incision allowed for a left frontal craniotomy and tumor resection, including ligation of the superior sagittal sinus. Microscopic analysis showed spindle cell proliferation with whorled patterns. Postoperatively, the patient had an uneventful recovery and was discharged after three days, reporting resolution of symptoms during follow-up.

CLINICAL DISCUSSION

The unique combination of the tumor's location, clinical manifestations, the patient's gender and age, along with the overall rarity of MEP, underscores the exceptional nature and significance of this case report.

CONCLUSION

This report emphasizes the need for a comprehensive understanding of the diverse manifestations of this rare subtype, underscoring the challenges associated with its diagnosis and treatment, and contributing valuable insights to the existing knowledge base regarding this unique pathology.

En plaque meningioma of the temporal bone: A systematic review on the imaging and management of a rare tumor

OBJECTIVE

To review the published cases of meningioma en plaque of the temporal bone (TB-MEP), to gather evidence on the clinical assessment and management of this rare entity.

METHODS

Following PRISMA statement recommendations, 383 abstracts were screened independently by two authors. Inclusion criteria were articles of human patients affected by TB-MEP; English or Italian language; availability of the abstract articles unrelated to TB-MEP, guidelines and systematic reviews were excluded. Only full-text articles reporting the diagnostic work-up and the management of the TB-MEP were considered for analysis.

RESULTS

A total of 12 articles were included, for a total of 25 patients with a mean age of 52 years (range: 31-71). The average time elapsed between the onset of symptoms and the actual diagnosis of TB-MEP was 36.5 months (range: 2-120). In most cases, the pathology presented with hearing loss (80 %), often accompanied by effusive otitis media (52 %), aural fullness (32 %), and tinnitus (32 %). The main Computed Tomography (CT) findings were hyperostosis (76 %), hairy appearance of bony margins (16 %), involvement of the mastoid and middle ear (48 %). Magnetic Resonance Imaging (MRI) revealed dural enhancement (28 %), temporal hyperostosis (20 %), a clearly enhancing extra-axial mass (28 %), compression of the surrounding vasculo-nervous structures (8 %) and the possible involvement of the temporal lobe (8 %). Forty percent of patients underwent various medical and surgical treatment before reaching the diagnosis. Forty-four percent of patients were sent to definitive surgical treatment, 44 % to follow-up while 8 % received radiotherapy.

CONCLUSIONS

Meningioma en plaque (MEP) is a rare tumour, particularly when it originates within the temporal bone. Appropriate imaging in patients complaining of audiological sign and symptoms is mandatory to avoid diagnostic delays, avoid inappropriate surgical procedures, and adopt the appropriate treatment.

Grade III en-plaque meningioma mimicking subacute subdural hematoma: A case report

INTRODUCTION

En-plaque meningioma (EPM) presents preoperative diagnostic challenges due to its atypical radiologic features. This case report describes the preoperative diagnostic challenges in identifying EPM that affected its operative management.

CASE REPORT

A 58-year-old female patient presented to the emergency department with decreased consciousness and a history of a fall on the head two months earlier. For the past year, the patient also complained of worsening headaches. One week before, the patient also complained of nausea, vomiting, and fluctuating fever. Although a CT scan of the head showed a mass in the left temporoparietal region, the patient was initially diagnosed with subacute subdural hematoma (saSDH) and planned for SDH evacuation surgery using the burr hole technique. However, intraoperative findings revealed an extradural intracranial tumor, so the procedure was switched to tumor excision craniotomy, and based on histopathological examination, it was confirmed to be an anaplastic malignant meningioma, WHO grade III.

DISCUSSION

EPM is one of the rare subtypes of meningioma with an atypical and radiologically variable appearance that often presents challenges in preoperative diagnosis. In this case, the patient's history of falling on the head and the CT scan of the head that resembles saSDH may obscure the preoperative diagnosis and affect the patient's management.

CONCLUSION

EPM can manifest like other intracranial disorders. In this case, the patient's fall history may obscure the clinicians' diagnosis of the meningioma, leading to preoperative misdiagnosis with saSDH. Therefore, meticulous preoperative diagnosis is essential to determining the patient's medical treatment and outcome.

Intracranial meningiomas at a tertiary hospital: Spectrum of MRI findings with histopathologic correlation

Background

Intracranial meningiomas consist of a heterogenous group of histological subtypes, some of which are rare. Data that may play an important role in neurosurgical decision-making regarding the incidence and MRI features of these histological subtypes in the South African population groups, are lacking.

Objectives

This study aimed to assess the spectrum of MRI findings and histological subtypes of meningiomas in the South African context, with the goal of improving the paucity of literature on the topic.

Method

A retrospective review of the MRI features of 41 cases of histologically confirmed intracranial meningiomas was performed at a tertiary hospital level. Imaging features were audited and correlated with histological subtypes during statistical analysis.

Results

Eleven different histological subtypes of meningioma were encountered. World Health Organization (WHO) Grade I meningothelial meningiomas were the most common histological subgroup. Overall, meningiomas were found to be predominantly isointense to grey matter on T1-weighted imaging, irrespective of the histological subtype, with greater signal variability on T2-weighted imaging. Morphologies of specific subtypes are in keeping with the literature.

Conclusion

Analysis of this series of intracranial meningiomas did not demonstrate statistically significant differences in MRI features between histological subtypes to allow for accurate preoperative prediction of meningioma subtype or WHO grade. This highlights the importance of definitive histopathological diagnosis rather than over-reliance on presumed benign imaging features.

Contribution

This original research article discusses the impact of histological subtype on the MRI appearance of intracranial meningiomas, with the aim to improve the paucity of literature on the subject in the context of the South African population.

[Convexity hyperostotic meningioma en plaque: a systematic review]

BACKGROUND

Planar hyperostotic meningiomas account for 2-9% of intracranial meningiomas. They are characterized by planar node following the contours of the inner surface of the skull. Hyperostosis is present in most cases. Timely diagnosis of skull base tumors is usually simple due to early involvement of the cranial nerves. However, convexity meningiomas en plaque usually reach large dimensions that complicates surgery and radiotherapy.

OBJECTIVE

To analyze the current state of diagnosis, molecular biology and surgical treatment of hyperostotic meningiomas en plaque.

MATERIAL AND METHODS

A systematic review was performed in accordance with the PRISMA guidelines. Searching for literature data included the following keywords: «planar meningioma», «hyperostotic meningioma», «meningioma en plaque», «infiltrative meningioma». We reviewed the PubMed and Google Scholar databases until May 2023 and enrolled only full-text Russian-, English- or French-language reports.

RESULTS AND DISCUSSION

Among primary 332 reports, 35 references met the inclusion criteria. We found less severity or absence of focal neurological symptoms, comparable incidence of intracranial hypertension and no histological differences between planar and nodular meningiomas. Analysis of molecular biological features of planar meningiomas, including cell cultures, is feasible. There is no consensus regarding surgical treatment and radiotherapy. Most publications are case reports.

CONCLUSION

The results of treatment of planar hyperostotic meningiomas, especially large and giant ones, are unsatisfactory. There is no a generally accepted algorithm for treating patients in the literature. This problem requires further research.

Patient-specific implants for reconstruction of orbit and skull following resection of spheno-orbital meningiomas: A two-implant concept

INTRODUCTION

The surgical treatment of spheno-orbital meningioma (SOM) is challenging. In addition to anatomical constraints that lead to a difficult resection, the reconstruction of the resulting defect is demanding. Uniform recommendations concerning the best reconstruction technique are not available in the existing literature. We propose a novel two-piece concept for reconstructing post-ablative defects using patient-specific implants.

MATERIAL AND METHODS

Between 2018 and 2021, seven patients underwent SOM resection using two digitally planned patient-specific implants for orbit and skull reconstruction. To analyze the accuracy of the reconstruction, preoperative plans were merged with postoperative data sets. The clinical outcome was evaluated by comparing the pre- and postoperative exophthalmos index (EI).

RESULTS

In all cases, adequate reconstruction and a satisfactory match between the final implant position and preoperative planning were achieved. The EI was reduced in all cases from a mean of 1.27 to 1.09 (p = 0.003).

CONCLUSIONS

The proposed concept of a two-piece reconstruction after SOM resection is an excellent way to manage the concern around post-ablative defects. The current technical conditions allow for a precise, safe, and predictable reconstruction.

Surgical management of skull base meningiomas and vestibular schwannomas

PURPOSE OF REVIEW

The aim of this study is to discuss surgical management of meningiomas and schwannomas of skull base.

RECENT FINDINGS

Meningiomas and schwannomas are typically benign neoplasm with a good prognosis after surgery. Patients should be treated individually related to several features: size and localization of tumor and its proximity with deep critical neurovascular structures, neurological status, age and comorbidity. Also, the widespread use of neuroimaging and the progressive and constant aging of the populations inevitably result in the increase of detection rate of incidental (asymptomatic) neoplasm.Nowadays, there are still controversies about the correct management strategy.

SUMMARY

Surgery represents the gold standard treatment, with the objective of gross total resection; however, it is not always feasible due to localization, encasement of neuro-vascular structure, invasion of cranial nerve and brain parenchyma. Stereotactic radiosurgery and radiation therapy are important to achieve a satisfactory functional outcome and tumor control in case of residue or recurrence. A multidisciplinary approach is pivotal.