Fulltext

Meningioma En Plaque Associated with Cerebrospinal Fluid Rhinorrhea: A Systematic Review of the Literature with Case Presentation

Abouammo MD 1 , Alsavaf MB 2 , Biswas C 3 , Narayanan MS 4 , Mansur G 5 , Gehrke RD 6 Show all authors , Abdelaziz MF 7 , Saafan ME 7 , Elsherif HS 7 , Wu KC 3 , VanKoevering KK 6 , Prevedello DM 3 , Carrau RL 8

Affiliations 

  • 1 Department 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
  • 2 Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  • 3 Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  • 4 Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Otolaryngology and Head-Neck Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 5 Department of Otolaryngology and Head-Neck Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 6 Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  • 7 Department of Otorhinolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt
  • 8 Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Electronic address: ricardo.carrau@osumc.edu
World Neurosurg, 2025 Feb;194:123371.
PMID: 39486580 DOI: 10.1016/j.wneu.2024.10.100

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications