Abouammo Moataz D, Alsavaf Mohammad Bilal, Biswas Chandrima, Narayanan Maithrea S, Mansur Guilherme, Gehrke Rodrigo D, Abdelaziz Mahmoud F, Saafan Magdy E, Elsherif Hossam S, Wu Kyle C, VanKoevering Kyle K, Prevedello Daniel M, Carrau Ricardo L
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.
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.
World Neurosurg. 2025 Feb;194:123371. doi: 10.1016/j.wneu.2024.10.100. Epub 2024 Nov 20.
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.
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.
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.
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.
脑膜瘤是最常被诊断出的颅内良性肿瘤。然而，平板状脑膜瘤（MEP）是一种罕见的亚型，占所有脑膜瘤的2.5%，其特征是沿硬脑膜呈扁平的地毯样增生，通常起源于蝶眶区域，因此会导致眼球突出、视力下降和眼眶疼痛。我们报告了一例表现为脑脊液鼻漏的平板状脑膜瘤患者的独特病例，并对文献进行了系统回顾。
按照PRISMA指南，在PubMed和Embase数据库中进行系统检索。使用了与平板状脑膜瘤相关的关键词和标准化索引词。检索不受出版日期限制。进行了筛选、数据提取和质量评估。分析了人口统计学、临床表现、管理方式和治疗结果的数据。
检索得到487个标题，36项研究符合纳入标准。共报告了530例平板状脑膜瘤患者，平均年龄为50.1±11.62岁。眼球突出是最常见的症状（95%），其次是视力损害（57.3%）、眼眶疼痛（38.3%）、眼肌麻痹（28.6%）和头痛（23%）。我们的患者是唯一一例出现自发性脑脊液漏的患者。85%的患者进行了手术切除，15.7%的患者进行了辅助放疗，1例患者接受了根治性放疗，8例患者密切随访未进行干预。
与自发性脑脊液鼻漏相关的平板状脑膜瘤极为罕见，带来了诊断和治疗挑战。对于某些平板状脑膜瘤病例，保守治疗可能是一个不错的选择，可使患者避免手术并发症，特别是对于难以到达的颅底区域。
