Adjuvant radiotherapy in a case of atypical meningioma after gross total resection: an unresolved issue

We present a case of a 48-year-old man diagnosed with parasagittal atypical meningioma (AM) involving biparietal bones with intracranial and extracranial extension up to galea aponeurotica of the scalp. The patient underwent Simpson’s grade 2 resection (GTR (gross total tumour resection) with coagulation of dural attachment). Currently, in AMs, the role of adjuvant radiotherapy is controversial after GTR. Here, through this case, we have discussed in detail issues related to tumour origin, that is, primary versus secondary extradural meningioma and controversial topics regarding the role of adjuvant radiotherapy in the management of AMs. We have presented our radiation treatment strategy addressing the high-risk zones related to tumour extension in this case.

Cervical intra-extradural meningioma with en-plaque, dumbbell-shaped, and an unusual calcified pattern in a young patient

Background: Most spinal meningiomas primarily grow in the intradural extramedullary location. Epidural meningiomas are uncommon; if detected, they usually coexist with intradural lesions. They inhere more aggressive and invasive characteristics compared with their counterparts inside the dura. Case Description: We report a 22-year-old female who was admitted to the hospital with weakness and numbness in both lower limbs. Her cervical magnetic resonance imaging revealed an en-plaque and dumbbell-shaped lesion located from C5 to C8. After gadolinium injection, the whole mass was enhanced and unveiled two portions: intradural and extradural. The bone window of the computed tomography scan revealed calcification inside the lesion. The patient underwent tumor removal surgery. The pathology findings showed a psammomatous meningioma. After 6 months of surgery, the patient has been able to walk with walkers. Conclusion: We should consider spinal meningioma as a differential diagnosis when encountering an extradural lesion in the cervical region. The optimal surgical treatment for young patient with epidural meningiomas is radical surgery with dura attachment removal.

Spinal extradural meningioma en plaque with nerve root attachment and extracanal (intrathoracic) extension

Meningiomas are relatively common primary spinal tumours, being the second most common intraspinal tumours probably after vertebral haemangioma.It constitutes about 25% of all intraspinal tumours; however, in the presence of extradural spinal lesions, the diagnosis of meningioma is uncommon and often not among the first two considerations. Purely extradural spinal meningioma, especially of the “En plaque” variety, usually simulate malignant disease (metastatic diseases and lymphoma) and may result in inadequate therapy, however, the presence of nerve root attachment is even rarer.Our case report is that of an entirely cervicothoracic extradural en?plaque meningioma (WHO grade 1) with a nerve root attachment (right C7) and intrathoracic extension. We highlighted the issues in diagnosis, operative intervention and long-term follow-up.