Meningioma en Plaque: Experience with 22 Cases

Abstract Background: Sphenoid wing meningioma en plaque is a unique subtype of intracranial meningiomas, known as intra osseous meningiomas that specifically grow at the base of the anterior and middle cranial fossa, extending to the sphenoid wing and orbit and associated with a significant hyperostosis. They result in neurosurgical complications by direct pressure of nearby cranial nerves, cavernous sinus and carotid artery. Aim of Study: Present our series of Sphenoid wing men-ingioma en plaque and to try to conclude the best surgical options and promising results. Patients and Methods: Retrospective analysis for our records regarding 22 patients with radiologically and patho-logically proven en plaque meningioma from Jan 2016 to Nov 2019. All patients underwent complete neurological examina-tion with detailed ophthalmic examination was performed. We adopted the pterional approach with its modification for all surgeries. Post operative CT scan was performed to asses degree of excision and possible recurrence. Results: Mean age was 42 years 21 were females and 1 male. The most common presenting symptom was proptosis in 20 (93%) patients and also 6 patients presented with visual affection (27%). 7 patients complained of peri-orbital pain. 5 patients observed solid swelling over the Temple region We could remove the tumors in most of cases totally Up to grade II on Simpson scale. In 5 out of 22 cases, the resection was subtotal. Improved Proptosis in 17 out of 22 patients post operative. Adjuvant radiation therapy was performed in 5 patients. After a mean follow-up of 24 monthes, 4 out of 22 patients presented by tumor recurrence (18,2%) the recurrences were mainly in the areas around the superior orbital fissure due to our inability to resect the tumor completely for fear of complications and exposed to another course of radiotherapy, No patient presented recurrence after radiation therapy. Conclusion: Early diagnosis, prompt surgical intervention with resection of all invaded bone as possible are key factors in improving outcome of spheno-orbital meningioma en plaque. Regular follow-up is mandatory as some cases may have unpredictable behavior.