Successful Craniotomy done with Excision of Tumor (Enplaque Maningioma)

Dr. Anil Arya MBBS, MS, DNB (Neuro Surgeon)

Surgical Case Reports 2017 © The Park Group of Hospitals. 2017

Abstract

“En plaque meningioma refers to a specific meningioma macroscopic appearance characterised by diffuse and extensive dural involvement, usually with extracranial extension into calvarium, orbit, and soft tissues. These tumours are thought to have a collar-like or sheet-like growth along the dura mater, different from the usual globular meningioma.”* This type of brain tumour is highly vascular and involves risky operation. Being a very rare type of tumour, this needs intensive care. A 45 year old woman with a progressive increasing headache on the right side of the brain for last years, who was also misdiagnosed by a private hospital in Sonepat, visited Park Hospital Panipat. The team at Park Hospital Panipat started the treatment with MRI and brain investigations wherein the En-Plaque Meningioma was diagnosed. There was pain and bulginess in both eye balls due to the tumour and weakness on the left side. The patient was discharged after a week of intensive observation and once we saw recovery signs in her with the ability to move smoothly her limbs.

Background

En-Plaque Meningioma is a rare type of brain tumour and requires intensive care. This is one of the slow growing benign tumours which is attached to the dura and are made up of neoplastic meningothelial cells. These are more common in Western World reporting around 24-30% cases. Meningioma en plaque represents a morphological subgroup within the meningiomas defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone. Histopathological features of meningioma enplaque are similar to that of usual meningiomas; however, it is sometimes difficult to predict the behavior in individual cases. Extra-cranial meningiomas form 1-2% percentages of all meningiomas. ** The en plaque variants commonly involve fronto-parietal, juxtaorbital, sphenoid wing, diffuse calvarial or rarely spinal region. *** Due to difficulty in complete resection, the recurrence rate of en plaque meningiomas is higher than the usual counterpart. **** These tumors are also more prone to develop malignant change (11%) when compared to intracranial meningiomas.

Case Presentation

A 45 year old woman visited Park hospital Panipat for an OPD consultation with Dr. Anil Arya wherein he studied the MRI reports and after brain investigations, he diagnosed a rare brain tumour. The lady had progressive increasing headache on the right side of the brain for last 5 years. However, for last 2 years there was pain and bulginess in both eye balls. The patient visited a private hospital in Sonepat for the treatment wherein the CT head was performed and based on the same she was misdiagnosed with Subdural Hematoma. During the operation, the doctor confirmed that the case is of Brain tumour. She was then referred to GB Pant Hospital in New Delhi for further treatment. However, she did not receive any treatment or response; thereafter she contacted Dr. Anil Arya at Park Panipat. After explaining the complexity of the surgery and the poor prognosis during and after the surgery, with due permissions, the patient was operated on 27th July 2017. The tumour mass was completely removed from the brain with craniotomy. Post operation, the patient is conscious oriented with signs of difficulty in limb movement.