gms | German Medical Science

Meningioma en plaque are a morphological subgroup of meningiomas. They are defined by a carpet-like lesion that infiltrates the dura and sometimes invades the bone. Various cranio-facial approaches have been applied for the treatment of these tumours. The purpose of this study was to determine the results obtained by the fronto-temporal approach.

Twenty-one (21) patients with a meningioma en plaque were included in the study. In all cases, surgery was performed by a combined fronto-temporal approach with orbital decompression. The presenting features, operative details and complications were documented. The adequacy of resection was reviewed and postoperative scans were analyzed to assess orbital reconstruction. Follow-up was between 1 and 7 years.

The majority (92%) presented with proptosis and had disease extending from the sphenoid wing into the orbital roof (71%) and the middle fossa (71%). Seventeen tumours were low grade and 4 high grade (according to the WHO classification) meningiomas. Temporary postoperative oculomotor disturbances were observed in 7 patients. In 2 cases, preoperative oculomotor disturbances remained unchanged postoperatively. Visual function remained unchanged in patients with no preoperative deficit (6/21). In 13 cases with moderate preoperative visual disturbances, visual function improved in 7 and remained unchanged in 6. Cosmetic results were excellent in 16, fair in 3 and poor in 2 patients. Proptosis resolved in 14 and persisted in 5 cases. Tumour recurrence was observed in 4 patients with a low grade tumour (4/17). All cases (4/4) with a high grade menigioma were submitted to postoperative radiation therapy.

Meningioma en plaque represents a difficult surgical challenge. The fronto-temporal approach with decompression of the orbita combined with bony decompression of the cranial nerves at the superior orbital fissure and optic canal enables good disease control with minimal morbidity and good functional and cosmetic results.