2025 Poster Presentations
P161: MENINGIOMA EN PLAQUE ASSOCIATED WITH CEREBROSPINAL FLUID RHINORRHEA: A CASE REPORT WITH SYSTEMATIC REVIEW
Moataz Abouammo, MD, MSc1; Mohammad Bilal Alsavaf, MD1; Maithrea S Narayanan, MBBS, MMED2; Guilherme Mansur, MD3; Chandrima Biswas3; Rodrigo D Gehrke, MD1; Mahmoud F Abdelaziz, MD, PhD4; Magdy E Saafan, MD, PhD4; Joshua Vignolles-Jeong, BA5; Noha E Shalaby, MD, MSc6; Mohamed Ammo, PharmB7; Ahmed N Elguindy, MD, MSc8; Kyle C Wu, MD3; Kyle K VanKoevering, MD1; Daniel M Prevedello, MD, MBA3; Ricardo L Carrau, MD, MBA1; 1Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; 2Department of Otolaryngology and Head-Neck Surgery, Hospital Kuala Lumpur, Jalan Pahang 50586 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia; 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; 4Department of Otorhinolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt; 5The Ohio State University, Wexner Medical Center; 6Faculty of Medicine, Tanta University, Tanta, Egypt; 7The University of Western Ontario; 8Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
Background: Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset characterized by a flat, carpet-like proliferation along the dura. MEP, accounts for only 2.5% of all meningiomas, typically arising in the spheno-orbital region; therefore, it often causes symptoms such as proptosis, decreased visual acuity, visual field defects, headaches, and orbital pain. The management of MEP is complex due to its extensive dural involvement and potential infiltration into adjacent bone and soft tissues, which complicates surgical intervention.
Methods: 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 on April 21, 2024, without restriction on the publication date. Screening, data extraction, and quality assessment were carried out by independent reviewers, with any discrepancies resolved by a third reviewer. Data on demographics, clinical presentations, management modalities, and treatment outcomes were analyzed.
Results: The search yielded 487 titles, with 36 studies eligible for inclusion. A total of 530 patients with MEP were reported, with a weighted mean age of 50.1 ± 11.62 years. Proptosis was the most common symptom (95%), followed by visual acuity impairment (57.3%), orbital pain (38.3%), ophthalmoplegia (28.6%), and headache (23%). Our patient represented the only case with a spontaneous CSF leak. Surgical resection was performed in 85%, adjuvant radiotherapy was carried out in 15.7% of patients, and one patient received primary radiotherapy, while close observation and follow-up were applied in 8 patients. Proptosis improved post-treatment in 77.4% of the patients, while visual acuity improved in 6.2%. The overall recurrence rate was 12.4%.
Conclusion: MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses significant diagnostic and therapeutic challenges. This systematic review emphasizes the need for heightened clinical suspicion and tailored management strategies to address other challenges associated with MEP. A multidisciplinary approach is essential for optimizing patient outcomes. Further research is necessary to enhance understanding of MEP's pathophysiology and to develop more effective treatment protocols.
