Primary Extracranial Meningiomas of the Sinonasal Tract: A Systematic Review

Abstract

Background Primary extracranial meningiomas (PEMs) of the sinonasal tract with no intracranial extension are rare. Our study presents the largest systematic review to date, providing a comprehensive overview and comparison of the characteristics, treatment, and prognosis of PEMs, with comparison to primary intracranial meningiomas (PIMs).

Methods A systematic review was conducted according to the PRISMA guidelines on PubMed, Embase, and Google Scholar up to November 1, 2022. A total of 70 documented cases from 64 articles were included. Data analysis was performed to compare low-grade (World Health Organization [WHO] Grade I) and high-grade (Grade II, III) PEMs.

Results Majority of patients were symptomatic with nasal symptoms (72.1%), followed by eye symptoms (41.2%) and facial swellings (41.2%). The nasal cavity was the most commonly affected site (70.0%). Most tumors were WHO Grade 1 (87.5%) with meningothelial histological subtype. PEMs have a predilection for involvement of surrounding structures, with more than half reporting erosion of sinonasal walls or orbital involvement (64.3%). Despite so, PEMs have a favorable prognosis, with high survival rates (95.3%) and low rate of recurrence (8.5%). Mainstay of treatment is surgical resection (98.6%). A total of 69/70 cases (98.6%) underwent surgical resection.

Conclusions There are no clear defining clinical features of PEMs; hence, it is imperative for clinicians to prioritize histological diagnosis to guide further management. A conclusive diagnosis of PEMs, i.e., exclusion of PIMs, requires imaging and potential intraoperative assessment. Its prognosis is likely dependent on both WHO grading and the ability to achieve complete surgical extirpation. Endoscopic resection is recommended even in high-grade PEMs for localized and resectable disease. Radiotherapy may be reserved for unresectable or recurrent tumors as salvage therapy.

Keywords

paranasal sinuses - meningioma - head and neck neoplasm

Previous Presentation

This study was presented as an oral presentation in the 29th Congress of the European Rhinologic Society in Bulgaria, 2023.

Publication History

Received: 30 November 2023

Accepted: 04 February 2024

Accepted Manuscript online:
07 February 2024

Article published online:
08 March 2024

• References

• 1 Bassiouni H, Asgari S, Hübschen U, König HJ, Stolke D. Dural involvement in primary extradural meningiomas of the cranial vault. J Neurosurg 2006; 105 (01) 51-59
• 2 Lang FF, Macdonald OK, Fuller GN, DeMonte F. Primary extradural meningiomas: a report on nine cases and review of the literature from the era of computerized tomography scanning. J Neurosurg 2000; 93 (06) 940-950
• 3 Rushing EJ, Bouffard JP, McCall S. et al. Primary extracranial meningiomas: an analysis of 146 cases. Head Neck Pathol 2009; 3 (02) 116-130
• 4 Thompson LD, Gyure KA. Extracranial sinonasal tract meningiomas: a clinicopathologic study of 30 cases with a review of the literature. Am J Surg Pathol 2000; 24 (05) 640-650
• 5 Lee KF, Suh JH, Lee YE, Berry RG. Meningioma of the paranasal sinuses. Neuroradiology 1979; 17 (03) 165-171
• 6 Perzin KH, Pushparaj N. Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIII: meningiomas. Cancer 1984; 54 (09) 1860-1869
• 7 Umana GE, Scalia G, Vats A. et al. Primary extracranial meningiomas of the head and neck. Life (Basel) 2021; 11 (09) 942
• 8 Mattox A, Hughes B, Oleson J, Reardon D, McLendon R, Adamson C. Treatment recommendations for primary extradural meningiomas. Cancer 2011; 117 (01) 24-38
• 9 Louis DN, Perry A, Reifenberger G. et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016; 131 (06) 803-820
• 10 Apra C, Peyre M, Kalamarides M. Current treatment options for meningioma. Expert Rev Neurother 2018; 18 (03) 241-249
• 11 Rivera JP, Carnate JM. Sinonasal tract meningioma. Philippine J Otolaryngol Head Neck Surg 2017; 32 (02) 60-61
• 12 Aiyer RG, Prashanth V, Ambani K, Bhat VS, Soni GB. Primary extracranial meningioma of paranasal sinuses. Indian J Otolaryngol Head Neck Surg 2013; 65 (02, Suppl 2): 384-387
• 13 Sigdel K, Ding ZF, Xie HX. Case of primary extracranial meningioma of the maxillary sinus presenting as buccal swelling associated with headache: a case report. World J Clin Cases 2022; 10 (03) 1008-1015
• 14 Hu X, Jiang M, Feng Z, Wang J, Wang P, Cai J. Primary heterotopic meningioma of nasal cavity: case report and literature review. Ear Nose Throat J 2022; 101 (09) NP383-NP388
• 15 Neems L, Christopher C. Orbital recurrence of ethmoid sinus malignant meningioma: case study and literature review. Ophthal Plast Reconstr Surg 2017; 33 (02) e49-e51
• 16 Szczygielski K, Gałusza B, Cierniak S, Jurkiewicz D. Minimally invasive transnasal approach for primary ectopic meningioma of the paranasal sinuses. Wideochir Inne Tech Malo Inwazyjne 2015; 10 (03) 477-480
• 17 Mori R, Cavallo LM, Guadagno E, Imperato A, Murayama Y, Cappabianca P. Extracranial spheno-ethmoidal sinus meningioma: case report. Turk Neurosurg 2014; 24 (05) 788-792
• 18 Possanzini P, Pipolo C, Romagnoli S. et al. Primary extra-cranial meningioma of head and neck: clinical, histopathological and immunohistochemical study of three cases. Acta Otorhinolaryngol Ital 2012; 32 (05) 336-338
• 19 Abir M, Rihab L, Bellakhdhar M. et al. A rare case of primary sinonasal meningioma: a case report. Int J Surg Case Rep 2022; 99: 107620
• 20 Zhang YI, Teng WQ, Chen XP, Wu J. Ectopic meningioma in the bilateral nasal olfactory cleft: a case report and literature review. Oncol Lett 2015; 9 (04) 1743-1746
• 21 Nozaki S, Yamazaki M, Koyama T. et al. Primary extracranial meningioma of the maxillary sinus presenting as buccal swelling. Asian Journal of Oral and Maxillofacial Surgery 2011; 23 (03) 134-137
• 22 Hoye SJ, Hoar Jr CS, Murray JE. Extracranial meningioma presenting as a tumor of the neck. Am J Surg 1960; 100: 486-489
• 23 Lopez DA, Silvers DN, Helwig EB. Cutaneous meningiomas–a clinicopathologic study. Cancer 1974; 34 (03) 728-744
• 24 Gittleman HR, Ostrom QT, Rouse CD. et al. Trends in central nervous system tumor incidence relative to other common cancers in adults, adolescents, and children in the United States, 2000 to 2010. Cancer 2015; 121 (01) 102-112
• 25 Maggio I, Franceschi E, Tosoni A. et al. Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas. CNS Oncol 2021; 10 (02) CNS72
• 26 Doddamani RS, Meena RK, Sawarkar D. Ambiguity in the dural tail sign on MRI. Surg Neurol Int 2018; 9: 62
• 27 Lee DH, Sim HS, Hwang JH, Kim KS, Lee SY. Extracranial meningioma presenting as an eyebrow mass. J Craniofac Surg 2017; 28 (04) e305-e307
• 28 Liu Y, Wang H, Shao H, Wang C. Primary extradural meningiomas in head: a report of 19 cases and review of literature. Int J Clin Exp Pathol 2015; 8 (05) 5624-5632
• 29 Mnejja M, Hammami B, Bougacha L. et al. Primary sinonasal meningioma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129 (01) 47-50
• 30 Bamanikar S, Ranjan S, Kumar H, Gore C, Kambale T. An atypical meningioma presenting at an unusual site. J Clin Diagn Res 2020; 14 (09) ED04-ED06
• 31 Maharjan L, Neupane Y, Pradhan B. Primary atypical meningioma of the nasal cavity: a case report and review of the literature. Case Rep Otolaryngol 2018; 2018: 7541892
• 32 Baek BJ, Shin JM, Lee CK, Lee JH, Lee KH. Atypical primary meningioma in the nasal septum with malignant transformation and distant metastasis. BMC Cancer 2012; 12: 275
• 33 Haber DM, Maniglia MP, Schiavetto RR, Molina FD, Maniglia JV. Primary meningioma of the paranasal sinuses: case report. Int Arch Otolaryngol 2007; 11: 1-10
• 34 Taxy JB. Meningioma of the paranasal sinuses. A report of two cases. Am J Surg Pathol 1990; 14 (01) 82-86
• 35 Ostrom QT, Gittleman H, Liao P. et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro-oncol 2017; 19 (Suppl. 05) v1-v88
• 36 Zhao L, Zhao W, Hou Y. et al. An overview of managements in meningiomas. Front Oncol 2020; 10: 1523
• 37 Rogers L, Barani I, Chamberlain M. et al. Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 2015; 122 (01) 4-23
• 38 Pinzi V, Biagioli E, Roberto A. et al. Radiosurgery for intracranial meningiomas: a systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 113: 122-134
• 39 Marchetti M, Sahgal A, De Salles AAF. et al. Stereotactic radiosurgery for intracranial noncavernous sinus benign meningioma: International Stereotactic Radiosurgery Society systematic review, meta-analysis and practice guideline. Neurosurgery 2020; 87 (05) 879-890
• 40 Ruge MI, Tutunji J, Rueß D. et al. Stereotactic radiosurgery for treating meningiomas eligible for complete resection. Radiat Oncol 2021; 16 (01) 22
• 41 Chen WC, Lucas CG, Magill ST, Rogers CL, Raleigh DR. Radiotherapy and radiosurgery for meningiomas. Neurooncol Adv 2023; 5 (Suppl. 01) i67-i83
• 42 Goldbrunner R, Minniti G, Preusser M. et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 2016; 17 (09) e383-e391
• 43 Sadar ES, Conomy JP, Benjamin SP, Levine HL. Meningiomas of the paranasal sinuses, benign and malignant. Neurosurgery 1979; 4 (03) 227-232
• 44 Bakshi J, Ahmed S, Chakraborty M. Meningiomas in the nose & paranasal sinuses. Indian J Otolaryngol 1979; 31 (03) 83-85
• 45 Khandekar S, Dive A, Mishra R, Upadhyaya N. Sinonasal inverted papilloma: a case report and mini review of histopathological features. J Oral Maxillofac Pathol 2015; 19 (03) 405
• 46 Lawson W, Le Benger J, Som P, Bernard PJ, Biller HF. Inverted papilloma: an analysis of 87 cases. Laryngoscope 1989; 99 (11) 1117-1124