Dural tail sign

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The dural tail sign occurs as a result of thickening ofand enhancement of the dura and~~, in~~ is most often seen adjacent to a meningioma. Initially the ~~majority of cases, is associated with~~ ~~meningioma~~ ~~formation. It~~sign was ~~initially thought to result from direct invasion of the dura, however subsequent studies demonstrated it~~felt to be ~~more a reactive process. As~~pathognomonic of meningiomas, however as experience grew, it ~~became~~has become increasingly noted to be present in many other conditions, although without the same regularity.

meningioma: ~~~65~~(by far the most common, seen in 52-78% ~~(range 60-72%~~of cases ⁴) ~~have a tail~~
pleomorphic xanthoastrocytoma (PXA)

~~It has also been reported with:~~

glioblastoma

chloroma
dural plasmacytoma
primary CNS lymphoma
sarcoidosis
vestibular schwannoma
~~metastatic tumours~~cerebral metastases
syphilitic gumma
medulloblastoma
desmoplastic infantile ganglioglioma

Pathology

Initially the dural tail was thought to result from direct invasion of the dura by the tumour however subsequent studies demonstrated it to be predominantly a reactive process due to vascular congestion and oedema. Having said that, the literature is still divided and a wide range of prevalence of tumour invasion of the dural tail has been reported (0-100%), with generally higher prevalences in WHO II (atypical) meningiomas ^4,5. This is further complicated by the presence of tumour cells in apparently normal dura adjacent to tumours ⁵.

Treatment and prognosis

Whether or not the dural tail should be resected and if so how much surrounding dura should be included in the resection (or gamma knife field) continues to be debated ^4,5,7.

History and etymology

It was first described in 1989 by Wilms et al as thickening of the dura surrounding meningiomas⁵.

-The dural tail sign occurs as a result of thickening of the <a href="/articles/dura-mater">dura</a> and, in the majority of cases, is associated with <a href="/articles/meningioma">meningioma </a>formation. It was initially thought to result from direct invasion of the dura, however subsequent studies demonstrated it to be more a reactive process. As experience grew, it became increasingly noted to be present in other conditions, although without the same regularity.<ul>
+The dural tail sign occurs as a result of thickening and enhancement of the <a href="/articles/dura-mater">dura</a> and is most often seen adjacent to a <a href="/articles/meningioma">meningioma</a>. Initially the sign was felt to be pathognomonic of meningiomas, however as experience grew, it has become increasingly noted to be present in many other conditions, although without the same regularity.<ul>
~~-<a href="/articles/meningioma">meningioma</a>: ~65% (range 60-72%) have a tail</li>~~
+<a href="/articles/meningioma">meningioma</a> (by far the most common, seen in 52-78% of cases 4)</li>
~~-</ul>It has also been reported with:<ul>~~
+<li><a href="/articles/glioblastoma">glioblastoma</a></li>
~~-<li>metastatic tumours</li>~~
+<li><a href="/articles/cerebral-metastases">cerebral metastases </a></li>
~~-</ul><h4>History and etymology</h4>It was first described in 1989 by Wilms et al as thickening of the dura surrounding meningiomas.~~
+</ul><h4>Pathology</h4>Initially the dural tail was thought to result from direct invasion of the dura by the tumour however subsequent studies demonstrated it to be predominantly a reactive process due to vascular congestion and oedema. Having said that, the literature is still divided and a wide range of prevalence of tumour invasion of the dural tail has been reported (0-100%), with generally higher prevalences in WHO II (atypical) meningiomas 4,5. This is further complicated by the presence of tumour cells in apparently normal dura adjacent to tumours 5. <h4>Treatment and prognosis</h4>Whether or not the dural tail should be resected and if so how much surrounding dura should be included in the resection (or gamma knife field) continues to be debated 4,5,7. <h4>History and etymology</h4>It was first described in 1989 by Wilms et al as thickening of the dura surrounding meningiomas 5.

References changed:

4. Wen M, Jung S, Moon KS et-al. Immunohistochemical profile of the dural tail in intracranial meningiomas. Acta Neurochir (Wien). 2014;156 (12): 2263-73. <a href="http://dx.doi.org/10.1007/s00701-014-2216-4">doi:10.1007/s00701-014-2216-4</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/25238986">Pubmed citation</a>
5. Wilms G, Lammens M, Marchal G et-al. Thickening of dura surrounding meningiomas: MR features. J Comput Assist Tomogr. 1989;13 (5): 763-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2778133">Pubmed citation</a>
6. Slot KM, Verbaan D, Uitdehaag BM et-al. Can excision of meningiomas be limited to resection of tumor and radiologically abnormal dura mater? Neuronavigation-guided biopsies of dural tail and seemingly normal dura mater, with a review of the literature. World Neurosurg. 2014;82 (6): e832-6. <a href="http://dx.doi.org/10.1016/j.wneu.2014.07.002">doi:10.1016/j.wneu.2014.07.002</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/25009164">Pubmed citation</a>
7. Bulthuis VJ, Hanssens PE, Lie ST et-al. Gamma Knife radiosurgery for intracranial meningiomas: Do we need to treat the dural tail? A single-center retrospective analysis and an overview of the literature. Surg Neurol Int. 2014;5 (9): S391-5. <a href="http://dx.doi.org/10.4103/2152-7806.140192">doi:10.4103/2152-7806.140192</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173303">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/25289168">Pubmed citation</a>

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