Dural tail sign
Citation, DOI and article data
Initially, the sign was felt to be pathognomonic of meningiomas, however as radiologist's experience grew, it has become increasingly noted to be present in many other conditions, although without the same regularity:
- meningioma (by far the most common, seen in 52-78% of cases) 4,8
- pleomorphic xanthoastrocytoma
- dural plasmacytoma
- primary CNS lymphoma
- vestibular schwannoma
- cerebral metastases
- syphilitic gumma
- desmoplastic infantile astrocytoma and ganglioglioma
- pituitary adenoma
- multiple myeloma 9
- solitary fibrous tumor of the dura 9
A useful mnemonic can be found here.
Initially, the dural tail was thought to result from direct invasion of the dura by the tumor, however, subsequent studies demonstrated it to be predominantly a reactive process due to vascular congestion and edema. Having said that, the literature is still divided and a wide range of prevalence of tumor 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 tumor cells in apparently normal dura adjacent to tumors 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 meningiomas 5.
- 1. Wallace EW. The dural tail sign. Radiology. 2004;233 (1): 56-7. doi:10.1148/radiol.2331021332 - Pubmed citation
- 2. Bourekas EC, Wildenhain P, Lewin JS et-al. The dural tail sign revisited. AJNR Am J Neuroradiol. 1995;16 (7): 1514-6. AJNR Am J Neuroradiol (citation) - Pubmed citation
- 3. Detwiler PW, Henn JS, Porter RW et-al. Medulloblastoma presenting with tentorial "dural-tail" sign: is the "dural-tail" sign specific for meningioma? Skull Base Surg. 1998;8 (4): 233-6. Free text at pubmed - Pubmed citation
- 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. doi:10.1007/s00701-014-2216-4 - Pubmed citation
- 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. Pubmed citation
- 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. doi:10.1016/j.wneu.2014.07.002 - Pubmed citation
- 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. doi:10.4103/2152-7806.140192 - Free text at pubmed - Pubmed citation
- 8. Sotoudeh H, Yazdi HR. A review on dural tail sign. (2010) World journal of radiology. 2 (5): 188-92. doi:10.4329/wjr.v2.i5.188 - Pubmed
- 9. Sotoudeh H & Yazdi H. A Review on Dural Tail Sign. World J Radiol. 2010;2(5):188-92. doi:10.4329/wjr.v2.i5.188 - Pubmed