The dural tail sign occurs as a result of thickening and enhancement of the dura and is most often seen adjacent to a meningioma.
Initially, the sign was felt to be pathognomonic of meningiomas, however, 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
dural plasmacytoma
A useful mnemonic can be found here.
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Pathology
Initially, the dural tail was thought to result from direct invasion of the dura by the tumor, however, some subsequent studies demonstrated it to be predominantly a reactive process due to vascular congestion and edema. In contrast, other studies have shown the presence of tumor cells in apparently normal dura adjacent to meningiomas 5.
Keeping this in mind, the literature is 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 2 (atypical) meningiomas 4,5. The likelihood of finding tumor cells within a dural tail also depends on the distance from the tumor and the morphology with smooth tails being less likely to contain tumor than nodular ones 10.
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.
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