Microsurgical removal of a petrous apex meningioma after stereotactic radiation: technical case report
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M Samii1, S K Rosahl, M S Tatagiba
1Department of Neurosurgery, Nordstadt Hospital, Hannover, Germany.
Objective And Importance:
Stereotactic radiation is increasingly advocated as a primary treatment option for benign cranial base lesions. The clinical course of the patient reported herein raises questions regarding the rationale for initiation of radiotherapy to a petrous apex meningioma before microsurgery.
Clinical Presentation:
We report a 50-year-old woman who experienced medically refractory trigeminal pain. She was diagnosed with a meningioma around the petrous apex and treated by fractionated stereotactic radiation. After a short period of alleviation accompanied by hypesthesia, the pain returned in a previously unknown and violent fashion.
Intervention:
Complete tumor removal through a retrosigmoid intradural suprameatal approach resulted in immediate and permanent pain cessation.
Conclusion:
Radiotherapy should be withheld for benign and accessible tumors of the cranial base until the option of radical microsurgical treatment has been explored.