Radioguided improved resection of a cranial base meningioma

In meningioma surgery, the completeness of resection is of great importance with regard to prognosis and recurrence. This is more difficult in meningiomas en plaque and cranial base meningiomas, which often involve the bone of the cranial base. We present a case in which radioguided resection of a meningioma using indium-labeled somatostatin receptors enhanced the extent of the resection and describe how this could be of potential use in maximizing resection of meningiomas involving the cranial base region.

A 45-year-old woman presented with a history of headache and no neurological deficits. Magnetic resonance imaging of the brain revealed a large enhancing extra-axial mass involving the left sphenoid wing region, suggestive of a meningioma. A somatostatin analog scintigram using In-labeled pentetreotide was obtained 24 hours preoperatively. This showed abnormal uptake in the left frontal region, consistent with a meningioma, because of the abundance and high affinity of somatostatin receptors in meningiomas. Intraoperatively, a radiation detection probe guided the resection until no gamma radiation could be discerned.

A postoperative magnetic resonance imaging scan and scintigram showed complete resection of the meningioma.

Radioguided surgery of meningiomas by labeling them with In is an innovative and feasible approach to help guide and maximize meningioma resection, especially those involving the cranial base region. This technique should be used further and studied to achieve better resection of meningiomas in general and of those involving the cranial base in particular.