Turkish Neurosurgery 2020 , Vol 30 , Num 3
Radiation-Induced Meningiomas: A Series of Four Consecutive Patients and a Review of Literature
1Bezmialem Vakif University, Department of Neurosurgery, Istanbul, Turkey
2Bakirkoy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Department of Neurosurgery, Istanbul, Turkey
3Istanbul University, Faculty of Medicine, Department of Pathology, Istanbul, Turkey
4Bakirkoy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Department of Neurology-Intensive Care Unit, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.21197-17.2 AIM: To assess the clinical outcomes of treatment for radiation-induced meningiomas.

MATERIAL and METHODS: Medical records were retrospectively reviewed for all cranial meningioma cases that were diagnosed and/or underwent surgery at our hospital from 2009 to 2016. All radiation-associated meningioma patients constituted the core sample for this study.

RESULTS: This series included one female and three male patients, with a mean age of 47.3 ± 16.3 years. The mean preoperative course was <3 months. The most common symptom was headache (100%) and three patients had alopecia and thin scalp skin. The mean of the age at which they underwent radiotherapy was 18.5 ± 13.7 years. The mean latency period was 19.2 ± 7.4 years. Initial malignancies included two patients with desmoplastic medulloblastomas (13-year-old female, 65 Gy), (11-year-old male, 54 Gy) and a patient with grade II oligodendroglioma treated with 30 Gy. A male patient received low-dose radiotherapy for chronic otitis at 10 years old. Histopathological examinations revealed the following: 1) fibroblastic-grade I, Ki-67 2%–3%, 25.5 years latency; cerebellopontine angle, 2) atypical meningioma grade II, Ki-67 8%, 21 years, frontal; and 3) transitional grade I, Ki-67 3%–4%, 11 years, frontal. The fourth patient had three radiation-induced meningiomas and 27 radiation-induced cavernomas, and was treated using a gamma knife. The mean follow-up period was 34.8±39.4 months. One patient had rhinorrhea and another experienced a cerebrospinal fluid fistula. Both underwent an additional operation. The former died because of meningitis on postoperative day 31.

CONCLUSION: Most radiation-induced meningiomas are low-grade, but they have a high trend of recurrence. Close follow-up and yearly magnetic resonance imaging would minimize the morbidity rate. To reduce fatal complications, surgery should be planned in conjunction with plastic surgeons. Keywords : Desmoplastic medulloblastoma, Oligodendroglioma, Radiation-induced meningioma, Radiation-induced cavernoma, Radiotherapy

Corresponding author : Anas ABDALLAH, abdallahanas@hotmail.com