Complications after gamma knife radsurgery for a parafalcine meningioma

Case contributed by Dr Bruno Di Muzio

Presentation

Known parafalcine meningiomas followed for around 10 years.

Patient Data

Age: 80-year-old
Gender: Female

There is a calcified extraaxial mass measuring 1.6 cm adjacent to the falx at the midline. There is a further extraaxial isodense mass measuring 1.4 cm adjacent to the anterior falx projecting towards the right. No mass effect.

Further mild increase in size of the right anterior parafalcine meningioma, protruding through falx to the left. The more posterior right parafalcine meningioma with protrusion to the left is very similar compared to most recent study and only mildly progressed from the earlier study. Both of these minimally distort the overlying gyri without significant mass-effect or evidence of parenchymal oedema. Stable mild small vessel ischaemic changes.

The patient was been followed in a different institution. A gamma knife treatment was proposed for the most anterior meningioma, probably due progressive increase and symptoms. He came to our emergency department after strong headaches and a first seizure episode.

The right anterior para falcine tumour now demonstrates increased dimensions, heterogeneous high T2 signal and enhancement, and an extensive right frontal lobe vasogenic oedema. There is also an incomplete peritumoral rim of enhancement. 

Conventional surgical approach was proposed and performed aiming to remove the necrotizing tumour.

A right frontal craniotomy has been performed, with a resection cavity in the medial right frontal lobe containing a mixture of fluid, gas and a small volume of acute blood. Vasogenic oedema is seen in the white matter of the right frontal lobe, extending into the corona radiata and centrum semiovale, stable compared to previous. There is associated mass effect, with mild compression of the frontal horn of the right lateral ventricle and effacement of the right cerebral convexity sulci. There is no hydrocephalus or midline shift. No acute cortical infarct. Mild periventricular white matter hypodensity in keeping with chronic small vessel ischaemia. No appreciable change in the right parietal parasagittal meningioma.​

Case Discussion

Meningiomas are benign encapsulated tumours that, depending on the region and extension, are suitable for radiosurgery treatment (e.g. Gamma-knife). Peritumourous imaging complications has been reported in around 23% of the cases 1.

Peritumoral oedema is known as the most common complication after treatment, as happened in this case. 

 

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Case information

rID: 42517
Case created: 24th Jan 2016
Last edited: 13th Mar 2016
Tag: rmh
Inclusion in quiz mode: Included

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