Unresectable Foramen Magnum Meningioma Treated With CyberKnife Robotic Stereotactic Radiosurgery

Abstract

Meningiomas are tumors that originate from the meningeal or dural cover of the brain and are the most common primary benign brain tumors. Currently, the accepted management of these tumors is attempted total surgical excision when technically possible and associated with an acceptable risk. However, radiation therapy has been shown to provide excellent local control when used either as an adjunct to surgery or as a primary treatment. We present a case report of a 46-year-old female patient with an unresectable left foramen magnum meningioma resulting in headaches, neck pain, and swallowing difficulty. The patient underwent CyberKnife (Accuray Incorporated, Sunnyvale, CA) radiosurgery to a dose of 3,000 cGy in five fractions in March 2011. The patient tolerated treatment without complications and has remained clinically well with no ongoing cranial nerve deficits as of the last examination in late 2019. This demonstrates the excellent local control obtained when using radiosurgery as both a surgical adjunct and a primary treatment for meningiomas.

The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas—A Multicenter Analysis and Review of the Literature

“…Four studies (33%) did not exclusively report on the treatment of FMMs. Only two other studies with a total of eight FMMs described outcomes after RRS, with most reports (83%) utilizing GK-based SRS [ 10 , 11 ]. Overall, approximately 100 unique FMM treatments with SRS have been reported to date.…”

Foramen magnum meningioma with excessive calcification and no dura tail sign

“…[ 2 , 5 , 15 – 17 ] Surgical resection is advocated to alleviate neurological symptomatology and gross total resection is often beneficial. [ 4 , 6 , 15 ] The classic approach to FMMs is the suboccipital craniotomy, or craniectomy, with or without cervical laminectomy. [ 2 , 17 ] We used the suboccipital approach to assess the tumor and completely resected it.…”

“…[ 19 , 20 ] On the other hand, radiation therapy has proven to be effective in controlling local lesions when used either as an adjunct to surgery or as a primary therapy. [ 6 ] Several radiosurgery sequences have exhibited local control rates of 92% to 100% at 5 years as well as 88% to 95% at 10 years. [ 6 , 7 , 21 ]…”

“…[ 6 ] Several radiosurgery sequences have exhibited local control rates of 92% to 100% at 5 years as well as 88% to 95% at 10 years. [ 6 , 7 , 21 ]…”

“…[ 1 , 2 , 5 ] Nevertheless, radiation therapy as an adjunct to surgery or as a primary treatment with radiosurgery has shown promising results in local control of the lesions. [ 6 , 7 ] We present a rare case of FMM with excessive calcification and without the dura tail sign which made the lesion mimic a teratoma.…”