MANAGEMENT OF INTRACRANIAL PLASMACYTOMA

The authors report on a study of eight cases of intracranial plasmacyt oma to identify the risk of progression to multiple myeloma and sugges t the treatment required for cure of solitary lesions. The diagnosis o f multiple myeloma or myelomatous changes was made in the immediate po stoperative period in four patients (50%), two of whom had skull base lesions. Of the four remaining patients, three were treated with compl ete surgical resection and radiation therapy and had no recurrence of plasmacytoma or progression to multiple myeloma during mean follow up of 12 years (range 2-25 years); one patient underwent subtotal surgica l resection and had recurrence of the tumor despite radiation therapy. It is concluded that multiple myeloma is unlikely to develop during t he long term in patients with intracranial plasmacytoma who do not dev elop multiple myeloma or myelomatous changes in the early postoperativ e period. However, lesions that infiltrate the skull base are not like ly to be solitary, and patients who harbor these neoplasms should unde rgo complete evaluation and close follow-up review to exclude multiple myeloma. A recurrence of solitary intracranial plasmacytoma is possib le with subtotal surgical resection despite radiation therapy. Definit ive treatment should consist of complete surgical resection with adjuv ant radiation therapy.