Microsurgical removal of a petrous apex meningioma after stereotactic radiation: Technical case report

OBJECTIVE AND IMPORTANCE: Stereotactic radiation is increasingly advocated as a primary treatment option for benign cranial base lesions. The clinical course of the patient reported herein raises questions regarding the ratio nale for initiation of radiotherapy to a petrous apex meningioma before mic rosurgery. CLINICAL PRESENTATION: We report a 50-year-old woman who experienced medica lly refractory trigeminal pain. She was diagnosed with a meningioma around the petrous apex and treated by fractionated stereotactic radiation. After a short period of alleviation accompanied by hypesthesia, the pain returned in a previously unknown and violent fashion. INTERVENTION: Complete tumor removal through a retrosigmoid intradural supr ameatal approach resulted in immediate and permanent pain cessation. CONCLUSION: Radiotherapy should be withheld for benign and accessible tumor s of the cranial base until the option of radical microsurgical treatment h as been explored.