Meningioma transformation to glioblastoma following stereotactic radiosurgery: A case report and review of the literature

Andre Everett Boyke; Michelot Michel; Catherine Michelle Garcia; Serguei I Bannykh; Julie Lynn Chan; Keith L Black

doi:10.25259/SNI_599_2023

Meningioma transformation to glioblastoma following stereotactic radiosurgery: A case report and review of the literature

Surg Neurol Int. 2023 Oct 13:14:364. doi: 10.25259/SNI_599_2023. eCollection 2023.

Authors

Andre Everett Boyke¹, Michelot Michel^{1

2}, Catherine Michelle Garcia¹, Serguei I Bannykh³, Julie Lynn Chan¹, Keith L Black¹

Affiliations

¹ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, United States.
² Department of Neurosurgery, University of Florida College of Medicine, Gainesville, United States.
³ Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, United States.

Abstract

Background: Meningiomas are the most common primary intracranial tumor with increasing incidence. Stereotactic Radiosurgery Gamma Knife (SRS-GK) is a commonly used modality for neoadjuvant and adjuvant treatment of these tumors and is often necessary for long-term disease control, particularly for the World Health Organization grade II/III meningiomas. While there is strong evidence to support the use of SRS-GK for meningioma, there exists a risk of secondary malignancy that is not well understood. We report a case of glioblastoma (GBM) that arose near the bed of a meningioma previously treated with SRS-GK and discuss other cases of GBM that emerged at a site of meningioma reported in the literature.

Case description: A 79-year-old female with a history of a blood-clotting disorder presented to the hospital with sudden facial sensory disturbances. On magnetic resonance imaging (MRI), a homogeneously enhancing lesion was observed in the right temporal lobe, consistent with a meningioma. Following 2 years of surveillance, the patient underwent SRS-GK for enlargement of the lesion. The patient later presented with headache and gait instability 12 years following SRS-GK. MRI revealed a large ring-enhancing lesion with surrounding edema histologically confirmed to be a GBM. At 9 months following initial tumor resection and a combination of radiotherapy and temozolomide, the patient was neurologically intact.

Conclusion: There is a very small risk of meningioma to GBM conversion following SRS. Although SRS-GK poses a risk of secondary malignancy, there are some reported cases that underwent malignant transformation without SRS-GK. This suggests that SRS-GK is not the only factor in transformation and is a reasonable therapeutic modality to consider utilizing. Patients and their families should be appropriately counseled on the potential risks of radiation therapy, even for benign lesions like a meningioma.

Keywords: Gamma knife; Glioblastoma multiforme; Malignant complication; Meningioma; Stereotactic radiosurgery.

Publication types

Case Reports