Multiple Meningiomas (MM) in the brain is a rare condition in which two or more meningiomas are present intracranially separated from each other. The incidence ranges from 1 to 10%. The treatment of MM includes Surgery, Sterotactic Radiosurgery (SRS) and fractionated External Beam Radiotherapy (EBRT). We report a 33 years old male who was evaluated for headache and was diagnosed with Supratentorial Meningiomas in 2008 for which he underwent Surgery at Coimbatore. Histopathological examination (HPE) was suggestive of Meningothelial Mengioma Grade I. He developed recurrence in 2017 and was managed conservatively. He underwent re surgery for the recurrence at Trivandrum in 2022. HPE was consistent with Atypical Meningioma WHO Grade II in left temporal/frontal region, left occipital and left parietal region. Transitional Meningioma WHO Grade I intraventricular region. He didn’t receive any adjuvant treatment.
He was evaluated for blurring of vision in February 2024 and MRI Brain showed multiple recurrent lesions. He again underwent surgery at Trivandrum. Postoperative HPE was suggestive of Atypical Meningioma WHO Grade II. Postop MRI showed multiple residual lesions. He came to Kauvery Hospital, Alwarpet for further management.
On examination, the patient was hemodynamically stable. He had no neurological deficits. After discussing in the Tumour Board it was decided to treat all the lesions. He was taken up for Radiotherapy Planning. He underwent a brain aquaplast for immobilization and contrast CT scan. We fused the planning CT with the MRI and delineated all the lesions with the help of our Radiologists. He received a total dose of 54Gy in 30 fractions using Rapid Arc technique respecting the constraints for all the other normal structures in the brain.
The treatment delivery was monitored using both online and offline imaging. He completed the treatment without any morbidity. Follow up MRI at 3 months and 1year shows overall good response to the treatment with post Radiotherapy changes.
Timely intervention, meticulous planning, use of higher end technology and team effort made the treatment successful. The patient is cured of his disease. Below are the pictures of MRI with delineation of lesions. Next is the CT with MRI fusion showing radiotherapy dose distribution and the last images are follow up MRI with post Radiotherapy changes
Figures A,B,C & D show MRI with delineation of lesions
Figure E shows CT with MRI Fusion
Figures F,J, I & K show Radiotherapy dose distribution
Figures L, M show follow up MRI with regression of the lesions with postradiotherapy changes
Dr. A.N. Ashwin Senior Consultant Radiation Oncologist Kauvery Hospital Chennai
