PMC8554081_01
Changes of the pre- and post-operative meningioma. Before (A) and after (B) the first surgery, 2008-06; Before (C) and after (D) the second surgery, 2009-01; Before (E) and after (F) the third surgery, 2016-05; Before (G) and after (H) the fourth surgery, 2019-09. The red arrow points to the tumor.
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May 2008, she had decreased hearing in the left ear, abnormal secretion in the left nasal cavity and a water-flow sensation in the laryngopharyngeal wall. Magnetic resonance imaging (MRI) showed a space-occupying lesion between the left cavernous sinus and the left pterygopalatine fossa (Figure 1A). In June 2008, she underwent meningioma resection in orbitozygomatic-infratemporal approach (Figure 1B). In January 2009, MRI revealed a residual tumor (Figure 1C), thus the tumor resection in the left nasopharyngeal wall was performed (Figure 1D). One month later, MRI showed a recurrent tumor involving cavernous sinus in the left cerebellopontine angle area (Figure 1E). In May 2016, partial excision of meningioma in the left skull base was conducted (Figure 1F). One month later, MRI indicated a recurrent tumor with distant diffusion (Figure 1G). In September 2019, cranio-orbital resection of space-occupying lesions based on the right fronto-orbital-zygomatic initial incision was performed under general anesthesia (Figure 1H).
Changes of meningioma at different shooting angles of MRI. (A, B) Meningioma recurred on 2020-07-23; (C, D) The lesions in the left cerebellopontine angle area enlarged on 2020-10-28; (E, F) The residual lesions lessened on 2020-12-24; (G, H) The residual lesions continuously reduced on 2021-06-09. The red arrow points to the tumor.
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MRI showed an abnormal enhancement ratio in the relative left brainstem and an enhanced lesion under the cerebellar tentorium, suggesting tumor recurrence and distant diffusion (Figures 2A, B). Two months after chemoradiotherapy, the lesion in the left cerebellopontine angle area enlarged (Figures 2C, D), which might be associated with response to radiotherapy in a short term. Then, sunitinib (50 mg/d) was orally administrated in combination with temozolomide chemotherapy, the residual lesions lessened after use of 2 months (Figures 2E, F). To date of June 9, 2021, MRI showed continued partial remission of residual lesions (Figures 2G, H).
The treatment timeline of the patient with multiple recurrent meningiomas.
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The treatment timeline of the patient is depicted in Figure 3.