Placement of cesium-131 permanent brachytherapy seeds using the endoscopic endonasal approach for recurrent anaplastic skull base meningioma: case report and technical note

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  • 1 Department of Neurosurgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey; and
  • 2 Stich Radiation Oncology and
  • 3 Departments of Neurosurgery,
  • 4 Otorhinolaryngology, and
  • 5 Neurology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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There are few therapeutic options available for the treatment of recurrent meningiomas that have failed treatment with surgery and external-beam radiation therapy (EBRT). As additional EBRT is clinically risky, brachytherapy offers an important alternative for optimizing local control. In skull base meningiomas, the endoscopic endonasal approach (EEA) has demonstrated an excellent extent of resection. However, in the case of recurrent, atypical, or residual meningiomas, the EEA alone may not be adequate to address microscopic, residual, highly proliferative disease. In this situation, local radioactive seed brachytherapy has been shown to improve control, but few reports of this technique exist. A 48-year-old right-handed man presented on multiple occasions with recurrence of an anaplastic skull base meningioma, after multiple prior gross-total resections and multiple rounds of radiotherapy had failed. The authors performed a maximally safe neurosurgical tumor resection via EEA supplemented by the intraoperative implantation of 131Cs low-dose permanent brachytherapy seeds. They describe a technique for permanent implantation of brachytherapy seeds and provide operative video of this technique. The authors submit that utilizing this technique in combination with EEA tumor resection renders a minimally invasive approach to improving local control in a patient with a recurrent anaplastic or atypical meningioma of the skull base.

ABBREVIATIONS EBRT = external-beam radiation therapy; EEA = endoscopic endonasal approach; GTR = gross-total resection.

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Contributor Notes

Correspondence Theodore H. Schwartz: Weill Medical College of Cornell University, New York, NY. schwarh@med.cornell.edu.

INCLUDE WHEN CITING Published online March 1, 2019; DOI: 10.3171/2018.11.JNS181943.

A.R.S. and A.G.W. share first authorship of this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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