Radiation-induced meningiomas: experience at the Mount Sinai Hospital and review of the literature

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✓ From the records of The Mount Sinai Hospital, seven cases which met established criteria for radiation-induced meningiomas were identified. This represents the largest series of radiogenic meningiomas documented in North America and includes both intracranial and intraspinal tumors. The records and pathological specimens were reviewed and these data analyzed with other cases retrieved from the world literature. This study reveals that radiation-induced meningiomas can be categorized into three groups based on the amount of radiation administered: 1) low dose; 2) moderate dose and miscellaneous; and 3) high dose. The overwhelming majority of cases had received low-dose irradiation (800 rad) to the scalp for tinea capitis and the second largest group resulted from high-dose irradiation for primary brain tumors (> 2000 rad).

The unique features distinguishing radiation-induced meningiomas from other meningiomas are reviewed. Although histologically atypical tumors were common in this series, overt malignancy was not encountered. The preoperative management of these lesions should include angiography to evaluate for large-vessel occlusive vasculopathy, a known association of meningiomas induced by high-dose irradiation. Given the propensity these tumors possess for recurrence, a wide bony and dural margin is recommended at surgical resection.

Article Information

Address reprint requests to: Michael J, Harrison, M.D., Department of Neurosurgery, The Mount Sinai Hospital, One Gustave L. Levy Place, New York, New York 10029.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 5. Left: Photograph of a patient in whom a radiogenic meningioma was diagnosed 32 years subsequent to the resection of a low-grade astrocytoma and administration of 4000 rad of radiation. Alopecia and atrophia of the scalp were present bilaterally (curved arrow). At surgery, meningioma was found invading the temporalis muscle beneath the alopecia. Right: Axial computerized tomography scan with contrast enhancement demonstrating extracranial tumor invasion into the soft tissue (arrow).

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    Photomicrographs of two different atypical meningiomas: both patients had received low-dose irradiation for tinea capitis. Left: Case 1. Extracranial muscle invasion: pleomorphic tumor is seen engulfing two separate muscle cells (arrows). H & E, × 123. Right: Case 3. Atypical meningioma with mitotic figures (curved arrow) and prominent nucleoli (straight arrow). An area of necrosis which was present is not visualized in this section. H & E, × 490.

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    Case 5. Upper: Vertebral angiograms, anteroposterior (upper left) and lateral (upper right) views, from the patient depicted in Fig. 1. Bilateral occlusion of the posterior cerebral arteries (arrows) is seen. Prior to irradiation, a normal angiogram was documented. Lower: External carotid artery angiogram, subtracted film from a lateral view, revealing tumor blush but no transdural collateral vessels.

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    Case 7. Left: Magnetic resonance T1-weighted image, coronal section, of a patient who had received 5000 rad following resection of a right parietal astrocytoma as a child. Tumor impingement on the superior sagittal sinus is evident (curved arrow). The skull deformity seen in the region of the tumor was residual from the initial surgery. Center and Right: Internal carotid artery angiograms, subtracted films from the venous phase. Early film (center) revealed that the anterior part of the superior sagittal sinus (open arrow) was normal but further posteriorly (large arrow) it was occluded. The tumor is visible due to its mass effect on the cortical venous structures (small arrows). Later films (right) revealed that the sinus was patent and should not be sacrificed at surgery. The clips were placed at the initial surgery.

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    Case 3, a patient who had received low-dose irradiation to the scalp for tinea capitis in childhood. Bone windows from axial (left) and coronal (right) computerized tomography scans demonstrate tumor recurrences in the bone margins surrounding a cranioplasty on two separate occasions. The cranioplasty is indicated by the solid arrowheads (left) and the curved arrow (right). The open arrowhead (left) and the small arrows (right) indicate the mottled bone where tumor has recurred.

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