Single meningiomas are histologically classified as benign tumors, but clearly malignant types have been encountered. The standard mode of management is total macroscopic removal with excision of the dural attachment and abnormal bone, if there is any. Despite this aggressive surgery, recurrence rates of approximately 9% have been reported with the removal of benign tumors, and the rate is much higher with the removal of malignant meningiomas. Recurrence most frequently occurs at the original tumor site and is most often explained by incomplete removal, which, in turn, is a function of the anatomic location of the tumor. Less common are regional recurrences, which may be explained on the basis of the multicentric origin of meningiomas. This theory may also explain the rare entity, "multiple meningioma." This article documents an unexpected regional recurrence of meningioma. The pertinent literature is reviewed.
Cancer 619447-1452, 1988.
INGLE MENINGIOMAS are generally regarded as be-S nign tumors that can be easily excised. It has been
shown that the probability of recurrence correlates with the grade of operation-the more radical the surgery, the less the chance of recurrence.'X2 The adequacy of surgery is largely a function of the anatomic location of the tumor. The role of postoperative radiation therapy is controversial, but it has been recommended in instances of incomplete excision or malignant h i ~t o l o g y . ~, ~ Even when therapy is believed to be adequate, there may be recurrences within the original tumor bed, or less frequently, independent of the attachment surface of the primary meningioma. We report an unexpected regional recurrence after total resection and local radiotherapy.
Case Report
A man 62 years of age presented in August 1984 with a 2-month history of confusion and a decrease in memory. A funduscopic examination disclosed flat disks, but no venous pulsations were seen. Eye rotations were full. The results of the rest of the clinical examination were normal except for the suggestion of Babinski's reflex on the left. Cranial computed tomography (CCT) revealed a mass involving the right parietal-occipital region (Fig. ).