Rocchetti Jenna R, Haldar Nilanjan, Haldar Debanjan, Andrews David W, Werner-Wasik Maria
Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, USA.
Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, USA.
Cureus. 2025 Aug 6;17(8):e89466. doi: 10.7759/cureus.89466. eCollection 2025 Aug.
While World Health Organization (WHO) grade I meningiomas are typically slow growing and associated with favorable prognoses, a subset may exhibit unexpectedly aggressive behavior and resistance to conventional treatment approaches. Recurrent grade I meningiomas, in particular, are associated with a poorer prognosis despite their benign histological classification, underscoring the need for advanced genomic and radiomic analyses to refine diagnostic accuracy. We present a case of a 52-year-old female with a grade I parafalcine meningioma initially deemed nonaggressive, but ultimately recurred multiple times over several years despite undergoing repeated craniotomies and several courses of radiosurgery. Notable tumor characteristics included its supratentorial location, high Ki-67 proliferative index, and NF-2 genetic alteration, which are all factors associated with decreased progression-free survival in grade I meningioma patients. The patient remains clinically stable eight months post salvage stereotactic radiation therapy (SRT). This case highlights the intricate surgical and radiotherapeutic decisions involved in managing recurrent grade I meningiomas, reinforcing the importance of multidisciplinary evaluation and individualized treatment strategies.
虽然世界卫生组织（WHO）一级脑膜瘤通常生长缓慢且预后良好，但有一部分可能表现出意想不到的侵袭性，并对传统治疗方法产生耐药性。特别是复发性一级脑膜瘤，尽管其组织学分类为良性，但其预后较差，这凸显了进行先进的基因组和放射组学分析以提高诊断准确性的必要性。我们报告一例52岁女性，患有一级大脑镰旁脑膜瘤，最初被认为无侵袭性，但尽管多次接受开颅手术和多个疗程的放射外科治疗，最终在几年内多次复发。显著的肿瘤特征包括其幕上位置、高Ki-67增殖指数和NF-2基因改变，这些都是与一级脑膜瘤患者无进展生存期缩短相关的因素。患者在挽救性立体定向放射治疗（SRT）后八个月临床保持稳定。该病例突出了处理复发性一级脑膜瘤所涉及的复杂手术和放射治疗决策，强化了多学科评估和个体化治疗策略的重要性。
