Case description

The patient is a 58-year-old female who, 20 years prior to presentation, underwent surgical resection of a transitional meningioma of the right petrous bone extending into the sigmoid sinus and tentorium. An asymptomatic, small, left lesser sphenoid wing meningioma was also detected at that time. The patient was lost to follow-up until December 2018. She then underwent brain magnetic resonance imaging (MRI), which showed growth of both the residual tumor invading the sigmoid sinus and the middle cranial fossa meningioma ( Figure 7.32.1 ). Her only symptom was tinnitus in the right ear with normal hearing. She underwent multisession CyberKnife stereotactic radiosurgery (SRS) for both meningiomas over 2 consecutive weeks ( Figure 7.32.2 ).

Preoperative postcontrast T1-weighted image showing the remnant tumor invading the right sigmoid sinus and crossing through the tentorium as well as the left lesser sphenoid wing tumor, abutting the cavernous sinus and extending to the middle cranial fossa.

Imaging of the treatment plan.

Critical Structure	Dose Tolerance
Sigmoid sinus	25–27 Gy in 5 fractions (internal guideline)
VIII cranial nerve	25 Gy in 5 fractions (internal guideline)

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