J Korean Neurosurg Soc.  2007 Jun;41(6):403-407.

Coexistence of Radiation-induced Meningiomas and Shunt Related Pneumocephalus in a Patient with Successfully Treated Medulloblastoma

• Kim YH
• Kim CY

Abstract

The authors encountered a case of simultaneous radiation-induced multiple meningiomas and ventriculoperitoneal (VP) shunt-related pneumocephalus. A 35-year-old man, who had undergone surgery for medulloblastoma 21 years previously and subsequently received high dose craniospinal irradiation with adjuvant chemotherapy and later underwent a VP shunt because of hydrocephalus, presented with a severe headache and weakness of both lower extremities. Computed tomography showed an air pocket lesion in the left temporal lobe and a large amount of pneumocephalus with a bony defect of the left tegmen tympani. In addition, a 3 cm sized well enhancing mass was noted in the in the right middle cranial fossa and additional small enhancing nodule in the left frontal pole. He was treated by left temporal craniotomy and repair of the bony and dural defects of the left tegmentum tympanum through extradural and intradural approaches, respectively. Afterwards, he underwent right temporal craniotomy and gross total removal of a rapidly growing right middle fossa mass and a left frontal mass. The histological examination was consistent with atypical meningioma, WHO grade II. In conclusion, physicians have to consider the serious long term complications of high dose radiation therapy and VP shunt placement and need to perform the neuroradiologic follow-up after such treatments for several decades.

Keyword

Medulloblastoma; Radiation induced; Meningioma; Ventriculoperitoneal shunt; Pneumocephalus; Tegmen tympani

MeSH Terms

Adult
Chemotherapy, Adjuvant
Cranial Fossa, Middle
Craniospinal Irradiation
Craniotomy
Ear, Middle
Follow-Up Studies
Headache
Humans
Hydrocephalus
Lower Extremity
Medulloblastoma*
Meningioma*
Pneumocephalus*
Temporal Lobe
Ventriculoperitoneal Shunt