2026 Poster Presentations
P151: ANALYSIS OF TOTAL TUMOR VOLUME RESECTED IN BILATERAL CRANIOTOMIES FOR RESECTION OF 16 MENINGIOMAS FOR INTRACRANIAL PRESSURE-RELATED HEADACHES
Jessica Eaton, MD; Danielle Dang; Michael Link; Mayo Clinic
Background: Multiple meningiomas are common in patients with a history of radiation, with neurofibromatosis type 2 (NF2), or with other mutations on chromosome 22. These patients can be challenging to manage, given multifocal tumor burden. We present a case of a patient with more than 15 meningiomas who developed debilitating headaches as the tumors progressed radiographically.
Case: A 47 year old female originally presented to an outside institution with right sided hearing loss in 2017. She underwent workup that demonstrated a right vestibular schwannoma, as well as multiple intracranial meningiomas, giving her a presumed diagnosis of NF2. She underwent retrosigmoid craniotomy for resection of the vestibular schwannoma at the outside institution, and was then managed conservatively with serial imaging until presenting to Mayo Clinic at 2025. During the intervening years she had developed severe, debilitating headaches that started on the right but progressed to affect both sides and were often accompanied by visual disturbances. Given the large volume of tumor bilaterally, we planned a staged approach to remove as many tumors as safely possible on each side to relieve the mass effect that we suspected of contributing to elevated intracranial pressure.
We initially performed a right frontotemporoparietal craniotomy for resection of 9 discrete tumors masses, with some of the masses representing collision tumors. The patient recovered extremely well, and 3 months after the first operation we performed a left frontotemporparietal craniotomy for resection of 7 discrete tumor masses. All of the tumors were WHO grade 1. We calculated that we resected a total tumor volume of 39.9 milliliters (ml) on the right and 39.1 ml on the left for a total tumor volume of 79.1 ml resected. The patient did well post-operatively, with complete resolution of her headaches. The remaining tumor mass along the superior sagittal sinus was treated with adjuvant radiation therapy.
