Laser interstitial thermotherapy for treatment of symptomatic peritumoral edema after radiosurgery for meningioma.

Symptomatic peritumoral edema (PTE) is a known complication following radiosurgical treatment of meningiomas. While the edema in most patients can be successfully managed conservatively with corticosteroid therapy or bevacizumab, some medically refractory cases may require surgical resection of the underlying lesion when feasible. Laser interstitial thermotherapy (LITT) continues to gain traction as an effective therapeutic modality for the treatment of radiation necrosis where its biggest impact is through the control of peritumoral edema.A 56 year-old female with neurofibromatosis 2 presented with a symptomatic, regrowing left frontotemporal lesion that had previously been radiated, then resected with confirmed recurrence of grade I meningioma, and subsequently radiated again for lesion recurrence. Given her history of two prior same-side craniotomies, including a complication of wound infection, she was not a candidate for further open surgical resection. Having failed conservative management, she underwent LITT with intra-operative biopsy demonstrating viable grade I meningioma. Post-operatively, she demonstrated radiographic marked, serial reduction of PTE and experienced resolution of her symptoms.This case demonstrates that LITT may be a viable alternative treatment for meningioma patients with symptomatic PTE who have failed medical therapy and require surgical intervention.