Objective and importance: Stereotactic radiation is increasingly advocated as a primary treatment option for benign cranial base lesions. The clinical course of the patient reported herein raises questions regarding the rationale for initiation of radiotherapy to a petrous apex meningioma before microsurgery.
Clinical presentation: We report a 50-year-old woman who experienced medically refractory trigeminal pain. She was diagnosed with a meningioma around the petrous apex and treated by fractionated stereotactic radiation. After a short period of alleviation accompanied by hypesthesia, the pain returned in a previously unknown and violent fashion.
Intervention: Complete tumor removal through a retrosigmoid intradural suprameatal approach resulted in immediate and permanent pain cessation.
Conclusion: Radiotherapy should be withheld for benign and accessible tumors of the cranial base until the option of radical microsurgical treatment has been explored.