Yttrium-90 radioembolization for treatment of anaplastic meningioma liver metastases

Meningiomas are the most common primary intracranial neoplasm. The WHO classification, focusing on histomorphologic and molecular features, distinguishes WHO grade -1, -2, and -3 tumors. WHO-3 meningiomas are exceedingly rare, comprising 1%-3% of cases, and have the propensity to metastasize to the lungs, followed by bone and liver. Due to their rare occurence, there are no consensus guidelines on metastatic meningioma management. External beam radiation therapy is often the treatment of choice, therefore transarterial radioembolization is a reasonable option for meningioma metastases to the liver. In this case report, we describe the clinical course and outcomes of a patient with WHO-3 meningioma and extensive hepatic metastases which were initially detected during workup for possible renal transplant, confirmed with DOTATATE PET/CT, and successfully treated with Yttrium-90 radioembolization and ablation.