How do you manage recurrent atypical meningiomas in patients who have previously received radiotherapy?

This question, I fear, requires some underpinning. A recurrent atypical meningioma is an aggressive tumor, more so that than appears to be appreciated broadly. Even between first and second recurrence, as shown in a study by Bagshaw and colleagues at the University of Utah (Neurosurgery 126:1822–1828, 2017) median local control decreases nearly by half, from 4 years to 2.2 years. As reported in another recent study by a group in Verona, Italy (Talacchi et al, World Neurosurgery 2016; 87:565-57...