What adjuvant therapy is recommended for a patient treated for a WHO grade 3 meningioma s/p GTR and adjuvant radiation one year ago, with negative brain MRI, who now presents s/p selective neck dissection of a enlarged lymph node with pathology confirming WHO grade 3 metastatic meningioma?

This is an uncommon but increasingly recognized scenario.

In full disclosure, I have only treated a handful of cases of disseminated anaplastic (Grade 3) meningiomas.

In the case described above, cervical lymph node metastasis from a WHO grade 3 (anaplastic) meningioma indicates systemic disseminatio...