An 8-year-old male neutered border collie was referred to the oncology team to discuss radiotherapy options for a left sided cavernous sinus meningioma.

The patient initially presented to his family veterinarian for evaluation of two grand mal seizures while out for a walk on 15/11/2017. The seizure activity continued in hospital, and he was referred to a local referral hospital and he was referred to a local referral hospital for further work up.

An MRI was done, and images detected a broad based extra axial contrast enhancing mass in the left cavernous sinus region consistent with a meningioma. The mass was deemed non resectable, and phenobarbital and prednisolone were initiated. He was referred to the oncology team on 30/11/2017 to discuss radiotherapy options. CT simulation for radiation planning was done on 4/12/2017 and stereotactic radiotherapy was initiated on 6/12/2017.

The patient did well throughout the course of therapy with no observable acute affects. However, seizure activity continued and Keppra was started on 8.1/2018. Intermittent seizure continued after this change and phenobarbital was substituted with zonisamide on 22/1/2018. The combination of Keppra and zonisamide was effective in controlling seizure activity. A follow up MRI was done on 8/6/2018 and documented a 60% decrease in tumour volume. The patient presented in July 2021 with recurrent symptoms and proceeded to a second course of radiotherapy and passed away 15 months later 5 years after initial diagnosis.