Although stereotactic radiosurgery has been proven to be an effective and noninvasive treatment for some skull base meningiomas, complications such as swelling, radiation necrosis, and cranial nerve dysfunction are possible in some cases. As to date, a surgical treatment for radiation necrosis (induced by stereotactic radiosurgery) in order to treat skull base meningioma has yet to be reported in few cases. Due to corticosteroid intolerance we performed in one patient a surgical resection of the radiation necrosis and tumor. Albeit rare, clinicians referring patients for stereotactic radiosurgery must be aware of such complications.