Salma Tabati, Fatma El Mabrouk, Meriem Fikri, Hafsa El Ouazzani, Firdaous Touarsa.
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 8
Date of Publication: 2026/08/06
Cystic meningiomas are uncommon and may mimic intra-axial neoplasms, particularly in young patients. An 18-year-old patient presented with progressive morning headaches, vomiting, blurred vision, and left-sided weakness. Magnetic resonance imaging demonstrated a 71 × 63 × 69 mm multilobulated right frontal convexity extra-axial tumor with a broad dural attachment, falcine extension, an intensely enhancing hypervascular solid component, internal necrotic change, and an inferior peritumoral cyst located between the tumor and the brain, consistent with Nauta type IV. Despite limited vasogenic edema, the lesion produced a 19-mm midline shift, subfalcine herniation, early right uncal herniation, and obstructive dilatation of the left lateral ventricle with transependymal cerebrospinal fluid flow. Simpson grade II resection was achieved. Histopathology showed syncytial meningothelial proliferation, eight mitoses per 10 high-power fields, and microscopic brain invasion, establishing an atypical meningioma, central nervous system World Health Organization grade 2. This case emphasizes the diagnostic value of recognizing extra-axial signs and the cyst-tumor-brain relationship, while using heterogeneous enhancement, necrosis, marked vascularity, and an indistinct tumor-brain interface as warning features rather than as surrogates for histologic grade.
Atypical meningioma; cystic meningioma; brain invasion; Nauta classification; magnetic resonance imaging
Download PDF