Sawafta Omar, Khamaysa Jehad, Hamdan Dawoud, Hajjeh Orabi, Zeidalkilani Jehad M J, Abuali Abdelrahman
Department of Medicine, An Najah National University, Nablus, Palestine.
Department of Radiology, Tubas Turkish Governmental Hospital, Tubas, Palestine.
Int J Surg Case Rep. 2025 Aug 25;135:111851. doi: 10.1016/j.ijscr.2025.111851.
Meningiomas are the most common primary tumors of the central nervous system. Atypical meningiomas, classified as World Health Organization (WHO) grade II, are relatively rare, accounting for 5-7 % of cases, and are known for their aggressive behaviour, including higher recurrence rates and potential brain invasion. Early detection and intervention are crucial, even in asymptomatic patients.
We report a case of a 45-year-old male presenting with a two-year history of painless, progressive swelling over the left parietal region. Neurological examination was normal. Imaging revealed a well-defined extra-axial lesion with bone erosion suggestive of atypical meningioma. Surgical resection via craniotomy was performed, and histopathology confirmed a WHO grade II atypical meningioma. The postoperative course was uneventful, and the patient remained asymptomatic with no recurrence on follow-up imaging.
Although often asymptomatic, atypical meningiomas can exhibit invasive features requiring prompt diagnosis and surgical management. MRI findings and histological markers, including mitotic activity and focal brain invasion, aid in accurate grading. Close follow-up is recommended due to the higher recurrence potential compared to benign subtypes.
This case highlights the importance of considering atypical meningioma in patients with isolated skull swelling. Timely diagnosis and surgical management are essential to prevent complications and ensure a favorable prognosis.
脑膜瘤是中枢神经系统最常见的原发性肿瘤。非典型脑膜瘤被归类为世界卫生组织（WHO）二级肿瘤，相对罕见，占病例的5-7%，以其侵袭性表现而闻名，包括较高的复发率和潜在的脑侵袭。即使是无症状患者，早期检测和干预也至关重要。
我们报告一例45岁男性，有两年左侧顶叶无痛性进行性肿胀病史。神经系统检查正常。影像学显示一个边界清晰的轴外病变，伴有骨侵蚀，提示非典型脑膜瘤。通过开颅手术进行了切除，组织病理学证实为WHO二级非典型脑膜瘤。术后过程顺利，患者无症状，随访影像学检查未发现复发。
尽管非典型脑膜瘤通常无症状，但可表现出侵袭性特征，需要及时诊断和手术治疗。MRI表现和组织学标志物，包括有丝分裂活性和局灶性脑侵袭，有助于准确分级。由于与良性亚型相比复发潜力较高，建议密切随访。
本病例强调了在孤立性颅骨肿胀患者中考虑非典型脑膜瘤的重要性。及时诊断和手术治疗对于预防并发症和确保良好预后至关重要。
