Recurrence of Atypical Meningioma: A Case Report

Atypical meningiomas are classified by the World Health Organization (WHO) as grade II central nervous system tumors, representing an intermediate biological profile between benign (grade I) and anaplastic (grade III) variants. They are defined by elevated mitotic activity, invasive growth patterns, and distinct histopathological features such as hypercellularity, small cell morphology, prominent nucleoli, and areas of necrosis. Clinically, these tumors often manifest with neurological symptoms - headaches, seizures, focal neurological deficits, personality alterations, or visual impairment - depending on their anatomical location. On imaging, atypical meningiomas typically show either homogeneous or heterogeneous contrast enhancement, surrounding edema, and exert mass effect on adjacent brain structures. MRI and MR spectroscopy help in assessing these cases. Surgery tends to be the main treatment, but recurrence is more common than what's typically seen in grade I meningiomas. Adjuvant radiotherapy is frequently recommended, particularly in cases of subtotal resection or when high-risk features are present. Given their aggressive behavior and propensity for recurrence or malignant progression, comprehensive multidisciplinary care and close surveillance are critical to achieving optimal clinical outcomes. In this case, we present a 57-year-old gentleman diagnosed with peritorcular meningioma.